Care Home: Langley House

What the care home does well The home provides a relaxed and comfortable environment for residents and is well maintained and clean. Residents enjoy continuity within the staff team, they can be confident that staff have a good understanding of their care and support needs including personal preferences. Communication between staff and between staff and residents is good, and there is an easy camaraderie in evidence. Residents are under no pressure to develop skills or take on things for themselves that make them feel uncomfortable, Langley house staff are supportive of residents being as independent as they want to be, when they want to be. There is an understanding that residents moods and motivation changes and at times they may need more help than others, support is flexible and responsive to changes. Some residents help out with household activities and chores by choice, one resident informed us "I like to be busy and helpful". Residents speak positively of living at Langley house, finding the staff team friendly, approachable and supportive. Staff are respectful of residents rights to make decisions and choices for themselves. The service demonstrates a commitment to improvement, and is responsive and compliant with regualtion. All health and safety checks and servicing are maintained. What has improved since the last inspection? The AQAA informs us that since the last key inspection the service has updated documentation including Statement of Purpose, user guide and policies and procedures, this information has been placed on disc and residents are able to view this on the computer in the residents lounge if they wish. The computerization of documentation and records is progressing. The AQAA informs us that in consultation with residents some redecoration and refurbishment of communal spaces has taken place providing a more relaxing and comfortable communal lounge for residents,. Staff report that when a resident leaves the home vacaqnt rooms are redecorated in neutral colours so that new residents are able to impress their own taste and personality on their room more easily. The AQAA tells us that all care staff have now achieved NVQ2 and two new staff have been enrolled onto the course. The service has addressed a previous requirement regarding the use of codes on medication administration records (MAR) What the care home could do better: This inspection has highlighted some improvements are needed to ensure that: Handwritten entries on medication records are signed and dated by the person entering the information. Although the home is to be commended for the programme of qualification training that has enabled all existing staff to have qualified and new staff to already be enrolled for courses, there is a lack of clarity as to the number of staff who have achieved mandatory training updates which are in date, and all staff are in need of updated adult safeguarding training. Requirements have been issued for improvement in these areas. The lack of clarity in regard to staff training has prompted us to recommend that the home develop a training matrix for staff and individual staff training profiles to aid record keeping in this area. Care plans, risk information and quality assurance will also benefit from improved content and clarity. We consider it good practice for staff managing difficult behaviours from some residents to be supported in their practice by the development of agreed guidelines to ensure staff adhere to these and provide consistent responses. To promote and effect improved hand washing amongst residents we have recommended the use of either paper handworks or electric hand driers, to support other measures already in place. Key inspection report Care homes for adults (18-65 years) Name: Address: Langley House 47 Collington Avenue Bexhill-on-Sea East Sussex TN39 3NB     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: Michele Etherton     Date: 2 6 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Langley House 47 Collington Avenue Bexhill-on-Sea East Sussex TN39 3NB 01424212934 01424212934 devijeeawon@langleyhouse.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rajeswaree Jeeawon care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Langley House is a care home providing personal care and accommodation to nineteen (19) people with mental health needs. It is owned and managed by Mrs Rajeswaree Jeeawon. The home is located approximately one mile from the centre of Bexhill, with access to shops, pubs, churches and the post office. The accommodation comprises of three floors, and includes communal space, plus thirteen (13) single bedrooms, and three (3) shared bedrooms. Five (5) of the bedrooms provide en-suite facilities. The fees charged in the serviced are #322.40 per week. The current e mail address is Devi@Langley.net. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 19 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 reader should note that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Langley House are referred to as residents. A key inspection of this service has been undertaken that has taken account of information received about and from the service since the last inspection. This includes an Annual Quality Assurance Assessment (AQAA) form submitted by the Registered Person. This was completed to a reasonable standard, telling only some of what we needed to know, and would benefit from improved detail and content to illustrate how the service operates on a day to day basis and current and future plans for service development, these shortfalls have been discussed at the site visit with the registered person who now has an improved understanding of the level of detail future AQAAs should contain. Care Homes for Adults (18-65 years) Page 5 of 31 Our inspection of the service has included a site visit to Langley house conducted on 26th May 2009 between 9:45 am and 18:00 pm. During this visit all key standards have been assessed in addition