Care Home: Lotus Care Home Ltd

Similar services:

• Foxley Lane (121a)
• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Chatsworth Care - Tudor Lodge

What the care home does well The home has supported the resident to make improvements in their health and general well-being. The resident receives one to one support in the home and two to one support in the community. The staff team are working hard to explore activities for the resident and are keen to ensure the resident is occupied and stimulated through having new experiences. What has improved since the last inspection? This is the home`s first key inspection visit since it registered in 2007 as they did not have a resident living in the home until May 2009. What the care home could do better: The recruitment checks need to be more robust, with detailed information obtained before a member of staff works in the home. The home must ensure it has a manageable and relevant induction for new members of staff. This must be available for inspection. The health and safety of the home and the resident must be paramount. The Manager must ensure there is a clear record of fire drills and that a detailed fire risk assessment is completed. Fire doors must close properly and fitted with appropriate door releasing equipment if they are to be kept open. Overall the Manager must ensure documents are available for inspection and that files are well organised so that information is easily accessed. Subsequent to the inspection visit we were informed by the Manager that the home had worked to address the requirements made and the shortfalls recorded in this report. The additional information given to us by the Manager have been included in this report. Key inspection report Care homes for adults (18-65 years) Name: Address: Lotus Care Home Ltd 11 Robb Road Stanmore Middlesex HA7 3SQ     The quality rating for this care home is:   one star adequate 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: Sarah Middleton     Date: 1 2 1 0 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 32 Information about the care home Name of care home: Address: Lotus Care Home Ltd 11 Robb Road Stanmore Middlesex HA7 3SQ 02089547702 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lotus Care Home Ltd care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 2 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care need on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Lotus Care Home Ltd is a care home registered to provide services for two adults with a learning disability. The home is located in a quiet residential area. The nearest London underground station (Stanmore) is about four minutes drive from the home but there are bus routes quite close to the home. The home is well furnished with new sofas and a television set in the lounge. The office and information about the home is kept in the lounge, as there is not room for a separate office. The kitchen is also well equipped. There are two single bedrooms, a toilet and a bath with a shower on the first floor. There is a garden at the back. The manager, who is also the co-director, said that the home is flexible about the fees and residents will be charged according to their needs. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 2 2 6 0 3 2 0 0 9 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: one star adequate 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: An unannounced inspection visit was carried out on the 12th October 2009. Before the visit we looked at: Information we have received since the home was registered in 2007. The Annual Quality Assurance Assessment (known as the AQAA). The AQAA gives the Care Quality Commission evidence to support what the home says it does well and gives them an opportunity to say what they feel they could do better and what their future plans are. How the home dealt with any complaints and concerns since registering. The views of professionals who visit the service. During the visit we: Talked with the Manager and a member of staff. Looked at information about the resident who lives in the home and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training Care Homes for Adults (18-65 years) Page 5 of 32 to meet the needs of the resident they care for. Looked around the home to make sure it was clean, safe and comfortable. We told the Manager what we found. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 7 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided for people thinking about living at Lotus Care Home. The information needs to fully outline what type of support the home can offer and any extra costs the resident might need to pay for. Assessments are carried out before an admission into the home to ensure the residents needs can be planned and met at the home. Evidence: The home has a Statement of Purpose and Service UsersGuide and we were shown copies of both of the documents. These required some amendments to explain the range of needs that the home can meet, such as autism, and those whose needs it could not meet. The home does not have facilities for people with poor mobility, for instance. The address of the Care Quality Commission also needed to be changed on one of the documents and we were informed subsequent to the inspection that the document had been updated. There was no information on the documentation, or in the homes contract/terms and conditions, about any extra payments which would be required for personal items, trips and meals out of the home, holidays or any other Care Homes for Adults (18-65 years) Page 9 of 32 Evidence: expenditure which could be an additional cost