Care Home: McGillicuddy House

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What the care home does well People who live and work at the home interact with one another like members of a family. There is constant communication between everyone; everyone is interested in what other people are doing; and people make time to listen to each other. The views of people who live in the home are regularly sought through conversations, house meetings and the personal centered planning process. Some housemates were present when, at the end of the inspection, a summary was made of the good things in the home and the things that need improving. The housemates added their own comments. "What do you think about the home" one housemate asked and then responded, "It is good living here". People feel confident to say if they are unhappy about any aspect of home life. They receive good advice about how to keep themselves safe by attending a local forum. Staff receive regular training to keep them up to date with current good practice in caring for people with a learning disability. In addition a large percentage of the staff team have gained a national vocational qualification. What has improved since the last inspection? Personal centred plans have now been developed which include housemates` individual needs and goals from their own point of view. People who live in the home have had more opportunities do take part in new and different activities since the local day centre has closed. Some people are going to attend college courses and are very excited about their recent visit to the college building. A staff training matrix has been developed which helps the appointed home manager identify which areas of training staff need to attend. This makes sure that all staff receive the right amount of training that they need. There has been some decoration in the home, including the kitchen. What the care home could do better: The home is not doing all that it can to make sure that the people who they employ to work in the home are suitable. A requirement has been made in this report that the home thoroughly assesses the fitness of all people before they work with people who live in the home. This will make sure that housemates are in safe hands. Staff are not given clear guidance on how to minimise any potential risks that have been identified in the care planning process. It is recommended that an audit is undertaken of all potential risks to people who live in the home and that written guidance is given to staff so that they know what to do to minimise any potential risks that have been identified. Some aspects of the home environment need to be assessed to make sure that they are not potentially harmful to the people who live in the home. These include hot radiators and pipe work. Key inspection report Care homes for adults (18-65 years) Name: Address: McGillicuddy House 18 Vicarage Road Strood Rochester Kent ME2 4DG     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: Nicki Dawson     Date: 0 2 0 9 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 30 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 30 Information about the care home Name of care home: Address: McGillicuddy House 18 Vicarage Road Strood Rochester Kent ME2 4DG 01634711781 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Assumpta Ann Payne,Mr Dennis Gover Payne care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number to be accommodated is 8 The registered person may provide the following categories of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission ot the hoem are within the following category: Learning disability (LD) Date of last inspection Brief description of the care home McGillicuddy House provides personal care and support for up to eight adults who have a learning disability. The home is a large semi-detached Victorian property situated in a quiet residential road close to Strood town centre. It has easy access to a variety of amenities and shops and is close to local bus routes and the train station. The accommodation is situated over four floors. There is a large open plan communal room that provides living, dining and kitchen facilities. Each person is provided with Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 8 Brief description of the care home their own bedroom so that no one has to share. There is a small well maintained garden. The garden contains a summer house which many of the people living in the home like to use. Restricted residential parking is available in the surrounding streets. Fees range from £400 to £540 per week. The last key unnannounced inspection to the home was on the 14th September 2007. Care Homes for Adults (18-65 years) Page 5 of 30 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 inspection was unannounced, which means that the people who live and work at the home did not know that the inspector was calling. Key unannounced inspections are aimed at making sure that the individual service is meeting the National Minimum Standards and that the outcomes for people using the service promote their best interests. The inspection started at 10 am and took 6 hours. Seven people who live at the home, two staff and the appointed home manager were involved in the inspection to gain their views and knowledge of the level of care, provided by the service. The main areas of the home including a number of peoples bedrooms were entered. A number of records to do with people care and safety were looked at. It is now a legal requirement for services to complete and return an annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how Care Homes for Adults (18-65 years) Page 6 of 30 well outcomes are being met for people using the service. It also gives us some numerical information about the service. The service returned their AQAA to us within the timescale requested and it contains all the information that we asked for. In this report the people who live in the home will be called, housemates as this is what they have chosen to call themselves. The person who manages the home will be referred to as, the appointed home manager. This person has been appointed by the registered home owner to manage the home, but has not been formally assessed by us as competent to do so. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home is not doing all that it can to make sure that the people who they employ to work in the home are suitable. A requirement has been made in this report that the home thoroughly assesses the fitness of all people before they work with people who live in the home. This will make sure that housemates are in safe hands. Staff are not given clear guidance on how to minimise any potential risks that have been identified in the care planning process. It is recommended that an audit is undertaken of all potential risks to people who live in the home and that written guidance is given to staff so that they know what to do to minimise any potential risks that have been identified. Some aspects of the home environment need to be assessed to make sure that they are not potentially harmful to the people who live in the home. These include hot Care Homes for Adults (18-65 years) Page 8 of 30 radiators and pipe work. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 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. People are provided with information about the service, but some of this information needs to be changed so that people have all the information they need to make a decision about whether to live in the home. People would benefit form a more comprehensive assessment of their needs before they move into the home, so that they can be sure that they will receive the right type of care. Evidence: The aims and objectives of the home are set out in the homes Statement of Purpose. The appointed home manager said that the Service user Guide, which contains details of the services and facilities that are available to the people living in the home, needs to be updated, so that it gives accurate information. It is recommended, that when the Service User Guide is updated, it is presented in a way that has more meaning for the people who live at McGillicuddy House. This would complement the audio version of the guide which is already available. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: Before a new person is admitted to the home a full needs assessment should be carried out to decide whether or not the home is a suitable place for the person to live. The assessment of one person that has recently moved to the home was looked at. The home obtained the joint assessment from the local authority social service department and used this information to make the decision of whether the home could meet the persons needs. It is recommended that the home develops its own tool to assess the needs of potential housemates, to complement the information obtained from the local authority. Care Homes for Adults (18-65 years) Page 12 of 30 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. Housemates each have a personal centered plan of care. Some plans would benefit from clearer guidance for staff as to how to minimise potential risks identified in these assessments. Housemates participate in all aspects of life in the home and their individual needs and choices are promoted. Housemates are supported to be independent. Evidence: Each person that lives in the home should have an individual plan of care that clearly sets out their health, personal and social care needs, together with the staff support that is required to meet these assessed needs. Three care plans were examined. The home has acted on the recommendation made at the last inspection, that each housemate has an individual person centred plan. These plans contain information Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: that is important to the individual such as their personal history, likes and dislikes, dreams/goals and how these can be met. There is evidence that some goals have already been met and that goals are regularly reviewed. Each housemate also has a communication passport which clearly states how they make their needs known on a daily basis. Each persons personal care needs current healthcare needs are detailed in the housemates six monthly reviews. All care plans should have written plans in place to minimise the effect of any potential risks. Evidence was seen that such plans are in place, but some are not regularly reviewed nor do they all contain clear guidance for staff about how to minimise potential risks. For example, the moving and handling assessment for one housemate had not been reviewed for two years. The risk assessment for one housemate is that they have a very low risk of epileptic seizures. The guidance for staff to follow is that they should be aware of what to do. These are not clear instructions for staff to follow should the person have a seizure. It is recommended that all risk assessments are audited to ensure that they contain clear guidance to staff to minimise potential risks to the people that live in the home. Housemates are encouraged to be as independence as possible. Since the last inspection one housemate is now going out locally in the community by themselves. Evidence was seen in the house meeting notes that this person is, really pleased with their new independence. Evidence was seen in personal centred plans that housemates are encouraged to make choices and decisions about their lives. Throughout the day housemates were observed discussing ideas about what they wanted to do with staff and staff listening and responding positively to these suggestions. The home assists some housemates with their weekly monies. The record for one housemate was looked at. It was found to be well organised, showing that monies are spent in the best interests of the people who live in the home. Housemates have regular, recorded meetings where they come together to discuss their home life. Each housemate takes turns to chair the meeting. The last minutes state that housemates organised a garden fete and from the money they brought a new large screen TV. One housemate proudly showed the new TV