Care Home: King Edward Road 50

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What the care home does well Residents appeared clean and well cared for. Staff were attentive and respectful towards them. The home is cheerfully furnished and feels cosy and comfortable. The garden is spacious and attractive. Residents pictures and their arts and craft items were displayed along the corridor and in the lounge. The home has a comprehensive training programme for staff. Staff were found to be knowledgeable regarding their roles and responsibilities There is a good range of social and therapeutic activities for residents. We were informed that two residents had taken part in an event organised by Sports for the Disabled. Care documentation is structured and contains appropriate risks assessments. The care of residents and the management of the home is closely monitored and the home won a company award for excellence for providing a high standard of care. The manager was able to provide examples of good practice and this included progress in the mental state and behaviour of some residents. What has improved since the last inspection? Improvements had been made in the physical environment. The premises were on the whole, well maintained and well furnished. The kitchen had been repainted and a new boiler is in place. At least fifty percent of care staff had the required National Vocational Qualifications in care. All relevant staff records were available for inspection. What the care home could do better: Evidence must be provided that residents or their representatives have been consulted regarding the care plans prepared. This can be in the form of signed care plans. This is to ensure that they are aware and consulted regarding the plans. Improvements are required in the administration of medication. The manager must consult with the pharmacist regarding the storage of tablets in the fridge. This is to ensure that medication is stored correctly. Details of any allergies that residents may have must be recorded prominently in their files. This is to ensure the safety of residents. The medication policy and procedure must be updated. The recent complaint made in February 2009 by a relative regarding the personal care of a resident must be responded to. This is ensure that residents are well cared for. A review of staffing levels must be undertaken so as to ensure that there is sufficient staff to meet the needs of residents. There must be a minimum of 2 care staff during the night shifts. This is to ensure that the needs of residents are fully met. A minimum of 4 fire drills must be organised in a 12 month period. At least one of the fire drills organised in this period must be carried out after dark. This is to ensure that staff are familiar with fire safety procedures. A safety inspection of the electrical installations and wiring of the home by an appropriately qualified professional must be arranged. This is for health and safety reasons. The ground floor kitchen windows must be provided with restrictors. These are required unless a risk assessment indicates otherwise. This is for security reasons. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: King Edward Road 50 King Edward Road 50 Barnet Hertfordshire EN5 5AS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Daniel Lim     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: King Edward Road 50 King Edward Road 50 Barnet Hertfordshire EN5 5AS 02083648282 02084403035 thopkins@adepta.org.uk www.pentahact.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): PentaHact Limited trading as Adepta care home 5 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The home must advise the registering authority at such times as either of the specified service users vacates the home. Two specified service users who are over 65 years of age may remain accommodated in the home. Date of last inspection Brief description of the care home 50 King Edward Road is a care home, which is registered to provide personal care and accommodation for a maximum of five adults with learning disabilities. The home was opened in 1991. The home is run by Adepta, an organisation that also have several other care homes for people with learning disabilities. The home is a detached twostorey building. There are four bedrooms on the first floor and one on the ground floor. There is a communal bathroom and toilet upstairs and a toilet and walk-in shower room on the ground floor. To the back of the house is a well maintained landscaped Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 5 Brief description of the care home garden with flowers and shrubs, garden furniture and barbecue equipment. The front of the house has a small parking area parking for several cars. The home is maintained by Sanctuary Housing Association. The home is located in a quiet residential area in Barnet. It is close to a range of community services such as shops, restaurants, bus and tube services located along the High Road in High Barnet. The fees for residents living in the home may be obtained from the manager. A copy of this Inspection report can be requested directly from the home or via the CQC website Care Homes for Adults (18-65 years) Page 5 of 33 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 quality rating for this service is 2 Stars. This means the people who use this service experience GOOD quality outcomes. This inspection was carried out by Daniel Lim, inspector on 1 April 2009 and took a total of eight hours to complete. We were assisted by the registered manager, Mr Trevor Hopkins and the deputy manager Mr Winter Rui Sheng. A second visit was made on 6 April 2009 to view documents and interview staff not present during the first visit. The area manager, Ms Jo Howland was present during this visit. Four residents were interviewed. Some communication difficulties were experienced with two of them. However, the general impression gained was that they were well cared for. This was also confirmed in completed survey forms received from four staff and a health