on top of the weekly fee. These documents need to be amended and provided to the resident and their family. Subsequent to the inspection we were informed that the terms and conditions and the Service User Guide had all been ammended to reflect more clearly the services offered in the home. We viewed the pre-admission assessment that had been completed by the staff working in the home. The Manager said another member of staff had completed the assessment but the document seen had then been written and signed by the Manager. We spoke with the Manager about ensuring the member of staff who obtains information about a new resident should also sign their name to the document. The pre-admission assessment looked at the needs of the new resident and generally provided the home with sufficient information. We spoke with the Manager about including a question on the residents preference for gender care support. It is important for the staff team to be fully aware of residents individual likes and dislikes and to record this on assessments and care plans. Following on from the inspection we were informed that this question would now be included in the assessments and care plans. We were told by the Manager that the placing authority had also carried out an assessment but this could not be found during the inspection visit. The Manager said that he had previously known the resident as he had worked at another care home where this resident had lived and had therefore known the residents needs and abilities. Care Homes for Adults (18-65 years) Page 10 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information on the resident is well maintained and informative. Residents are supported to make daily decisions about their lives. The resident is supported to be safe through risks being assessed and minimised. Evidence: We viewed the residents file to see the care plan and risk assessment. These provided good information about the resident. Their needs and the support they require from staff was clearly recorded. The Manager acknowledged the resident had made some improvements since moving into the home and these needed to be recorded on an updated care plan. We viewed a lifestyle plan where the Manager had recorded what the resident liked to do with his time, such as ride a bike. This provided us with some specific information about the resident. The home should continue to record relevant information in a person centred way. We viewed evidence to show that a review of the new placement had taken place in Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: July. All the relevant people were involved in this meeting. Another meeting had been booked a few weeks after this inspection visit. We also viewed a sample of daily notes which recorded what the resident had done each day. These provide staff with important information about how the resident has been that day. The resident is supported to make daily decisions, with the help of the staff team and family members. We saw evidence of a residents meeting where their relative had attended to speak on the residents behalf, as they could not fully participate. Those staff we asked described how they knew what the resident liked and disliked, as the resident uses sounds, gestures and single words. The risk assessments seen detailed the potential risks posed to the resident, along with the information about how the staff team could help to minimise those risks. These will be updated as and when any risks change. Care Homes for Adults (18-65 years) Page 12 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to engage in activities in the community. The home encourages residents to maintain social relationships. The home provides well balanced and varied meals, which meet cultural needs. Evidence: The resident had until recently been attending a day centre three times a week. This had stopped approximately three weeks ago and the Manager informed us that the home had been actively looking for alternative groups and classes for the resident to attend. Subsequent to the inspection we were informed that the resident now attends a day centre and various other clubs. The resident enjoys riding a bike and we suggested that it could be easier if the home also had a bike for staff to use. Various groups are being looked at including the local Mencap day centre, gardening group Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: and computer classes. The resident also enjoys music and attends a music group and visits the snooker hall. Staff informed us that the resident enjoys drives out and meals out. Evidence of regular meals out could be seen in the residents personal finance book. We were pleased to see that the home has taken a keen interest in ensuring the resident is stimulated and occupied with their time. Feedback from the residents Social Worker was also positive regarding how the staff team are seeking different groups and clubs. We were informed that the funding is still to be agreed for some of the extra staffing needed and for the groups. The resident needs two staff to go out with them in the community to ensure they are safe and supported appropriately. We were told that the resident has regular contact with their relative and that they advocate on behalf of the resident. On average the resident stays with their relative every six weeks. The home keeps in close contact with the relative to ensure they are kept up to date. The Manager explained that, if a resident was able, they could lock their bedroom doors for privacy. The resident living in the home is not able to read their own post. The resident was taken out