to the inspector as she entered the home. Care Homes for Adults (18-65 years) Page 14 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported to live fulfilling lives. Evidence: People who live at McGillicuddy House are given opportunities for personal development. Personal centred plans evidence that some housemates are supported to learn how to use their money. During the inspection housemates were observed taking part in a range of household tasks including cooking, washing up and sorting out the laundry. It was also observed that housemates receive a lot of emotional support from staff through regular conversations. The home has adapted positively to the recent closure of the local day centre which most housemates used to attend. The appointed home manager has used this as an opportunity to develop more activities for the people who live in the home. Housemates talked about the activities that they take part in with enthusiasm. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Comments from housemates include, I won three pounds at bingo, I make the lunches at Age Concern, and I do the cooking. Activities recorded in individual files include gardening, drama, picnics, days out, shopping, swimming, arts and craft and water pistol fights! One housemate has a voluntary job and some housemates are due to start college in September. Evidence was seen in the house meeting minutes that housemates are actively involved in planning activities and that they are encouraged to try out new interests. Activities that housemates take part in are recorded in individual files. In addition a monthly review is kept of all activities that take place by everyone living in the home. Some housemates are due to go on holiday soon. The appointed manager said that not all housemates wan to go and this was confirmed by people living at the home. One housemate shared photographs of a recent birthday that they celebrated. The housemate celebrated their day by having a garden party with friends and family, complete with a marquee and a beautifully decorated cake. The home has good links with the local community. Some housemates shop independently at the local shops, some attend a local church. The appointed home manager stated in the AQAA (annual quality assurance assessment) that a successful summer garden fete was organised which was supported by new contacts at bingo, neighbours and local shops. People living at the home said that their friends and relatives are welcome to visit them at their home. Evidence was seen in daily notes that housemates are encouraged to keep in contact with their relatives. Internet access has recently been installed so that housemates can keep in contact via e-mail. Housemates were observed moving freely around the home during the inspection. People who chose to have keys to their rooms to maintain their privacy. People who live in the home are involved in all aspects of meal preparation. During the inspection housemates were asked their choices for the evening meal. One housemate went out to the local shops to buy food items that were needed for the day. One housemate was observed preparing the evening meal. In addition, people are also involved in baking on a regular basis. Person centred plans contain photographs of cakes that housemates have proudly made. During the inspection, one housemate was supported to make an orange cake and the smell that came from the kitchen indicated that the cake was absolutely delicious! Care Homes for Adults (18-65 years) Page 16 of 30 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. People who live in the home have their personal and healthcare needs met. People who live in the home are being encouraged to administer their own medications where they have been assessed as able to do so. People would further benefit from clearer guidance being given to staff in some aspects of the management of medicines. Evidence: The personal support that housemates require and a summary of their healthcare appointments and needs are detailed in their six monthly reviews. This evidences that people who live in the home receive regular support from a range of healthcare professionals as required. Important healthcare information about each housemate is contained in individual personal centred plans. The appointed home manager said that individual healthcare plans are currently being developed for each housemate and this will be a valuable addition to the person centred plans. A new hospital assessment form has been completed for each housemate. This form contains all the information that hospital staff would need, should the person be admitted to hospital. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of housemates receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form (MAR sheet) the medicine has been given or, if it hasnt been given, the reason why. On examination of the MAR sheets it was found that there were no gaps in the record, indicating that medicines are given to housemates as prescribed by their GP. Following the recommendation made at the last inspection there is now guidance in place for housemates who are prescribed medicines that are PRN (as and when required) and some people are responsible for administering part of their own medication. The training matrix evidences that only staff who give out medicines have been formally trained to do so. The home manager said that he regularly observes staff giving out medication to ensure that it is done safely. It is recommended that this assessment of staffs competency to administer medicines is formalised and undertaken on a regular basis. It is also recommended that the homes policies and procedures on medication, which give guidance to staff, be extended to include a wider range of aspects concerning the administration and storage of medication. Care Homes for Adults (18-65 years) Page 18 of 30 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. People who live in the home are confident that any concern or compliant they make will be listened to and resolved to their satisfaction. Staff feel confident