professional. Care Homes for Adults (18-65 years) Page 6 of 33 Statutory records were examined. These included three residents case records, the maintenance records, accident and incident records, financial records, complaints records and fire records of the home. The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Four care staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents and staff meetings were examined. These indicated that residents and staff had been consulted and informed of changes affecting the running of the home. The completed Annual Quality Assurance Assessment form or AQAA was received by CQC. Information provided in the assessment was used for this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Evidence must be provided that residents or their representatives have been consulted regarding the care plans prepared. This can be in the form of signed care plans. This is to ensure that they are aware and consulted regarding the plans. Improvements are required in the administration of medication. The manager must consult with the pharmacist regarding the storage of tablets in the fridge. This is to ensure that medication is stored correctly. Details of any allergies that residents may have must be recorded prominently in their files. This is to ensure the safety of residents. The medication policy and procedure must be updated. The recent complaint made in February 2009 by a relative regarding the personal care of a resident must be responded to. This is ensure that residents are well cared for. A review of staffing levels must be undertaken so as to ensure that there is sufficient Care Homes for Adults (18-65 years) Page 8 of 33 staff to meet the needs of residents. There must be a minimum of 2 care staff during the night shifts. This is to ensure that the needs of residents are fully met. A minimum of 4 fire drills must be organised in a 12 month period. At least one of the fire drills organised in this period must be carried out after dark. This is to ensure that staff are familiar with fire safety procedures. A safety inspection of the electrical installations and wiring of the home by an appropriately qualified professional must be arranged. This is for health and safety reasons. The ground floor kitchen windows must be provided with restrictors. These are required unless a risk assessment indicates otherwise. This is for security reasons. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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. Admissions are not made to the home until a full needs assessment has been undertaken by the manager. Admissions only take place if the service is confident that the needs of people to be admitted can be met. This ensures that the admissions to the home are appropriate. Evidence: The AQAA of the home indicated that residents in the home are properly assessed and effort is made to respond to their needs. It made the following comments We support individuals in a person centred way. Cultural and faith needs are paramount. The pre-admission assessments which were examined were noted to be appropriate and comprehensive. The assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: No new residents had been admitted since the last inspection of the home. Care Homes for Adults (18-65 years) Page 12 of 33 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. The service recognizes the rights of individuals to have control of aspects of their lives. Residents are consulted on how the service runs and activities they wish to participate in. Each individual has a comprehensive care plan, and these include appropriate risk assessments. Evidence: The AQAA of the home states that they Support people in an individual way, opportunities are available for individuals supported to lead fulfilling lives of their own choosing in accordance with their understanding. Updated peoples support plans, each person has had a review, pictorial menu has been put in place. The three residents case records contained detailed care plans. Reviews of the care to be provided had been carried out. The preferences of residents had been documented. There was documented evidence that residents had been encouraged to be as Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: independent as possible. Risks assessments had been prepared for residents. They were noted to be appropriate and up to date. Staff had a good knowledge of the needs and behaviour of residents. They were aware of action to take to minimise any potential risk to residents. The care plans had however, not been signed by either residents or their representatives. This is necessary to indicate that they have been consulted and are in agreement. A requirement is made for evidence to be provided that residents or their representatives have been consulted regarding the care plans prepared. This can be in the form of signed care plans. Meetings had been organised and there was evidence that residents had been consulted regarding the activities provided and the management of the home. The minutes of these meetings were available for inspection. Care Homes for Adults (18-65 years) Page 14 of 33 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. The home had sought the views of residents and considered their varied interests when planning their daily routines. Links to specialist support are facilitated when needed. Residents have opportunity to develop skills and are encouraged to be as independent as possible. The arrangements for the provision of meals take into account the preferences of residents and their dietary needs. Evidence: The AQAA made the following comments People are supported to partake in courses that match their ability and interest. Two individuals attend an art course weekly, this course ended in Oct 2008 due to some funding issues. We are still looking for new course for them which they enjoy doing. People are supported to choose where they would like to go on holiday and budgetary issues are explained as appropriate. Menus are in accordance with