for a drive, a walk and then a meal out on the day of the inspection. We viewed a sample of menus. These can change and the actual meals the resident has eaten are recorded on the daily notes. Overall, the meals were varied and showed that the resident was eating food to also meet their cultural needs. The Manager confirmed that fresh produce is used and fresh fruit and vegetables were seen in the kitchen during the visit. As noted earlier, the resident also has regular meals out. As the resident refuses to be weighed, the Manager should ensure the resident remains at a healthy weight. Care Homes for Adults (18-65 years) Page 14 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents health needs are met well. Arrangements for the handling, storage and administration of medication are good. Evidence: We were informed that the resident living in the home needs full support with personal care. Their health needs were recorded on their care plan and the home had been vigilant in recording any changes in their health needs. We were informed that there had been an improvement in the residents health and it is hoped that this will continue. We saw evidence that the home had purchased specialist equipment that would ensure the safety of the resident when they were sleeping at night. This was seen as good practice and the Manager should be commended for obtaining this for the benefit of the resident. Health appointments are recorded on a separate form, which makes it easy for the staff team to monitor changes in health and monitor visits. The resident has a GP and Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: has access to other health professionals. Where there are difficulties for the resident in being treated, for example if they refuse treatment and examination, this is noted on the residents care plan. The Manager had requested through the GP for a referral to the local Speech and Language Therapist. This form of support and guidance can assist the staff team in looking at various methods and tools to use when communicating with the resident. It can also be a way for the resident to communicate effectively with the staff team. Following on from the inspection visit we were informed that the Manager had been in contact with the local primary care team to ensure the referral is processed as soon as possible. The medication supplies are held in locked box, within a locked cabinet, in the lounge. At present this is sufficient for the resident, who only has liquid medication. The medication is supplied each 28 days and a Medication Administration Record sheet (MAR) is printed by the pharmacist. The medication coming into the home is recorded. There was one medication from the residents previous placement, which was not now used and the Manager was advised to return this to the pharmacist. The Manager said that only those staff who are trained in medication administration are able to give the medication. He had a book for recording when the medication had previously been taken to the day centre for administration. Care Homes for Adults (18-65 years) Page 16 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and relatives concerns or complaints would be listened to and acted upon. Residents are not fully protected by the homes recruitment processes. Evidence: The home had not had any complaints since it opened. We discussed with the Manager the benefit in devising a complaints form that could clearly record a complaint and action taken to resolve the complaint. It is difficult to assess if the resident would be able to express their concerns and complaints to the staff team. However their relative, who is in regular contact with the home, would act on behalf of the resident and express their views to the home. The home had one safeguarding allegation made to the placing authority that was investigated and not upheld. We were satisfied that the home had acted quickly to assist with the investigation. We viewed the Managers record of the allegation and, as discussed above, we advised him to develop a safeguarding record that would record the facts and show the action taken to resolve and address the concerns raised. Subsequent to the inspection visit we were informed that a safeguarding record was now in place. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Staff had received training on safeguarding and the Manager informed us that he would be looking for the staff team to attend the local authoritys training on this subject. The home has the Local Authoritys Safeguarding policy and procedure. We viewed staff recruitment files, for more detail see Standard 34. We found shortfalls in all the files viewed which could place residents at risk. All information gathered on an applicant who wants to work in the home must be obtained and available for inspection. The residents relative manages their finances, with the home managing the personal weekly allowance that the resident is entitled to. We counted and checked this to find it was slightly over by £1.00 to what had been recorded in the finance book. We advised the Manager to keep clear accurate records to ensure there are no errors. Regular counts and audits should be recorded in the finance book. Care Homes for Adults (18-65 years) Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of living in a clean and welcoming home. People are not protected by the fire precautions and lack of assessments. Evidence: A tour of the home revealed that, overall, the home was generally clean and wellmaintained. We noted there was a hole covered up in the kitchen ceiling. We were informed this had been caused by recent