to the progress made by the service in addressing a previous requirement in regard to medication issued at a random inspection undertaken on 22nd December 2008. Surveys have been distributed to residents, staff, relatives and health and social care professionals and only one response has been received to date to inform the inspection, responses received subsequent to the draft report will be taken into consideration prior to the publishing of the final report. During our site visit we undertook a tour of the home, and interviewed the registered providers and staff. Not all residents were on the premises during our visit although we spoke with six in some depth during the course of the day. We sampled a range of documentation including care plans, risk information, Medication administration records (MAR), staff recruitment, training and supervision records, complaints and accident records, health and safety servicing and records. We also noted updated policy and procedure information in addition to the Statement of Purpose and user guide. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: This inspection has highlighted some improvements are needed to ensure that: Handwritten entries on medication records are signed and dated by the person entering the information. Although the home is to be commended for the programme of Care Homes for Adults (18-65 years) Page 7 of 31 qualification training that has enabled all existing staff to have qualified and new staff to already be enrolled for courses, there is a lack of clarity as to the number of staff who have achieved mandatory training updates which are in date, and all staff are in need of updated adult safeguarding training. Requirements have been issued for improvement in these areas. The lack of clarity in regard to staff training has prompted us to recommend that the home develop a training matrix for staff and individual staff training profiles to aid record keeping in this area. Care plans, risk information and quality assurance will also benefit from improved content and clarity. We consider it good practice for staff managing difficult behaviours from some residents to be supported in their practice by the development of agreed guidelines to ensure staff adhere to these and provide consistent responses. To promote and effect improved hand washing amongst residents we have recommended the use of either paper handworks or electric hand driers, to support other measures already in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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. Prospective residents are provided with information to inform their decision making and enable them to understand and agree the terms and conditions of residency. They are encouraged to visit and stay over and benefit from an assessment of their needs prior to admission to ensure these can be appropriately supported however, the level of detail and content needs improvement to ensure decisions affecting placement are appropriately made and this also informs the development of an effective support plan. Evidence: Information to inform prospective residents about the service is routinely reviewed and updated, and is provided for them to read and to inform their decision making. This informaiton is also available on the computer for existing residents to read if they wish. Newer residents informed us that they had had an opportunity to visit and have short stays prior to making the decision to come and live at the home. We noted preadmission assessment information and supporting psychaictric reports lacked detail Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: about the day to day mental health needs of residents to adequately inform decisions as to whether these can be met. Whilst there is no evidence from our site visit that residents or staff have been placed at risk from some information not being made clear, we consider it essential that the home gather information from a range of sources including the outcomes of face to face interviews with prospective residents to inform admission decisions. We discussed these omissions with the registered Person who undertakes assessments of new residents and has agreed to ensure assessments are compelted more robustly in future. There is an expectation that prospective residents will visit and stay for a short while before a formal admission takes place to ensure that compatibility with other people in the house is fully considered. We noted terms and conditions/contract information in the files of those residents viewed and this was signed by the residents concerned. Care Homes for Adults (18-65 years) Page 11 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are up to date signed and re-evaluated monthly but would benefit from being more reflective of individual resident preferences around daily routines, established goals are too broad making achievements difficult to measure. Residents lead an independent lifestyle within a responsible risk taking strategy, but how the assessment of risk has been judged needs further clarity. Evidence: Individual support plans are in place and residents informed us that they have some input into these with staff, residents sign their plans. Residents have benefited from stability within the staff team over a number of years.Whilst our discussion with staff indicates they demonstrate a great deal of knowledge and awareness of individual residents, shortfalls of detailed information within care plans has been mitigated by the continuity within the staff team. From our discussions with staff, and individual residents about daily routines and an examination of support plans, we have noted that plans currently lack detail in regard Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: to personal routines of residents and their preferences around this, improved detail would be of benefit to newly appointed staff familiarizing themselves with residents support needs. Goal planning is in place, but, goals viewed are in most cases too broad to be achievable or measurable e.g To live independently with minimal support. We found little reference either in daily records or within the goal planning itself of how residents are to achieve individual goals, and consideration should be given to breaking goals down into more focused specific goals; in this way residents progress can be more easily assessed and measured. This was discussed with the registered Person during the site visit who has agreed to ensure goal planning is more readily achievable. Residents we spoke with made clear they do what they want to do most days governed only by mealtimes and whether or not they attend activities outside the home. Some reported they attend the day centre and are able to develop their skills and independence there. Another resident reported they wished to undertake employment and are currently seeking work, but the current financial climate is making this difficult. All residents are independent travelers both in the local area and the larger towns locally, risk information is recorded in files viewed and re-evaluated each month along with care plans. Amendments are made in response to any incidents. We found that whilst good reviewing systems are in place risk information itself is brief and lacks detail of the risk reduction measures in place and whether a significant risk remains. The detail of recording and assessment of risk needs further improvement. Care Homes for Adults (18-65 years) Page 13 of 31 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. Residents are encouraged to lead independent lifestyles and would benefit from improved opportunities to develop their daily living skills either in the home or within the local community.Residents are supported to maintain links with their relatives and friends. They enjoy meals provided at the home and have opportunities to make snacks and drinks for themselves. Evidence: Residents do not have individual activity planners and are encouraged to lead an independent lifestyle, maintaining an active community presence and making use of local leisure and community facilities,some residents attend a day centre regularly and report that they have an opportunity there to develop their skills around budgeting , managing money, and cooking. Residents spoken with who aspire to move on do not see the home as providing the Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: support they need to develop independence, although a number of residents informally undertake household tasks. The home has been supportive of residents moving on and several have managed to do so successfully retaining links with the home afterwards. The Registered person should consider whether the home should be more actively developing a programme of daily living skills for those interested residents, or helping the residents concerned to access such resources in the community to aid the achievement of established goals Routines within the home are relaxed and flexible. The AQAA informs us that some residents have previously expressed a wish for more activities in house, but are often the least motivated to participate. A programme of activities based on what residents seem to prefer has been developed, and residents can choose to participate in this or not. Residents are encouraged to source interests and activities outside of the home. Whilst residents are actively encouraged to take control of their own lives and be independent, we noted from our discussions with staff, residents and examination of records, some examples of staff support where perhaps residents could be encouraged to be more independent e.g residents who need support around shaving, Residents should be encouraged and prompted to make their own health appointments with staff support. Residents spoken with who have family members and retain contact, commented that their relatives can visit them here at the home but more commonly they go out to visit them. Residents do not have keys to the front door but those spoken with commented that there is no problem coming back late to the home. Staff are always available and willing to let residents in within reasonable times unless forewarned that the resident may be later than usual. Residents enjoy the food provided at the home. Although breakfast times are fixed, staff reported that residents can come down after this time and still get something to eat and drink. There is a menu and this provides two choices for the main meal of the day. Residents are also provided with facilities to make their own drinks during the day and some are assessed to have these also in their rooms. Some residents are actively involved in food preparation and clearing up after wards. Residents we met with spoke positively about the standard of food within the home and during our visit one resident delayed going out because they did not wish to miss the lunch. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal, physical and emotional wellbeing of residents is well supported, and this will be improved by further strengthening of arrangements for recording medication Evidence: Continuity in staffing has enabled staff to develop a very good understanding of individuals and their preferences around daily routines, but, this information may not always be well recorded in support plans. Staff reported that the majority of residents undertake their own personal care although one or two require some interventions to help with shaving or hair washing, staff spoken with are respectful of residents rights to make choices about what level of staff support they want, preferences for staff support around this are taken account of if residents make this known. Residents we spoke with commented that they have access to routine health care checks. One resident confirmed that they have refused to attend the dentist in the past and will probably continue to do so, the resident confirmed that they do access optician appointments when they are due, and has also made use of chiropody appointmens from time to time. This resident said they did not make their own doctor appointments and never had since coming to the home, they thought they probably Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: would be able to do this for themselves but had never thought about it. Residents should be encouraged with staff support to make their own health care appointments if they have capacity to do so. Residents have access to support from specialist mental health professionals either in the community or coming into the home dependent on need Residents weights are regularly recorded and staff who undertake this reported that they weigh residents where they are at the time if they are willing, this sometimes does not afford residents the appropriate level of privacy and clear guidelines need to be established for staff to ensure the dignity and privacy of residents is promoted at all times. Residents ages range between thirty one and sixty eight, all are currently fit and active, the mental health of the majority of residents is stable and the level of breakdowns an return to hospital minimal. At this visit we assessed whether the service has addressed a requirement from a recent random inspection in December 2008. This related to use of appropriate codes on medication Administration Record (MAR) sheets and ensuring no omissions in recording of administration. We examined MAR sheets and found this requirement to have been met with improved recording and clarity in guidelines available to staff within the medication record file. Our examination of records highlighted that a number of handwritten entries are recorded on the MAR sheets, when asked about these staff confirmed these are not made by the same staff member. As none of the changes are signed or dated by the person entering the information, there is no audit trail in the event of a medication error. We have issued a requirement that all changes to medication dosages are signed and dated by the person making the change, and authorization for such changes can be clearly audited within the homes documentation. At present the home does not have any controlled drugs, but, the suitability of medication storage in the event of some being prescribed to a resident has been discussed along with the general location and security of current medication. The registered person has indicated a willingness to revise the current arrangements and are also advised to discuss this with the visiting pharmacist, who assesses medication arrangements at the home routinely. Care Homes for Adults (18-65 years) Page 17 of 31 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. Residents feel listened to, systems are in place to safeguard residents but improvements are needed to staff training in the area of safeguarding adults to improve their practice. Evidence: A complaints procedure in place and displayed for residents and visitors, a comments and suggestion box is also provided. Residents spoken with expressed confidence in approaching staff or the registered persons with any concerns or issues and that these would be sorted ou. One survey we received indicated that whilst the resident knew who to speak to they did not understand the formal process of making a complaint; whilst we accept that the procedure is openly displayed in the home it is important that residents understand the process and consideration should be given to making this a topic for discussion within the resident meetings to ensure all residents are fully familiar with how to make a complaint. We examined the complaints record which has been updated to ensure confidentiality of complainants is maintained. No complaints are currently recorded and none have been received by Care Quality Commission. From our examination of records, and discussions and interviews with staff and residents, we are aware of at least one resident in the home whose behaviour can at times be difficult. Discussion with staff highlighted a general consensus as to how this Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: behaviour is to be managed, but no formal written guidelines have been developed; we have discussed the importance of ensuring all staff understand and respond consistently to behaviours exhibited by residents keeping within agreed guidelines which support their care practice. Guidelines should be agrred with all parties and kept under review to ensure they remain relevant and this is a recommendation. Personal allowance monies are held on behalf of some residents and a system is in place to record income and expenditure, we sampled three resident balances against records held and found these to be accurate. The registered persons and some staff demonstrated an awareness of recent changes in legislation in respect of mental capacity and deprivation of liberty, training information has been sourced to deliver to staff. None of the present residents are subject to any restrictions or deprivation of liberty. When we spoke with staff they indicated an awareness of their roles and responsibilities in respect of adult safeguarding and understood the different types of abuse that could be reported. Staff have not have not had their training updated within the past two years. The registered person was at one time trained to deliver this training to staff but this has not been updated since 2005. Training given to staff at that time is not recorded, no certificates were issued, and staff spoken with did not recall this as a training session. As no new training is currently booked we have issued a requirement for this to be provided. A copy of the local safeguarding protocols should be available in the home for staff reference and this has been brought to the attention of the registered provider. An adult safeguarding was raised earlier this year but this was investigated and unfounded and is now closed. Care Homes for Adults (18-65 years) Page 19 of 31 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. Residents