individual Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: preferences and on a rolling basis. People are supported to maintain intimate friendships. Mail is opened with the person it is addressed to and explained. Staff interact well with the people at the service. We note that the home has a weekly programme of activities for residents. These include holidays, day centre attendance, outings to places of interests, pubs and a club for people with learning difficulties. Some of the residents and staff interviewed were able to confirm that such activities take place. We further noted that some residents went out for walks with staff on the days we visited. We observed that one resident has a special interest in trains. We noted that staff had made effort to assist him in purchasing relevant books and magazines and a train set. He appeared to be enjoying his hobby. The manager informed us of an example of good practice. He stated that two residents had taken part in an event organised by Sports for the Disabled. The arrangements for the provision of meals was discussed and the kitchen was inspected. It was noted to be well equipped and clean. Daily recorded temperatures of the fridge and freezer had been kept. These were satisfactory. A fire blanket was in place. The menus examined appeared varied and balanced. Staff informed us that residents had been consulted regarding their likes and dislikes and their cultural observances had also been noted. We were present when lunch was served. We note that this was prepared in an attractive manner and residents appeared to be enjoying it. The bedrooms of residents contained ornaments and souvenirs which reflect individuals interests. Care Homes for Adults (18-65 years) Page 16 of 33 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. Residents living in the home have access to healthcare services in the local community. There is evidence in the case records that healthcare needs are monitored and appropriate intervention taken. Some deficiencies were however, noted in the arrangements for the administration of medication. These may place residents at risk and must be rectified. Evidence: In this area the AQAA stated that All care support needs are documented in the support or care plan. People receive personal care in private. Medication is stored, recorded and administered in accordance to legislation. Each person has a designated keyworker, support or care plans. Staff receives training on Medication, Health & Safety, Food Hygiene as statutory. The sample of three residents case records contained detailed care plans and assessments. These plans were structured, up to date and had been subject to reviews. The care plans of a resident who was at risk of having seizures or fits was Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: examined. We noted that the risk assessments and care plans were appropriate and comprehensive and contained guidance to staff on ensuring the safety of this resident and how this resident is to be cared for. We noted that all residents we met were cleanly dressed and looked well cared for. Staff were caring and responsive towards residents. There was regular interaction between staff and residents. The manager quoted an example of good practice. He stated that one of the residents who was apprehensive and fearful of leaving the home had made significant improvements and could now be taken out of the home for activities. He attributed this to the help and care provided by staff. We examined the administration of medication. There is a photo of each resident in the Medication Administration Record charts. The MAR sheets examined were appropriately signed. There was evidence that staff had been provided with training in the administration of medication. Medication was stored in a locked cabinet which is secured to the wall. Some medication in tablet form was also stored in the fridge. The fridge was used as a cool place for medication storage. This was discussed with the manager as we are not sure if it is appropriate for the storage of tablets. A requirement is made for the manager to consult with the pharmacist about this. The home has a policy and procedure on medication but this was not sufficiently comprehensive and did not include guidance on the storage of medication and the required temperature range. Allergies that residents have were not recorded prominently either on the MAR charts or in the front of their case records. This must be done to ensure the safety of residents. Care Homes for Adults (18-65 years) Page 18 of 33 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 arrangements for responding to complaints and for adult protection were on the whole, satisfactory. The home has an open culture that allows residents to express their views and concerns in a safe environment. This ensures that residents are well treated and protected from abuse. Evidence: The AQAA made the following comments All staff has CRB checks, no new employee can start until clearance is received. All staff have pova training. Risk assessments are in place. Complaints procedure is in place from the organisation and local procedure at the service. Complaints are rare at the service, however the service receives complaints as opportunities to improve and develop the service. The complaints record was examined. We note that a complaint was made by a relative in Februay 2009 regarding the lack of personal care for a resident. However, there was no record to indicate that this had been responded to. The manager apologised for the delay and reassured us that he will be responding to the complaint soon. Complaints made must be promptly responded to. A requirement is made in this report for the complaint to be responded to without delay and for us to be informed of the outcome. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: Staff were aware of the procedure to follow when responding to allegations of abuse. There was documented evidence that staff had been provided with adult protection training and when interviewed, they were aware of the procedures to follow when responding to allegations or incidents of abuse. The home has an adult protection policy and procedure together with the local authority guidelines. An allegation of misconduct was made recently against a staff member. We note that the organisation had responded appropriately and action was taken to safeguard residents. Care Homes for Adults (18-65 years) Page 20 of 33 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 home provides a physical environment that is aimed at the specific needs of the people who live there. It is clean, tidy and well furnished. The manager had ensured that the physical environment of the home provides for the individual requirements of people who live there. Residents are allowed to personalise their bedrooms. Overall, the home provides a pleasant and comfortable environment to live in. Evidence: The Aqaa submitted made the following comments There is a homely feel, items that need replacing are identified, reported and addressed. Monthly health & safety checks. Maintenance issues are reported to the organisations housing department and to the housing association. Each person has their own room, with their own belongings, which is decorated as per their individual taste. The premises felt homely and cheerful and the chairs and sofa were comfortable. During our visit, we note that the bedrooms inspected had been personalised by residents with their own pictures and ornaments. These bedrooms were well furnished. There is an aquarium in the lounge. This looked attractive. Arts and crafts items of residents were on display. There were also photos of residents and staff along Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: the corridor and in the lounge. Some areas of the home had been repainted. The gardens were attractive and seating had been provided. No offensive odours were detected in the home. The two residents we spoke to said they were satisfied with the accommodation provided. Safety inspections had been carried out on the gas and portable appliances. The manager stated that no specialist equipment was required as all residents were independently mobile and did not require any specialist equipment. Care Homes for Adults (18-65 years) Page 22 of 33 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 service has a good recruitment procedure that is followed in practice. Management recognizes the importance of training and tries to deliver a programme that meets statutory requirements. However, the staffing arrangements need to be reviewed to ensure that the needs of residents are fully met. Evidence: The AQAA made the following comments Adepta has a robust recruitment process. New staff undergoes the national skills tests. Staff at the service is capable to meet the needs of the people supported, with the exception of some on restricted duties. Any concern over staff performance is addressed and expectations for improvement identified. Sickness is relatively low in the service. Staffing levels reflect the needs of the people supported and are reviewed each year when budgets are set. We examined the duty rota. It indicated that in addition to the manager, there was normally a minimum of two care staff on duty during the day shifts and one care staff on duty during the night shifts. Staff on duty are also involved in domestic chores such as cleaning and cooking. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: Four staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence in staff records to indicate that staff had been provided with essential training relevant to their area of work. Staff stated that there was a good team spirit and they worked well together. The records of four staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss issues related to the care of residents and their training need. The issue of Equalities and Diversity was discussed with staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. They were aware that they must not discriminate against residents and they indicated that this was stressed to them during their induction and in training on adult protection. The AQAA stated that Diversity policy is in place, comprehensive support plans are in place, people are supported to live in accordance to their preferences. Staff at the service ensure that the culture of the people who live at King Edward Road remains paramount for example, traditional English food is on the menu, a person of Jewish faith is supported to attend the synagogue and partake in religious events. Three of the staff interviewed by us indicated that there were some occasions when the home was short of staff. They stated that extra staff is not always provided for escort duties. Two staff stated that they were concerned that only one staff is on duty during the night shifts. They explained that there had been a recent incident in which a resident had a fall during the night shift and there was difficulty attending to this resident with only one staff. Another stated that there are residents with high needs, difficult behaviour and residents who may experience fits. This staff stated that some residents may still be awake in the night and needed supervision. One staff further stated that having only one staff presents a problem when attending to the personal care of residents of the opposite sex. We were informed that staffing levels had previously been discussed with the manager by staff. Two of the completed staff survey forms also indicated that the night staffing levels need to be improved and one survey form stated that additional staff is also needed during the day to ensure that Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: more activities can be provided for residents. We discussed these concerns with the manager and area manager. The manager indicated that he was aware of the concerns expressed by staff. The area manager indicated that an increase in staffing would affect the funding of services. A requirement is made in this report for staffing levels during the day to be reviewed. In