to speak out and take action to protect service users, if they have any concerns about their care. Evidence: Neither the home nor the commission has received any complaints about the service in the last year. People living in the home said that they know who to talk to if they have a concern and that staff listen to them and act on what they say. At the last key unannounced inspection it was suggested that the home could make the complaints procedure more accessible to the people who live in the home by making an audio version of the procedure. This is something would benefit the housemates at McGillcuddy and would show that the home is doing all that it can to encourage people to speak out. Some people who live in the home attend Medway Valuing People forum where people are encouraged to speak out about important issues. One housemate explained that they have met members of the police force and that they talk about keeping themselves safe with regards to drugs and money. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Staff have a good understanding of what is good care practice. The staff training matrix evidences that most staff have received formal training in safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 20 of 30 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. Housemates benefit from living in a home which meets their needs. To make sure that the home is safe at all times for the people who live in it, further assessments of risk should be carried out with regards to potentially hot radiators and pipe work. Evidence: The home continues to make gradual improvements to the environment for the benefit and comfort of the people who live there. The kitchen has had new flooring and decoration. The appointed manager has identified areas of the home where further improvements are needed. People who live in the home have use of a kitchen/living room area. This leads directly out into the garden where housemates also have use of a summer house. People were using the summer house on the day of the inspection. I like it here, commented one housemate. The summer house offers a quiet space with seating, a TV and stereo. Bedrooms viewed have been personalised to reflect individual tastes and interests. One housemate was very proud to show the inspector some of their personal Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: belongings and a number of housemates offered photographs to look at which recorded events that are important to them. One of the bedrooms smelt of damp and this was noted at the last visit to the home. The appointed manager said that that this room is in need of more frequent ventilation and that this matter would be attended to. A smell of urine was found in one residents bedroom. It is recommended that the bedroom carpet is thoroughly cleaned or a more suitable replacement acquired. An assessment of any potential risks to housemates health and safety has been carried out for each persons bedroom. It is required that these assessments be extended to include the risk of someone scolding themselves on uncovered hot radiators or pipe work if they fall. People who live in the home have the use of a shared bathroom and shower room. Staff said that to make sure that people bathe in water that is at a safe temperature, the water temperature is checked every time a person has a bath. Thermometers were observed in the bathroom to do this. It is recommended that as a further precaution that the bath water temperature is recorded regularly to make sure that it remains at a temperature that is safe to bathe. It was observed that the home was clean on the day of the inspection. The staff training matrix evidences that staff have received or are booked on training in how to minimise the spread of infection in the home. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of the people who live in the home and a staff training programme is in place to make sure that these needs are met in a satisfactory way. Housemates can not be assured that the current recruitment practices within the home always protect them from potential harm. Evidence: The staff rota indicates that there are a minimum of two staff on duty from 8am to 8pm, with one staff on duty from 8pm to 8am. The appointed manager said that the rota is flexible and an extra member of staff is on duty to make sure that housemates can go out and about in the community. Indeed, on the day of the inspection there were three staff on duty in the morning, including the appointed manager. Records evidence that 80 of staff are trained to National Vocational Qualification (NVQ) level 2 or above. This exceeds the National Minimum Standards of 50 of staff. This award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Before new members of staff are employed at the home a number of checks need to be carried out to make sure that all members of staff working at the home are suitable to care for vulnerable service users. Files were seen for two new members of staff. It was found that the home is not doing all that it can to ensure the safe staff recruitment of staff. One criminal records bureau check had been obtained a week after the person had been employed at the home; neither file contained either an application form or a record to evidence that the potential applicants had been interviewed as to their suitability for the position of a care worker; and one file did not contain a photograph of the member of staff. Requirements are being made about these breaches of the Care Homes Regulations 2001, which state that, The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person: a recent photograph; details of criminal offences; a full employment history; a statement by the person as to his mental and physical health. It is recommended that monitoring systems are put in place to ensure that these breaches of the regulations do not occur in future. The appointed manager is responsible for making sure that care staff have the skills they need to support the residents who live in the home. Evidence was seen that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. In addition to the introductory training, care workers undertake a number of training courses that develop their skills in caring for the people that live in the home. The appointed manager has completed a staff training matrix, which identifies the training that each member of staff needs to achieve. There are few gaps in this record indicating that most staff are trained in the areas that are essential for them to be able to perform their roles effectively. The home believes that staff supervision is important so that staff have the opportunity to discuss care practice, the philosophy of the home and their own development needs. Staff files viewed show that a formal supervision programme is in place in addition to informal support. Care Homes for Adults (18-65 years) Page 24 of 30 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. People who live in the home benefit from the management approach, which is individual and open. People who live in the home are regularly asked about their views of the service. For housemates to be assured that their health, safety and welfare is promoted at all times, some further action needs to be taken. Evidence: The appointed manager is responsible for the day to day running of the home. He has been employed in this position for two years and has both of the formal qualifications specified by the National Minimum Standards. These awards are recognised by the commission to be useful because they help to make sure that people who manage residential care services have the competencies that are necessary to do so. The appointed manager said that he has already submitted his application to become the registered home manager. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: There is evidence that a culture of mutual support is encouraged in this home. For example, when one housemate was upset, another housemate informed a member of staff about this fact. The housemate received reassurances from both the staff member and other people living in the home. People who live in the home were observed talking to and gaining assurances from the appointed manager and staff members throughout the inspection. The whole staff team always gave their time generously to the people who live in the home. Evidence was seen that staff meetings take place regularly for all care staff to help better communication between everyone involved. For the home to run in the best interests of the people who live in it, it is important to have a system in place which regularly obtains their views and those of visitors, about the standard of care that they receive from the home. Evidence was seen in housemates files that housemates have recently completed a questionnaire asking them their views about certain aspects of daily life. The appointed home manager said that he took action to address any improvements that were identified during the surveys. For this good practice to be evidenced, it is recommended that a report is made summarising the responses from the questionnaires and that the survey is extended to include relatives and professionals who regularly visit the home. At the last visit to the home it was recommended that the home should further strengthen the quality assurance system by implementing monitoring systems used in the home to make sure that they are effective. Particular attention should be given to areas that have been identified in this report as needing improvement, such as risk assessments and the recruitment and selection of care staff. The appointed home manager has told us that there are no people living at the home subject to a deprivation of liberty authorisation, under the Mental Capacity Act 2005. The appointed home manager made a declaration in the AQAA (annual quality assurance assessment) that all items of equipment in use in the home remain in good working order. As mentioned previously in this report, environmental risk assessments have been carried out but need to be extended in some areas to make sure that the home is as safe as possible to the people who live in it. The staff training matrix evidences that a rolling programme is in place to make sure that care staff are trained in all necessary areas to enable them to care for housemates safely. Care Homes for Adults (18-65 years) Page 26 of 30 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 30 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 24 13 Radiators and pipe work within the home must be assessed for the risk they present to the people that live in the home and action taken to minimise any identified risk. This will minimise the possibility of people burning themselves on hot radiators should they fall. 02/11/2009 2 34 19 Before new staff work at the 14/10/2009 home documentation as to their suitability must be obtained including a criminal records check; an application form containing their past employment history with the reason for any gaps in their employment and a statement of their health and fitness; and a photograph. This will ensure that only Care Homes for Adults (18-65 years) Page 28 of 30 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 people who are assessed as fit to work with vulnerable people will be employed at the home. 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 9 There should be an audit of all risk assessments for people that live in the home. This will make sure that there is clear guidance in place for staff to minimise any potential risks that have been assessed. Staff should have their competency to administer medication assessed formally on a regular basis. This will make sure that medicines are given to housemates safely. The homes policies and procedures on medication should be extended to include taking verbal orders from GPs, what to do when medicine is administered when housemates are out in the community and self administration. This will make sure that there is clear guidance for staff to administer medicines safely. 2 20 3 20 4 24 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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