electrical work and would be fixed the week of the inspection. Subsequent to the inspection visit we were informed that the kitchen ceiling had been fixed. The home does not have a separate office and there was a small desk and filing cabinet in the living room. Although we acknowledged there is limited space to keep records and files we suggested that the Manager explores using possible other spaces in the home as this current situation could disturb the residents and could be seen as encroaching on their living space. We looked at the homes fire precautions. A visit by the London Fire and Emergency Planning Authority (LFEPA) in 2007 had found the fire precautions satisfactory. They had visited again in August 2008 and required that a fire risk assessment was Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: compiled, as required under their legalisation. The Manager was not able to produce a risk assessment for us and, although he had the LFEPA book on risk assessments in residential homes, he agreed one had not been completed. The fire risk assessment must be completed within the timescale given. Following on from the inspection visit we were informed that there was now in place a fire risk assessment. We saw that the washing machine was tucked under the stairs. The Manager confirmed that this had been seen by a fire officer and was deemed safe. We also found that the fire door between the lounge and the kitchen did not close fully of its own accord and had to be closed manually. We advised the Manager that the closure device, which is a chain, must be repaired to enable to door to close and provide a fire door. We also found that the residents bedroom door was being propped open with a piece of carpet. We discussed this with the Manager and said that, if the door is to be kept open, then a device must be fitted to ensure that it closes in the event of a fire. We advised that this could be of the battery operated type which fits at the base of the door. Subsequent to the inspection visit we were told that the fire door in the kitchen had been fixed and that the residents bedroom door is kept closed whilst the home looks at devices that could be purchased to keep the door open safely. Care Homes for Adults (18-65 years) Page 20 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have attended training to enable them to meet the needs of the resident. The poor recruitment checks could place residents at risk. Evidence: The home comprises of a small team who come from a range of backgrounds. There is only one woman currently working in the home. The Managers brother also works in the home. The staff team had met once since the resident had moved in and we were told there would be more regular team meetings. The Manager encourages staff to complete NVQ qualifications. One support worker is studying NVQ level 2. Another member of staff has completed NVQ level 3 and is waiting for their certificate. We saw a copy of the rota for the current month. The home currently has five staff working, including the Manager. The shifts are from 9am to 5pm and from 5pm to 10pm. The waking night staff work from 10pm to 9am. We noted that one staff, completing a waking night shift, was shown as driving the resident to the day centre. The Manager said that this had now ceased as the resident no longer attended the centre. He was reminded that the rota must be a reflection of the work actually Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: undertaken and must be amended accordingly. There is always at least one member of staff working, and two work if the resident goes out into the community. We viewed staff recruitment records for the whole staff team, including a person who had yet to work in the home. Overall, we found major shortfalls in the files seen. There were incomplete application forms, with little information on them, such as nothing recorded about the applicants education and/or qualifications, no record of their employment history or names of referees, one of which should be of their last or most current employer. There was also no evidence on one file of a current Criminal Record Bureau Check (known as CRB) carried out on behalf of the Manager/Provider. The Manager during the inspection contacted this member of staff asking them to bring in this CRB. Subsequent to the inspection the Manager informed us that this member of staff had not yet brought in this CRB but another CRB application had been applied for and the member of staff was not working in the home until this had come through. He also informed us that the majority of the information needed had now been obtained. On one application form, we recognised the Managers handwriting. He confirmed he had filled in the applicants name and address and had ticked some of the information about the applicants health and had dated the form. This was discussed with the Manager who said he would sit with an applicant to help them fill in the form. We raised our concerns with the Manager, as usual good practice would be for the applicant to complete all the required information and send this to the Manager so that he could decide based on the information given, whether he would interview the person. We stressed to the Manager that he must not complete or write on the applicants application form. Another file had only one reference and the Manager said he would chase this second reference up. We spoke with the Manager about the need to get references verified, preferably on headed paper or requesting that the referees complete the reference form the Manager sends out. The files seen also did not have recent photographs of each member of staff. There was no evidence that interviews had taken place. We talked through the shortfalls with the Manager and stressed the importance of ensuring all this information is in place before a person works in the home. Regardless of whether the Manager knows the member of staff, good practice needs to be in place so that residents are not placed at risk. Following on from the inspection visit we were informed that all the necessary and required information on each member of staff had been obtained and was available in Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: the home. We saw from the documentation in the staff files that there were no completed induction procedures. The Manager had in place the Skills for Care paperwork for the core skills but none had been started or completed. He said that one staff had taken a section home to do. An induction checklist was said to be available but no examples were found. Most staff had undertaken the majority of the basic training courses, but these were not shown as part of an induction process. We advised the Manager to have a planned induction programme, showing the basic and advanced courses that staff need to perform the work in the home and when they are taken. It must be evidenced that a thorough induction programme has been undertaken, demonstrating that staff are competent, and it is recorded. Subsequent to the inspection visit we were informed that staff had gone through the induction process. Overall, staff had attended training courses on core subjects in 2008, such as fire safety, food hygiene and handling medication. In early 2009 there was also evidence that staff had attended training on Autism and Aspergers Syndrome. We spoke with the Manager about ensuring staff receive training this year to demonstrate they are up to date with the skills and knowledge they need to work in the home. The Manager acknowledged that the individual training records had not been filled in and that he needed to also develop an overall training plan that would show, at a glance, the whole staff team and what training they had attended. Recording training makes it easier to then identify when staff are due for refresher training. It was difficult to fully assess all the training attended as some of the certificates were several years old and, as noted above, the documentation had not been filled in. We were informed that the Manager uses an external trainer but that he would also be exploring other sources such as the Local Authority. Subsequent to the inspection visit we were informed that training courses had been booked and that an overall training plan was now in place. There was some evidence that staff are receiving one to one supervision. This must be offered for all staff on an ongoing basis. Care Homes for Adults (18-65 years) Page 23 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager needs to demonstrate more of an understanding of his role and responsibilities. The health and safety checks and systems need to be more robust in order to protect the welfare of residents. Evidence: The Manager, who is the Registered Provider, has had previous care work experience. Following on from the inspection visit the Manager informed us that he had worked previously as a Registered Care Manager for a home and for an Adult Placement Scheme. He has just started studying for a relevant management qualification. The home had been registered for approximately two years before the first resident moved into the home. Therefore, there had been time to prepare the home and ensure systems were all in place ready for when it opened. However, there has been some evidence throughout this inspection visit that shows that there is room for improvement. The Manager has worked with the staff team to improve the life of the resident living in the home, but we are concerned there were areas where the Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Manager had not met the National Minimum Standards and Care Home Regulations. Emphasis must now be on addressing the shortfalls referred to in this report to ensure the home runs effectively and safely. The Manager showed us a survey, that would be for residents or their relatives to complete, where they could make comments about the home. We suggested that surveys for other professionals could also be developed and given out. We discussed with the Manager the need to also consider, in the future, developing a short quality assurance report that would record what improvements the home had made, areas to be addressed and future aims and objectives. This could then be available for inspection, the residents and their relatives. The Manager agreed to start considering how to devise this report. We examined the file of policies and procedures. All of these were dated July 2007. The file was not indexed, so it was not possible to ascertain if all of those required policies, listed in the National Minimum Standards, were in place. As no recent reviews appeared to have taken place, we could not see if any had been changed in line with any new legislation or recent good practice. The Manager was advised that an index would make access for the staff easier, and that there should be a system, such as a signature sheet, to show that staff have read the policies as this was not clear in the induction documentation. We found that the record keeping to be in need of some improvement. The Manager was not always able to find the information we required. The files, including those for staff and maintenance, were not divided into sections, making it difficult for us to