enjoy living in a clean safe comfortable home, which will benefit from planned upgradings to bathroom areas. Evidence: The home provides a safe comfortable and homely environment for residents, they predominantly enjoy single occupancy of bedrooms and these reflect their personal tastes and interests,. All health and safety checks are maintained and fire checks and tests are being undertaken. It is recommended that fire points are physically tested weekly and a recording made of this. Regular fire drills are held every two months and are recorded, fire training was taking place on the day of our visit. Communal bathrooms are in need of upgrading, and a programme to undertake this work is planned to commence shortly. We discussed the need for the home to promote good hand washing principles with residents and consequently whilst liquid soap was noted in communal bathrooms the presence of cloth towels should be discouraged for communal use. The registered provider reported difficulties with paper towels blocking toilets and has agreed to consider the use of electric hand dryers and we recommend this is progressed. The laundry is adequate for the present resident needs but some thought should be Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: given to encouraging those residents who are working to wards independence to undertake their own laundry arrangements with the support of staff as part of skills development and achieving goals. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough qualified staff on duty but shortfalls in staff induction and mandatory training may impact on their ability to support residents appropriately and effectively. Some improvements are needed to ensure that staff recruitment files are compliant with regulations Evidence: The majority of residents have minimal support needs and the number of trained staff available is currently satisfactory. Until the recent appointment of two new staff the whole staff team were trained to NVQ2 and the home is to be commended for this. A programme of qualification training is in place and well supported with some staff already studying for an NVQ3, two newly appointed staff are also booked onto an NVQ3 course. The home has not recruited new staff for some time and their recent appointment of two new staff has highlighted that their previously robust procedures have not been adhered to. Examination of new staff files indicated that whilst all relevant checks and references have been obtained, one staff member had commenced limited working at the home under supervision with only references and a POVA check in place. The registered person has been reminded that only under exceptional circumstances are new staff to commence work before receipt of a satisfactory CRB, where they do so, Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: this must be under close supervision of other staff and their supervision must be clearly documented. The content of the new staff files was not in keeping with schedule 2 of the Care homes Regulations 2001, in that no current photographs, or ID were in place, there is no evidence that gaps in employment or verification of reasons for leaving previous care roles has been sought from applicants and these omissions need to be addresse. The quality of photocopies of photographs was also discussed with the registered person as this needs improvement. Discussion with staff and the registered persons, in addition to examination of displayed staff certificates, indicates that staff have received mandatory training but much of this now needs updating. The registered person reported that mandatory training is usually undertaken in a block booking and this is now underway, with a fire training session booked for the evening of our visit, which was confirmed with the arrival of the trainer. Whilst we are advised that some further training has been booked, without a training matrix or individual staff training profiles which we would recommend as good practice, there is a lack of clarity as to what training staff need updating. Recruitment files examined, highlighted some initial basic induction for staff but this is not in keeping with skills for Care and there is no evidence that care competencies have been assessed and found to be satisfactory. The registered person is required to address the identified shortfalls within staff mandatory and induction training. Staff reported they had access to regular staff meetings and found the registered persons approachable and open, examination of records indicates that supervisions are held regularly but the content of these meetings is not well recorded and does not fully reflect discussions that take place in regard to training and personal development of staff, this has been discussed with the registered person and some suggestions made for improving the overall standard. Care Homes for Adults (18-65 years) Page 23 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed and systems are in place to protect and promote the health, safety and general well being of residents, the service would benefit from improving the content and detail of some records maintained. Evidence: The Registered person and manager has demonstrated she has the competency, required qualifications and relevant experience to run the home. There is evidence that the service is person centred and promotes independence respecting the right of individuals to take responsibility for their actions; outcomes for residents are generally good with few breakdowns, residents are encouraged to exert control over their daily routines at a pace suited to them. Records are generally to a good standard but would benefit from improved details and content to evidence that good practice is being maintained this has been discussed with the manager. A completed AQAA has been returned by the home within timescale. This told us some of what we needed to know and gave us a reasonable picture of the current situation; although there are areas where supporting evidence would have been more useful, to Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: illustrate what the service has done in the past twelve months and future plans. The AQAA informs us that the home has a full range of policies and procedures and these have been reviewed recently, during our visit we were able to view some of these and found the information well maintained and accessible to staff, who when asked, were able to indicate where they would find relevant policy information for reference. The home has actively sought to reduce the level of paperwork by moving information into an electronic format, the availability of a computer for residents in the lounge has also meant that policy and procedure information saved to disc can be viewed by residents if they wish to do so.Links to relevant statutory legislation in respect of regulation of care homes and other relevant legislation have also been signposted for staff and residents within policy information if they wish to look further. A Quality assurance programme in place, and regular audits of aspects of the service are conducted, and resident views are sought, analysis of findings and feedback are summarized within each specific area and any actions identified are progressed, currently this information is not drawn together into an overall quality assurance report for the service, and this was discussed with the registered person who has agreed to do so and make this available to the Commission upon request. The Home has a consistent record in meeting relevant health and safety requirements and legislation and the AQAA informs us that all servicing and checks have been updated, a random sampling of the electrical installation and gas supply confirmed this to be the case. An examination of accident/incident records highlighted a low level of both however, one or two incidents which involved either an admission to A & E or the involvement of the police have not been made known to the Commission through regulation 37 notifications, although clearly other agencies have been informed, this oversight was discussed with the registered person and highlighted a genuine misunderstanding in regard to what constituted a reportable event, this has been clarified and the registered person has confirmed their intention to report any further incidents/accidents of this kind to the Commission. A current certificate of insurance is in place. Care Homes for Adults (18-65 years) Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 31 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 19 13 The registered Person must 30/06/2009 ensure that all handwritten changes made to MAR sheets are signed and dated by the person making the change so that authorization for the changes can be clearly audited within the homes records Regulation 13(2) Care homes Regulations 2001 The Registered Person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 2 23 13 The registered person is to ensure that all staff receive updated adult safeguarding training at a level relevant to their role and this must be maintained and updated a minimum of two yearly. The registered person must 30/07/2009 Care Homes for Adults (18-65 years) Page 27 of 31 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 obtain a copy of local adults safeguarding protocols for reference and to inform staff practice. Regulation 13(6) Care Home Regulations 2001 The Registered Person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 3 35 18 The registered person must 30/07/2009 ensure that staff are provided with updated mandatory training in food hygiene, infection control, first aid, moving and handling and medication at the intervals stated by the training organization and that new staff are provided with induction in keeping with skills for care common Induction standards and this can be evidenced Regulation 18(1)(c) The Registered Person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users (c) ensure that the persons Care Homes for Adults (18-65 years) Page 28 of 31 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 employed by the registered person to work at the home receive(i) training appropriate to the work they are to perform including structured induction training and (ii) suitable assistance, including time off , for the purpose of obtaining further qualifications appropriate to such work 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 6 Care plans would benefit from information being more person centered and reflective of individual resident personal preferences, goals need to be more focused and achievable with systems in place to measure progress Risk information should more clearly evidence the risk reduction measures in place and whether a significant risk remains. Behaviour guidelines agreed with all relevant parties should be developed to inform staff practice when dealing with challenging behaviour and ensure consistency in the response and support delivered by staff Fire points should be randomly tested weekly and recorded The registered provider should promote good hand washing among st the resident group and provide them with a means to dry their hands after wards that minimizes the risk of cross infection, cloth towels in communal areas should be discouraged. The registered Person should develop a training matrix to 2 9 3 23 4 5 24 30 6 35 Care Homes for Adults (18-65 years) Page 29 of 31 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 highlight training needs and gaps within the staff team and should consider the development of individual staff training profiles to maintain a clear record of training undertaken by staff. 7 39 Registered person to provide an annual report of the outcomes of quality assurance and evidence how residents have been influential in service development, the report should be made public and available on request to the Commission Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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