Care Home: Millstream

What the care home does well Staff working in the home were observed to be kind and caring and communicated well with people living in the home. The returned surveys from people living in the home all indicated that the people felt that staff were kind and caring. Comments included `They show me compassion and care`. We ask if people feel that care staff and managers treat them well and all the surveys said `yes`. The home provides healthy and nutritious meals which meets individual choices and preferences. Religious needs are well met and the home takes into account individual diversity. Friends and families are welcome at the home and encouraged to visit. What has improved since the last inspection? At the time of our visit the registered provider had acted upon recommendations from the Occupational Therapist and had purchased new equipment. This will further support the safety of the people living in the home. The home is currently improving how they support people with their individual healthcare needs and are actively working with multi disciplinary teams to address any shortfalls. Care plans and risk assessments have improved and are now contain more detail and guidance for staff. A quality assurance assessment has been carried out by the registered provider and identified areas of improvement. There is now a commitment from the larger organisation to address these areas. What the care home could do better: The home has recognised that there a number of improvements which need to be addressed. At the time of our visit they were working towards achieving these and many of the areas we identified were outlined on the homes own improvement agenda. The pre-assessment process does not serve to adequately safeguard the people moving into the home. Although the care plan and risk assessment records have improved the service retains a large of amount of records, some of which are maintained in an archived file. We saw that current records were not always available in the relevant file and this makes it difficult to ensure that staff have access to up to date information. There are areas of the home which will benefit from refurbishment and decoration. It is acknowledged that the registered provider has recognised this and there are immediate plans to address the improvements. The registered provider must ensure that staff receive the training they require to give them the skills and qualifications to meet the needs of the people living in the home including areas of specialist care and support. Staff do not always have the opportunity to spend meaningful time with people or support them to go on outings. Returned surveys from people living in the home identified that they would like to go out more. Service user records also showed that staff did not have time to spend with people as described in their care plans. Key inspection report Care homes for adults (18-65 years) Name: Address: Millstream Mill Road Frindsbury Kent ME2 3BT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Butts     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: Millstream Mill Road Frindsbury Kent ME2 3BT 01634299970 01634299971 millstream@evesleighcaregroup.co.uk springmeadow@ilg.co.uk Evesleigh (Kent) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD). Date of last inspection Brief description of the care home Millstream is situated on the outskirts of Strood. Local services are approximately 1.5 miles away downhill. It is in keeping with the local area. The home caters specifically for adults with a diagnosis of Huntingtons Disease, and service users who have a diagnosis of an Acquired Brain Injury and whose individual needs they can meet. The home can accommodate and provide a service to twenty service users. The home is set over three floors. All bedrooms are en-suite and there is a range of shared spaces. There is a designated smoking lounge. There is a large rear garden which has terraced, Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 Brief description of the care home paved and lawned areas and has good access for service users. There is some parking space to the front of the building. The home provides a range of information of prospective and current service users including a Statement of Purpose and Service Users Guide and CSCI reports are made available in the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection carried out by two inspectors over the course of one day. We spent time spent looking around the environment, talking to staff and some of the people living in the home. We looked at a selection of records including those in place for the care and support of people living in the home such as care plans, risk assessments and medication for example. We also looked at staff records including recruitment, training and staff rotas. All services are required to provide an Annual Quality Assurance Assessment (AQAA). This gives us information about how the service considers they are performing and where they feel they can make improvements. It also provides statistical information about the service. Information from the AQAA had been used in this report where appropriate. Care Homes for Adults (18-65 years) Page 6 of 31 Prior to our visit we had also asked people living in the home and staff to complete surveys. We wanted them to tell us what they think of the service provided. We received twelve surveys back, three from members of staff and nine from the people living in the home. The registered person has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the commission, but will be referred to as the manager for the purpose of this report. The manager was present during the inspection and was supported by the area manager. Feedback was given to the area manager at the end of the visit. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home has recognised that there a number of improvements which need to be addressed. At the time of our visit they were working towards achieving these and many of the areas we identified were outlined on the homes own improvement agenda. The pre-assessment process does not serve to adequately safeguard the people moving into the home. Although the care plan and risk assessment records have improved the service retains a large of amount of records, some of which are maintained in an archived file. We saw that current records were not always available in the relevant file and this makes it difficult to ensure that staff have access to up to date information. There are areas of the home which will benefit from refurbishment and decoration. It is acknowledged that the registered provider has recognised this and there are immediate plans to address the improvements. The registered provider must ensure that staff receive the training they require to give them the skills and qualifications to meet the needs of the people living in the home Care Homes for Adults (18-65 years) Page 8 of 31 including areas of specialist care and support. Staff do not always have the opportunity to spend meaningful time with people or support them to go on outings. Returned surveys from people living in the home identified that they would like to go out more. Service user records also showed that staff did not have time to spend with people as described in their care plans. 