addition, a further requirement is made for staffing levels on the night shifts to be increased to a minimum of two staff. This is required to ensure that the needs of residents are met and for health and safety reasons. Care Homes for Adults (18-65 years) Page 25 of 33 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 service is planned to be user focused and take account of equality and diversity issues. It generally works in partnership with residents and their representatives. Staff supervision is in place. The manager has highlighted areas that are deficient and is working to improve the care provided. Further improvements are needed in the area of quality monitoring and in Health & Safety. Evidence: The AQAA made the following comments Manager has achieved NVQ Level 4 in care and holds the professional certificate in management. Has 17 years supervisory and management experience and has been a registered manager at 3 different services since 2002. Assistant managers and support staff are competent in their roles and have opportunities to develop their skills. Staff have appraisals and development plans. Staff are encouraged to take on activities and responsibilities to develop self for example personal stretch. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: We discussed the management of the home with the registered manager. He was found to be knowledgeable regarding his role and responsibilities. He informed us that the home had won a company award for excellence in providing a high standard of care. There was evidence that residents are consulted regarding the management of the home. Residents meetings had been held. The minutes of these meeting were examined. It indicated that residents and relatives were informed of progress in the home and their suggestions had been responded to. A consumer survey and audit had been carried out recently. The surveys indicated that residents were generally happy with their support, although there is variation between people. The audit visits found some good examples of involvement as well as times when there could have been more efforts to engage people. Weekly fire alarm checks had been documented. The home had an up to date fire risk assessment. Staff had been provided with training in fire safety and Health and Safety. We however, note that only one fire drill had been organised in the past twelve months. This is not sufficient. A minimum of four drills are needed in a twelve month period. One of these must be carried out after dark. This is to ensure that staff are fully aware of action to take in the event of a fire. The accident records were appropriately filled in and we had been informed of significant accidents and incidents. On a tour of the premises, it was noted that window restrictors were engaged in the bedrooms visited. However, the ground floor kitchen windows did not have any restrictors. These are required unless a risk assessment indicates otherwise. this was brought to the attention of the manager and a requirement is being made accordingly. Safety checks had been carried out on the portable appliances. We were however, not provided with a safety inspection certificate for the electrical installations of the home. This is required to ensure that the installations are safe. The home has a current certificate of insurance. The financial records of three residents were examined. These were noted to be well maintained. Receipts had been obtained for transactions made on behalf of residents. Care Homes for Adults (18-65 years) Page 27 of 33 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 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Evidence must be provided 22/06/2009 that residents or their representatives have been consulted regarding the care plans prepared. This can be in the form of signed care plans. This is to ensure that residents or representatives are aware and involved in the preparation of care plans. 2 19 13 The manager must consult with the pharmacist regarding the storage of tablets in the fridge. This is to ensure that medication is stored correctly. 29/06/2009 3 19 13 The medication policy and procedure must be updated to include guidance on the storage of medication and the temperature at which medication is to be stored. 22/06/2009 Care Homes for Adults (18-65 years) Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that medication is stored correctly. 4 19 13 Details of allergies that residents may have must be recorded prominently in their files and medication charts. This is to ensure the safety of residents. 5 22 22 The recent complaint made in February 2009 by a relative regarding the personal care of a resident must be responded to. This is ensure that residents are well cared for. 15/06/2009 15/06/2009 6 33 18 Staffing levels on the night 03/08/2009 shifts must be increased to a minimum of two staff. This is required to ensure that the needs of residents are fully met and for health and safety reasons. 7 33 18 A review of staffing levels 30/06/2009 must be undertaken. This review must be carried out in consultation with staff and residents or their representatives. A report following this must be forwarded to the CQC. Care Homes for Adults (18-65 years) Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is necessary to ensure that the needs of residents are fully attended to. 8 42 23 A safety inspection of the electrical installations and wiring of the home by an appropriately qualified professional must be arranged. This is for health and safety reasons. 9 42 13 The ground floor kitchen windows must have restrictors. These are required unless a risk assessment indicates otherwise. This is necessary for security reasons. 10 42 23 A minimum of 4 fire drills must be organised in a 12 month period. At least one of the fire drills organised in this period must be carried out after dark. This is to ensure that staff are familiar with fire safety procedures. 15/06/2009 01/06/2009 15/06/2009 Care Homes for Adults (18-65 years) Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!