find the information. Checklists had been put in the staff files, for instance, but had not been fully completed. The Manager also needs to ensure that he is fully aware of the information which is required to comply with the Care Home Regulations, so that he can demonstrate he is meeting them. This was not evident to us on this visit. We examined a sample of the maintenance records. We found that the gas check was carried out in June 2009 and the fire alarms and extinguishers serviced in May 2009. An electricity check had been carried out in 2007 and a form for another check, which also recorded the small electrical appliance testing, was available. However, this was not dated. The Manager was unable to show us evidence, from the homes records, of when the test had been completed. Subsequent to the inspection visit we were informed that the electrical test had now been dated by the engineer. The last Legionella check was in October 2007 and the Manager informed us that the hot water is regulated, and the hot water temperatures tested, but there were no records of this. He was advised that there should be recorded. Following on from the inspection visit Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: we were informed that a test for Legionella had taken place and that hot water temperatures are taken and recorded. The fridge and freezer temperatures are taken daily and they were up-to-date and within the required ranges. The Local Authoritys Environmental Health Officer had visited in October 2007 but said that they would return when the home had residents. The Manager needs to inform them that the home is now operating. There was no Fire Risk assessment completed. We have made a requirement under the Environment section of the report for this to be carried out as a matter of urgency. We were told this was now in place following on from the inspection visit. We saw that the fire alarms were checked weekly, up until 10th October 2009. No fire drills were recorded as having taken place but the Manager said that these are held when the alarms are checked. We advised that he must record them and show that all of the staff are fully conversant with the procedures for evacuation. This must include those staff who work at night. Subsequent to the inspection visit we were informed that fire drills are in operation and are documented. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Registered/Manager Provider must ensure that the Statement of Purpose has sufficient information to show who can be accommodated in the home and how their needs will be met. To ensure that there are the facilities staffing and training to meet the needs of the residents. 30/11/2009 2 1 5 The Registered Provider/Manager must ensure that the information provided to residents has details of any additional payments required. To ensure that people are aware of any additional payments they are required to make. 30/11/2009 3 23 13 In order to protect the resident the recruitment processes must be robust. 02/11/2009 Care Homes for Adults (18-65 years) Page 28 of 32 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 To protect the welfare of the residents living in the home. 4 24 13 The Registered Provider/ Manager must ensure that suitable equipment is in place to prevent the spread of fire and that any equipment is maintained in good order. To ensure that people are protected against the risk of fire. 5 24 23 The Registered Provider/Manager must ensure that the home has a fire risk assessment in accordance with the Regulatory Reform (Fire Safety) Order 2005. To ensure that every precaution has been taken to protect residents, staff and visitors from the risk of fire. 6 34 19 All recruitment checks, such as completed application form, current Criminal Record Bureau Check and two references, must be carried out before a person works in the home. 02/11/2009 31/10/2009 31/10/2009 Care Homes for Adults (18-65 years) Page 29 of 32 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 Robust recruitment checks can safeguard residents from harm. 7 35 17 The Registered Provider/Manager must ensure that all staff undertake the induction procedure and that a record is kept of this. To ensure that staff are fully conversant with policies of the home, are competent and have the necessary skills to work in the home. 8 37 10 The Registered 30/11/2009 Provider/Manager must ensure the home meets the National Minimum Standards and the Care Homes Regulations. The home needs to have robust systems in place in order to protect residents and staff. 9 41 17 The Registered Provider/Manager must ensure that the records are kept in an orderly manner, are easy to access and are up-to-date. 30/11/2009 30/11/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 To ensure that the record keeping is accurate, easy to access and meets the Care Homes Regulations 2002. 10 42 13 The Registered Provider/Manager must ensure it is recorded when fire drills are held to demonstrate that the home is training staff and carrying out the necessary fire precautions. To ensure that staff are seen to have the knowledge and practice to evacuate in the event of a fire. 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 30/11/2009 1 35 It is recommended that individual training records are completed. An overall training plan should also be developed to record the whole staff teams training. The Manager/Provider should develop a report about the home which looks at what has been achieved and future aims and objectives. 2 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - 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!