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home do not always benefit from a full assessment of need which results in the home not being confident that they can fully meet individual needs. Evidence: At our last visit we found that records for when new people moved into the home were not robust. There is an assessment process which has the potential to fully assess the person and ensure that the home can be confident that they will be able to meet the individual needs of a prospective service user. We looked at the assessment for a new person who had moved into the home. We found that at the point of moving in the home had failed in its obligations to undertake a full assessment of need. There was a lack of written records and the senior member of staff team who had undertaken the assessment was unclear about the process. Since moving into the home it had been recognised that the person had complex needs, some of which have resulted in having an impact on other service users in the home. In order to ensure that the home can be fully confident that they will be able to Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: meet individual needs a full assessment must be undertaken and where necessary obtain additional assessments and advice from appropriate professionals. In order to meet the needs of the people in the home it is the registered providers responsibility to ensure that staff are trained and competent in the needs of the people living in the home. Millstream only provides care and support to people with a diagnosis of Huntingtons disease or people who have an acquired brain injury. Staff were able to demonstrate a good basic awareness of individual needs but have lacked support in appropriate training in specialist areas which will fully meet the complex and individual needs of the people living in the home. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff support people with their daily needs. Improved support with regards to individual capacity will further benefit the people living in the home. Evidence: As part of our visit we looked at the care plans and risk assessments which were in place for the people living in the home. We looked at four and saw that these had improved since our last visit. They now they gave a clearer guidance of the support which people needed within the home. Some areas of the care plans, however, still lacked clarity for individual people and will benefit from ongoing development. We spoke to staff about the support they provided and most staff were aware of what was in the care plans, although they stated they did not read them on a regular basis. One member of staff told us that they had not read the care plans. Staff told us that they were given up to date information about individual people at the handover between shifts. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Each person has a key worker and there are arrangements in place to have regular meetings with their key worker which gives people the opportunity to have a say about the care and support they receive and also identify any aspirations they may have. We saw evidence of some action being taken as a result of the key worker meetings, but where a meeting was not always able to take place, there were no evidence that these had been rearranged. Risks are assessed and there is guidance in place to minimise identified risks. Although is some instances a risk was identified, for example managing an individual should they display any challenging behaviour but the guidance on how to fully manage this was not clear. Staff, however, were clear about how they supported an individual person. The home retains a large amount of records for the individual person and each person has two files, one of which should contain older information. We saw that current information had been placed in this folder and this means that staff did not always current and up to date information available to them. People have not been fully assessed with regards to their mental capacity needs or any issues recorded around deprivation of liberty. There was little evidence to show that staff responsible for this were confident in carrying out an assessment. The manager is aware of these issues and is looking at ensuring these are addressed. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in a flexible manner by a kind and caring staff group. The home provides a varied and nutritious menu. Service users are not always fully protected as staff are not consistently following guidelines with regards to fluid supplements. Evidence: We spoke to staff and viewed records as to how people are supported with their activities. Routines are flexible and people are generally supported in making choices about how they spend their day. There is an activities coordinator who arranges different pastimes and events for people to participate in. There are in house activities such as music sessions, arts and crafts and aromatherapy. The Annual Quality Assurance Assessment (AQAA) states Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: that they could improve on the activities offered. Conversations with staff and records we viewed did not support that people were always able to participate in their preferred activities. For example the care plan for one person stated that they liked to go the cinema and gardening, but the records for this person showed that they had not taken part in these. Staff told us that the person had not gone out for a while. Care plans also identified that staff should spend time with each person during the day, but records did not show this was happening and in some cases staff had recorded that they did not have time to spend with people. Staff told us that people to have the opportunity to go on outings and recently there had been a trip to a large designer shopping centre. This was dependent upon staffing levels and a member of staff told us that one service user had only been able to go because the key worker volunteered to assist on the outing. It is the registered providers responsibility to ensure that there are sufficient staff available to support people with their chosen activities. The involvement of friends and family is encouraged and people are able to visit. People are supported with any religious needs and where there are any language barriers the home has arranged for a person to come in and visit so that they can fully communicate with the individual. People with Huntingtons disease need a high calorie diet and there is a varied menu available. Meals are prepared so that they cater for individual needs including ensuring that people receive the right consistency of food. Any religious needs are catered for with regards to meals. People also require food supplements and thickeners in drinks and there is guidance in the dining area for these. However when we spoke to staff not all members of staff were clear about following the guidance. For example one person told us that they would add three or four teaspoons of thickener to a drink for a particular person, but another member of staff told us that the person only needed two spoonfuls. It is the registered providers responsibility to ensure that staff follow the guidelines for the individual service user. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support provided to people with regards to their individual healthcare needs is improving. The monitoring of support with regards to food and fluids needs to be more robust. Evidence: The Annual Quality Assurance Assessment (AQAA) told us that peoples needs and wishes are respected at all times. We looked at four care plans and they all identified individual choices. Staff recognition of individual preferences varied. For example we asked two members of staff the preferences for one particular service user in relation to how they were assisted with their personal care. One member of staff was clear about the individual preferences and how the person chose how they were assisted with shaving for example. The other member of staff was less clear and was not able to demonstrate that they would always offer choice. Discussions with other members of staff evidenced that they would respect individual choices and preferences. We looked at the healthcare needs for the people living in the home. We saw that these were not always being fully met in a timely manner. People are supported to Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: have access to G.P.s, opticians and dentists for example. However where it was identified that appointments had not always been obtained for people in a timely manner. There were occasions where reviews or appointments had cancelled or postponed and the home had not challenged these and made arrangements for these to be carried out sooner. The manager had been aware of this and was able to show evidence that she was now following these up It is recognised that the home has had difficulty accessing appropriate healthcare support for people with Huntingtons and that there is a lack of specialised knowledge and support in the area. The home is now working actively with the local authority and appropriate healthcare professionals to address this. Where they are unable to access appropriate services it is the responsibility of the registered provider to ensure that individual needs are met and they either obtain funds from the commissioner of the individual service user or access private services to support any current healthcare input. The home continues to work closely with the Speech and Language Therapy Team and the palliative care team. The monitoring of weights and food and fluid intake was not robust with gaps in the records and unclear information. The registered provider needs to ensure that staff complete appropriate records in order to monitor the well being of the people living in the home. We looked at medication and how people are supported in this area. The care plans we looked at contained risk assessments for peoples medications. We viewed the medication administration record (MAR) sheets and saw that at the time of our visit these had been completed appropriately. There are systems in place to audit medication in and out of the home. Controlled drugs are stored separately. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place and people told us they were able to voice their concerns. The home is working with multi disciplinary teams to improve the health, safety and well being of people living in the home. Evidence: There is a complaints procedure in place and this is on display. We spoke to three people living in the home and they said that if they had any concerns they would speak to staff. Returned surveys all indicated that people were happy to voice any concerns. A safeguarding investigation has been conducted by a multi-disciplinary team following concerns about the movement and handling practices within the home. The registered provider has responded positively to the recommendations made and is in the process of ensuring that staff receive the additional training they require. The safeguarding also identified the shortfalls in the healthcare support and as previously stated the manager is now actively addressing this. Not all staff had completed trained in safeguarding vulnerable adults, but there is a training program in place which is addressing this. Staff we spoke to were clear about action they would take and who they would report any concerns to. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: At our last visit we found that peoples individual money was well managed with a clear audit trail. We did not look at any records at this visit but the administrator confirmed that the system remained the same and that it was regularly audited. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from having access to their own en suite rooms with sufficient additional toilets and specialised bathrooms. The communal areas of the home are in need of redecoration and refurbishment and although this does not pose a risk to the people living in the home it does not create a pleasant and pleasing environment to live in. Evidence: The home is situated in the Strood area of the Medway Towns and can accommodate up to twenty people. The layout of the home is that it is spread over three floors with bedroom accommodation situated in different parts of the home. There are three lounge areas which are used by the people living in the home and one of these is a designated as smoking lounge. There is a separate dining area. There is also an area of the home which has been dedicated as an activities lounge. We had a look around the building. The lounge areas and the activities room were all sparse and lacked a homely atmosphere. There was a lack of furniture and in one lounge area there were only two or three chairs and a television. The walls were in need of redecoration as many areas were chipped and marked. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: All bedrooms are en suite and there are no shared rooms. Bedrooms have been individualised with people having their own possessions. Personal space demonstrated that peoples rooms were their own and were comfortable. The patio area to the rear of the property had been neglected in that there were weeds covering the paved areas and there was litter lying around. Tubs of plants were seen to be either dead of dying. The majority of the garden is not accessible to the people living in the home. There was a raised flower bed area which had been attended to and contained a variety of flowers and plants. There are sufficient number of toilets and bathrooms situated around the home. As the home provides accommodation to people with physical disabilities they have specialist equipment in place. This includes lifts to all floors, aids and adaptations are provided such as lifting hoists, grab rails and toilet riser seats. There are Parker baths in the bathrooms. The Annual Quality Assurance Assessment (AQAA) asks what the home could do better. This states that they could provide more specialist equipment. The home has received input from the Occupational Therapy team and are currently acting on their recommendations which includes purchasing additional equipment including ceiling track hoists. We are not making a requirement about the equipment in the home as we are confident that this has been addressed. A staff call system is available in individual bedrooms and communal areas. These were seen to be maintained appropriately with regular checks carried out. There is a designated laundry area with separate washing, drying and ironing areas and this is suitably equipped with systems in place to reduce the risks of cross infection including industrial strength machines. There are sluicing facilities on each floor. The registered provider has made a commitment to the redecoration and refurbishment of the home and we were informed work was starting in the next few weeks following our visit and this included an extension to the dining area. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are cared for by staff who are kind and caring. Improved training in the specialist needs of the people who live in the home will enhance the care and support they receive. Staff levels meet individual daily needs but the ongoing review of the deployment of staff will further improve how people are supported. Evidence: It is the registered providers responsibility to ensure that there are the appropriate numbers of staff on duty at all times to ensure that people are supported in a manner that meets their needs. We looked at staff rotas and spoke to staff about the staffing levels in the home; we also looked at service user records. Since our last visit the number of night staff on duty has increased and staff told us that this was an improvement. There are nine staff on duty in the mornings and eight staff allocated on duty for the afternoon. However the layout of the premises and the needs of the individual people living in the home has a high impact on the deployment of staff. There are people living in the home who are in need of one to one support and there are communal areas which have allocated staff rostered on duty. Service user records and conversations with staff showed that there were staff available to Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: support people with their personal care needs, but there was limited time available for staff to support people with additional needs particularly with regards to activities and outings. Examples of this have been reflected in this report. We looked at the recruitment file for three members of staff. These records showed that each person had been employed in accordance with Care Homes Regulations (2001) and that their files contained the appropriate documentation including evidence of references and a current Criminal Records Bureau (CRB) check. The registered provider (ILG) provides the training for staff. There are mandatory training courses in place to ensure that staff are given the right knowledge, qualifications and skills to support the people living in the home. The registered provider has recognised that the mandatory training program for staff requires updates and that staff are not always transferring skills they have learned into the working environment. The manager was able to provide us with a training program which identifies allocated staff to attend courses. We saw that staff had not received appropriate training in the specialist needs of the people living in the home. The people living in the home have complex needs and the registered provider needs to ensure that staff are qualified and competent to meet these needs and ensure that the appropriate training is available for staff. There is a staff induction program in place, records we viewed for the new members of staff did not show that everyone had completed this. There are plans by the registered provider to ensure that this addressed. We spoke to members of staff about their knowledge of how to support the individual people living in the home. This varied amongst the different members of staff we spoke to. Some staff were knowledgeable about individual needs and told us how they assisted a specific person. Other staff were unable to give a clear indication on how they would help people and in one instant described a movement and handling technique which is not recognised as good practice. Some staff told us that they had read the care plans and other staff said that they had not. None of the staff, however, had looked at care plans on a regular basis and said that they were informed of any changes at staff handovers. It was evident throughout our visit that staff are kind and caring and are committed to supporting the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is working towards developing the service in the best interests of the people living in the home. Improved commitment from the registered provider will support this. Evidence: There is an operations in manager in place who oversees the running of the home. She is supported by a head of care and a deputy manager. The operations manager was clear about her role and the direction in which she wanted the home to go. The supporting management team, however, were less clear about their roles. When we spoke to them about their duties and where these overlap there was a lack of accountability as to who would ensure that the appropriate action was taken to support people. For example an appointment had been needed to be made for a service user and neither of the supporting management team had done this and had thought the other person had done this. The home is part of the Independent Living Group (ILG), who is the registered provider. They provide the quality assurance visits to monitor the service. We saw that Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: prior to our visit they had carried out a full compliance visit and recognised that there were many areas of improvement needed. The home is currently working with statutory bodies to address these. There is a lack of specialised knowledge with regards to the needs of the people in the home within the larger organisation. The area manager told us that this had been recognised and that they were looking to improve this to ensure that there was the specialised knowledge available in the organisation to support the service. There are systems in place for monitoring and recording incidents and falls, although the information within these was not always robust and did not fully identify what action had been taken or ways to prevent reoccurrence. The Annual Quality Assurance Assessment (AQAA) tells us that all necessary safety checks have been completed with regards to the servicing and maintenance of the equipment in the home. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered provider shall 30/07/2010 not provide accommodation to a person at the care home unless the needs of the person have been assessed by a suitably qualified or suitably trained person. This is so potential service users can be confident that they have received a full assessment and that the home will be able to meet all their needs. 2 19 12 The registered provider shall 31/07/2010 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. In that: Staff follow the correct guidelines and care plans in relation to fluid intake. