Care Home: Meridan House

What the care home does well The home is purpose built and the garden is attractive and well maintained. Seating had been provided. Residents indicated that staff were approachable and had treated them with respect and dignity. Support is being provided by professionals from the local Community Mental Health Team. There is a comprehensive training programme for staff. They were aware of Equality and Diversity issues and the need to treat all residents with respect and dignity. Effort had been made to ensure that care documentation is structured and contained up to date care plans and risk assessments. What has improved since the last inspection? All residents were noted to be clean and well dressed. We were informed by the deputy manager that the provision of personal care to residents had been closely monitored to ensure that residents are well cared for. Improvements had been made in the arrangements for the administration of medication. Deficiencies identified in the last inspection report had been rectified. A review of staffing levels had been undertaken so as to ensure that there is sufficient staff to meet the needs of residents. The new manager is in the process of applying for her registration with the CQC. This is to ensure that she is suitable for the management of the home. Half of the home had been refurbished and redecorated. Work is being carried out on the second half of the home. The necessary fire drills had been organised for the home. What the care home could do better: The Statement of Purpose and Service User Guide must be amended to reflect the recent management changes as the home now has a new manager and a new client group with different needs. This is to ensure that prospective residents and their representatives are fully informed. The care and plans of care of the resident identified to the manager and in the section on Health and Personal Care must be reviewed to ensure that it contains a specific risk assessment together with a written strategy for addressing the risk of illicit drug use. This is to ensure that this resident is well cared for. The night staffing arrangements must be reviewed to ensure that where possible, a mix of male and female staff are on duty during the night. Where this is not possible, a risk assessment must be carried. This is to ensure that residents are well cared for and residents and staff are not put at risk.The fire risk assessment must be updated to reflect recent changes in the home. Fire safety training provided for staff must be carried out by a suitably qualified person. This is to ensure that staff are fully trained in fire safety and to ensure the safety of all those in the home. A system for summoning assistance promptly in the event of an emergency must be provided for staff. This is to ensure the safety of residents and staff. The CQC should be informed of changes affecting the use of the home. Approval should be sought from us, risk assessments carried out and residents informed. This is to ensure the welfare of residents and that the organisation of the home complies with legislation and the National Minimum Standards. The home must have a written procedure for ensuring that where possible, all relatives and representatives of residents are fully consulted and informed well ahead of time of any transfer of residents to alternative accommodation. This is ensure the welfare of residents and to ensure that their relatives and representatives are well informed. Key inspection report Care homes for adults (18-65 years) Name: Address: Meridan House 1 Stonecrop Close Colindale Avenue Colindale London NW9 5RG     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: Daniel Lim     Date: 2 1 1 2 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Meridan House 1 Stonecrop Close Colindale Avenue Colindale London NW9 5RG 02082054048 02082052986 meridan.house@richmondfellowship.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richmond Fellowship Name of registered manager (if applicable) Ms Juliana Zvanyadza Manjoro Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Foxlands and Meridan will have one registered manager and a designated deputy manager in each home. The homes Meridan House and Foxlands House will function seperately with their own registration and independent staff group to provide personal care only. There is one female service user at Meridan House over the age of 65 (D.O.B 30/11/1937). The CSCI must be informed when this service user no longer receives care at the home. Date of last inspection Brief description of the care home Meridan is a care home registered to provide personal care for a maximum of twelve younger adults with mental disorders. The home was previously set up to accommodate patients discharged from Napsbury Hospital in Hertfordshire. However, Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 12 1 9 0 3 2 0 0 9 Brief description of the care home due to recent re-organisation it now accommodates residents with a range of mental health problems. The home is operated by a charity called The Richmond Fellowship which also operates several other care homes for people with mental health problems in London. The stated aim of the home is to provide a home where residents can be cared for with dignity and where they can lead as independent a life as possible. The home is a modern, detached two storey house which was opened in 1998. It has twelve single bedrooms. All bedrooms have ensuite facilities. The staff office, kitchen, diner and two large lounges are on the ground floor. The bedrooms and two smaller lounges are on the first floor. There are two communal bathrooms on the ground floor and one communal toilet on each floor. There is a small front garden and an attractive larger back garden which is partly paved and accessible to service users. The home is within walking distance of Colindale Hospital and about a mile away from Edgware Hospital. It is also close to shops, restaurants and public transport facilities along the Edgware Road. The fees charged by the home are based on a block contract with the local health authority. The provider must make information about the service available, including reports to service users and other stakeholders. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 STAR. This means the people who use this service experience GOOD quality outcomes. This inspection was carried out by Daniel Lim (Regulatory Inspector) on 18 December 2009 and took a total of six hours to complete. We were assisted by the deputy service manager, Anita Daly. We were informed by the deputy manager that the home had just re-opened after being closed for renovations and there were four new residents living in the home. Two residents who were in the home during this inspection were interviewed. Two CQC completed surveys were received from residents. Statutory records were examined. These included three residents case records, the maintenance records, accident and incident records, financial records, complaints records and fire records of the home. Care Homes for Adults (18-65 years) Page 6 of 33 The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Four care staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents and staff meetings were examined. The completed Annual Quality Assurance Assessment form or AQAA was received by us. Information provided in the assessment was used for this inspection. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide must be amended to reflect the recent management changes as the home now has a new manager and a new client group with different needs. This is to ensure that prospective residents and their representatives are fully informed. The care and plans of care of the resident identified to the manager and in the section on Health and Personal Care must be reviewed to ensure that it contains a specific risk assessment together with a written strategy for addressing the risk of illicit drug use. This is to ensure that this resident is well cared for. The night staffing arrangements must be reviewed to ensure that where possible, a mix of male and female staff are on duty during the night. Where this is not possible, a risk assessment must be carried. This is to ensure that residents are well cared for and residents and staff are not put at risk. Care Homes for Adults (18-65 years) Page 8 of 33 The fire risk assessment must be updated to reflect recent changes in the home. Fire safety training provided for staff must be carried out by a suitably qualified person. This is to ensure that staff are fully trained in fire safety and to ensure the safety of all those in the home. A system for summoning assistance promptly in the event of an emergency must be provided for staff. This is to ensure the safety of residents and staff. The CQC should be informed of changes affecting the use of the home. Approval should be sought from us, risk assessments carried out and residents informed. This is to ensure the welfare of residents and that the organisation of the home complies with legislation and the National Minimum Standards. The home must have a written procedure for ensuring that where possible, all relatives and representatives of residents are fully consulted and informed well ahead of time of any transfer of residents to alternative accommodation. This is ensure the welfare of residents and to ensure that their relatives and representatives are well informed. 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 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken by the manager. Admissions only take place if the service is confident that the needs of people to be admitted can be met. This ensures that the admissions to the home are appropriate. Evidence: The AQAA states: We provide service users with information such as the complaints policy, equal opportunity and diversity, harrassment policy and a support plan which details information about the home. The Statement of Purpose is discussed and explained to service users and copies provided. The service also has a brochure which also explains about the service. We examined a sample of three pre-admission assessments. These were noted to be appropriate and comprehensive. The assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: prepared for residents admitted to the home. The deputy manager informed us that the Statement of Purpose and brochure had not been amended. The Statement of Purpose and Service User Guide must be amended to reflect the recent management changes as the home now has a new manager and there is a new client group with different needs. This is to ensure that prospective residents and their representatives are fully informed This must be done to ensure that they are up to date. Comments made by residents included the following: They let us use all the service well. Always comfortable. We have been treated with respect. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognizes the right of individuals to take control of their lives there is evidence that residents are involved in decision making about the home. Residents are consulted on how the service runs and activities they wish to participate. Each individual has a care plan, and residents are involved in the development of their care plans. The care plans include appropriate risk assessments. Evidence: The AQAA states : We have consulted and listened to the residents. Service users individual case notes and Individual Support Plans have their views stated and signed. Risk assessments contained residents comments and signatures. Residents who were interviewed indicated that staff had listened to them and were responsive towards their preferences. They stated that there were meetings in which they can voice their opinions. The minutes of such meetings were available for Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: inspection. We note that residents could go out of the home and two residents had gone out with a staff member on the morning of the inspection. Two other residents chose to remain in their bedrooms. The three residents case records which were examined contained comprehensive and appropriate care plans and assessments. Important details and the preferences of residents had been documented. There was documented evidence that residents had been encouraged to be as independent as possible and take responsibility for certain tasks within the home. Risks assessments had been prepared for residents. They were generally comprehensive and up to date. Staff were aware of action to be taken to minimise risk and protect reisdents. There was documented evidence that the care of residents had been reviewed. The minutes of these reviews, including reviews done by health and social services professionals were kept in the case records and available for inspection. We were also informed that there is support for residents from professionals from Richmond Fellowship and from the local Commmunity Mental Health Team who visit th home regularly. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had sought the views of residents and considered their varied interests when planning their daily routines. Links to specialist support are facilitated when needed. Residents have opportunity to develop skills and are encouraged to be as independent as possible. The arrangements for the provision of meals take into account the preferences of residents and their dietary needs. Evidence: The AQAA states : We have activities for residents which are held in a day centre at the service. The activities at the service addresses every individuals need. Service users with high needs also attend a specific day service at the Richmond Fellowship Employment and Training Centre. The activities at the service include arts and crafts, cooking, going to the cinema, sports as well as community activities every Thursday. Service users have Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: been consulted about all activities at the service. Service users are consulted about holiday venues and provided with 5 to 7 days paid holidays every year. The case records of residents contained social care plans detailing social and educational activities that residents have been involved in. We note that the home had a weekly programme of varied activities programme for residents and this was displayed outside the office. Activities that residents had been involved in included cooking, shopping and going to the day centre and library. We were informed by the deputy manager that residents had been involved in household chores such as cleaning their bedrooms, doing the laundry and washing. We were also informed that the activities room had now been relocated to a room in another building at the front of the home. Meetings had been organised and residents had been consulted regarding the management of the home and activities organised. The minutes of these meetings were available for inspection. The kitchen was inspected and found to be clean. Daily recorded temperatures of the fridge and freezer had been kept. These were satisfactory. A fire blanket was in place. The menus examined appeared varied and balanced. Residents interviewed stated that they were satisfied with the meals provided. Care Homes for Adults (18-65 years) Page 16 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to healthcare services in the local community. There is evidence in the case records that healthcare needs are monitored and appropriate intervention taken. The arrangements for the administration of medication was on the whole, satisfactory. This ensures that residents are well cared for. Evidence: The AQAA states: All service users go for regular physical check up at the GP surgery. They also attend the dentist, chiropodist and optician appoinments. Community Nurse and Occupational Therapists are accessed when needed. Medication is obtained, recorded, administered in line with the medication policy of the Richmond Fellowship. We have the appropriate medication storage where medication is kept at the right temperature and this is recorded and monitored daily. Service users are assessed for self-medication and some are supported to take medication. Medication is audited by a designated staff at the service. All medication is reviewed periodically by the doctors and when staff have concerns such as side effects, they inform the medical team or consultant. We work as partners with the local pharmacies who periodically come to the project for audit. It is Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: mandatory that all care staff attend medication training. We noted that residents we met were cleanly dressed and they informed us that they were satisfied with the care provided and staff had treated them with respect. This was also confirmed in the two completed residents surveys received. With one exception, all residents feel supported by staff. One resident suggested that there be more support and interaction with the key worker concerned. The deputy manager informed us that support is provided by psychiatrists and other members of the local Community Mental health Team who visit the home regularly to monitor the progress of residents. We examined a sample of three residents case records. These were structured and each contained appropriate care plans and assessments. Plans of care had been signed by residents or their representatives. We examined the care and plans of a resident who had a history of recent challenging behaviour. The care plans contained a risk management plan for this resident. There was evidence that staff had been provided with training in the management of challenging behaviour. There was however, no specific risk assessments for a resident with a history of illicit drug use. This was discussed with the deputy manager and manager. A specific risk assessment containing guidance to staff on how this issue is to be managed must be provided and it should provide guidance on how often the bedroom is to be checked for illicit drugs. The manager explained that the resident concerned had been subject to drug screening and that the results have so far been negative. In addition, she stated that the home has a policy regarding illicit drug use and random room searches are mentioned in the policy. She nevertheless agreed that the issue of searching the bedroom would be reviewed. We examined the arrangements for the administration of medication. Medication received had been recorded. Medication was stored in a locked cabinet which is secured to the wall. The temperature of the medication room and the fridge had been recorded daily and were satisfactory. Only one gap was noted for medication to be administered only if required. This was brought to the attention of the deputy manager who agreed to ensure that this was completed. There is a monthly audit of medication which is good practice. There is a record of medication sent back to pharmacy and this is appropriately signed. Following a requirement made in the last inspection report, there was guidance for staff on medication prescribed for residents. Details of allergies that residents have were recorded on three MAR charts. On one of the four MAR chart, allergies were not recorded. This is necessary to ensure the safety Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: of the resident concerned. At the time this report was written, we were informed by the manager that all MAR charts now contained details of any allergies that residents may have. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for responding to complaints and for adult protection were on the whole, satisfactory. The home has an open culture that allows residents to express their views and concerns in a safe environment. This ensures that residents are well treated and protected from abuse. Evidence: The AQAA states: We respond promptly to complaints. We treat service users with respect and dignity. We ensure that they are protected from abuse and exploitation. We have a detailed handover and share information with residents. We have key working sessions where residents are able to ventilate their feelings or concerns. We promote openness in the service. The complaints record was examined by us. Complaints were recorded and kept in a folder. We note that complaints made had been promptly responded to. The home has a comprehensive adult protection policy and procedure. The protection of vulnerable adults was discussed with staff. They were aware of the procedure to follow when responding to allegations of abuse. There was documented evidence that staff had been provided with adult protection training. The local authority guidelines were available in the office. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: Since the last inspection, we were notified of an allegation of abuse made against a staff member. The home had co operated with the local community mental health team and appropriate action had been taken to ensure that residents are safeguarded. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is aimed at the specific needs of the people who live there. People who use the service can personalise their bedrooms. However, improvements are needed to ensure that premises are pleasant and safe for residents. Evidence: The two residents we spoke to said they were satisfied with the accommodation provided. During our inspection of the premises, we note that bedrooms had been personalised by residents with their own pictures and ornaments. The bedrooms were well furnished. The gardens were well maintained and seating had been provided. The premises were clean and no offensive odours were detected in the home. The two completed CQC surveys received indicated that the home was always fresh and clean. The required safety inspections for the gas and portable appliances had been carried out. Residents were noted to be independently mobile and did not require any specialist equipment. The laundry room was cluttered with various items of furniture. The deputy manager explained that this was because of a Christmas party held the previous night in the home. She reassured us that they would be moved out soon. Renovation and redecoration of the second half of the home was in the process of being completed. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: We found that this part of the home had various items of furniture, boxes and tins of paint along the corridors. This was unsightly and posed a health and safety risk. This was brought to the attention of the manager and the area manager. They reassured us that there are no plans to accommodate any residents in this part of the home until work has been completed and the area cleared. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a good recruitment procedure that is followed in practice. Management recognizes the importance of training and tries to deliver a programme that meets statutory requirements. There are however, concerns regarding the night staffing arrangements. These may place residents and staff at risk. Evidence: The AQAA states: We have competent, skilled and well trained staff. We carry out a robust induction of new staff in line with the skills for care pathways. Staff are aware of their roles and responsibilities. Staff receive supervision and have opportunities to develop more skills to support residents. The recruitment process is very thorough and fair. All staff have satisfactory Enchanced Criminal Records Bureau and Police record Checks before starting work. All staff receive mandatory training and essential training. These are to ensure that staff are trained to support the residents in recovery. We have staff who either have NVQ L3 qualifications and above or who are currently participating in the NVQ training. We have adequate staffing levels and have contingency plans in place to cover shifts when service users needs are high or during emergencies. Four staff who were on duty were interviewed on a range of topics associated with Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: their work. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence in staff records to indicate that staff had been provided with essential training relevant to their area of work. Staff stated that there was generally a good team spirit and they worked well together. The records of three new staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any issues related to the care of residents and their training. We examined the duty rota. It indicated that in addition to the manager and deputy manager, there was normally a minimum of two care staff on duty during the day shifts and two care staff on duty during the night shifts. In addition, the home has a contract cleaner. We note that on some night duty shifts, only male staff were on duty. This is not an ideal arrangement as we are aware from the case records examined, that one resident has a history of inappropriate sexual behaviour. In addition, a previous female resident had accused a male staff of sexual assault. In view of this, the night staffing arrangements must be reviewed to ensure that where possible, a mix of male and female staff are on duty during the night. Where this is not possible, a risk assessment must be carried out to ensure that residents and staff are not put at risk. Following the inspection, the area manager reassured us that when preparing the rota they always endeavour to have a gender mix for all shifts. This was not always possible as they have an equal proportion of both male and female support staff and is difficult to achieve when covering a shift rota and when staff are away on days off, training or holidays. He added that they will bear this in mind when recruiting new staff. The issue of equalities and diversity was discussed with staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. They were aware that they must not discriminate against residents and they indicated that this was stressed to them during their induction. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is planned to be user focused and take account of equality and diversity issues. It aims to work in partnership with residents and their representatives. The manager is aware of areas that are deficient and is working to improve the care and management of the home. Evidence: The AQAA states: The manager consults staff and service users about the running of the home. The service manager has regular supervision with staff to ensure that any concerns staff have about the service is dealt with following appropriate procedures. The service manager has monthly team meetings with staff as well as attending other management meetings and the information and knowledge acquired is shared with the staff team. She is establishing a good, trusting and open relationship with the service users and she is able to listen, consult and share information with the team. The Individual Support Plan and Risk Assessments are regularly monitored and reviewed when necessary. The health and safety of service users is paramount and team Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: meetings are used to train staff in health and safety as well as checking and documenting fire doors, fire drills and fire emergency alarm systems and all other equipments at the service. The manager was not present during the inspection. We however were able to interview her by phone following this inspection to obtain clarification on some issues. She stated that the home has just reopened after being closed for refurbishment and all residents in the home are new. The manager stated that she has the RMA or Registered Managers Award. She also informed us that she is in the process of applying for registration with us. There was evidence that Regulation 26 reports had been prepared following visits by the area manager and consultation meetings with residents and staff had been organised. The minutes of these meetings were available for inspection. A current certificate of insurance was available for inspection. No financial records of residents were examined. We were informed by the administrator that no residents money was being kept by the home. The required health & safety inspections on the portable appliances, gas and electrical installations had been carried out. The fire logbook was examined. The weekly fire alarm tests, emergency lighting checks and fire drills had been carried out and documented. No recent fire risk assessment was available for inspection. The manager informed us during our telephone conversation that the fire risk assessment of the home had not been updated following the refurbishment of the home. We noted that the necessary fire drills had been carried out. We discussed fire training with the manager. We were informed that some fire training had been carried out by the manager and a member of staff during the induction of new staff. When asked for clarification, she stated that neither of them had appropriate qualifications in fire safety. To ensure that staff receive adequate training, such training must be provided by a suitably qualified person. We further discussed security within the home as one staff interviewed stated that having a buzzer would be useful in an emergency. We also noted that the administrator was on her own for part of the time in an office on the first floor. We were informed that staff had not been provided with emergency buzzers that can be used to summon assistance. This was brought to the attention of the manager. To ensure the safety of residents and staff a system for summoning assistance promptly Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: in the event of an emergency must be provided for staff. We were informed by a staff member that proper consultations were not carried out when the previous residents were relocated to other homes. This was discussed with the area manager. He reassured us that consultations had been carried out. However, he stated that an independent advocacy service was not used to represent residents. He explained that effort that been made but they were not able to find suitable advocates. He further reassured us that relatives had also been consulted as part of the process. We however, noted that there was documented evidence that a relative who was the next of kin of a resident expressed concern that he was not informed of the transfer. We also noted from the incident report we were provided stated that the manager only attempted to inform him of the transfer one day prior to event and that an apology was later given by the manager. All representatives and relatives ought to have been informed well ahead of time of any transfer of residents to another home. This is ensure the welfare of residents and to ensure that their representatives and relatives are well informed. No minutes of consultation meetings with either residents or their representatives were provided. The area manager explained that individual consultation would have been recorded in the minutes of residents CPA meetings or key working notes and meetings with their care co-ordinators who took the lead in looking for places for the residents involved. He further added that residents relatives were contacted via a letter and they addressed individual issues with the relatives as they arose. In view of the concern and dissatisfaction expressed by a staff member and a relative, the home must have a written procedure for ensuring that where possible, all relatives and representatives of residents are fully consulted and informed well ahead of time of any transfer of residents to alternative accommodation. This is ensure the welfare of residents and to ensure that their relatives and representatives are well informed. We note that a room in the home had been used to accommodate admin staff from the sheltered housing unit of the organisation. Approval was not sought from us regarding this change of use. The CQC should be informed of changes affecting the use of the home. Approval should be sought from us, risk assessments carried out and reisdents informed. This is to ensure the welfare of residents and that the organisation of the home complies with legislation and the National Minimum Standards. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 39 24 The home must have an 12/06/2009 effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The Statement of Purpose 15/03/2010 and Service User Guide must be amended to reflect the recent management and admission criteria changes in the home. This is to ensure that prospective residents and their representatives are fully informed. 2 19 13 The care and plans of care of the resident identified to the manager and in the section on Health and Personal Care must be reviewed to ensure that it contains a specific risk assessment together with a written strategy for addressing the risk of illicit drug use. 15/03/2010 Care Homes for Adults (18-65 years) Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that this resident is well cared for. 3 33 18 The night staffing 15/03/2010 arrangements must be reviewed to ensure that where possible, a mix of male and female staff are on duty during the night. Where this is not possible, a risk assessment must be carried. This is to ensure that residents are well cared for and residents and staff are not put at risk. 4 37 12 The home must have a written procedure for ensuring that where possible, all relatives and representatives of residents are fully consulted and informed well ahead of time of any transfer of residents to alternative accommodation. This is ensure the welfare of residents and to ensure that their relatives and representatives are well informed. 15/03/2010 Care Homes for Adults (18-65 years) Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 42 13 A system for summoning 15/03/2010 assistance promptly in the event of an emergency must be provided for staff. This is to ensure the safety of residents and staff. 6 42 23 The fire risk assessment 08/03/2010 must be updated to reflect recent changes in the home. This is to ensure that staff are fully informed and to ensure the health and safety of all those in 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 37 The CQC should be informed of changes affecting the use of the home. Approval should be sought from us, risk assessments carried out and residents informed. This is to ensure the welfare of residents and that the organisation of the home complies with legislation and the National Minimum Standards. Care Homes for Adults (18-65 years) Page 32 of 33 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). 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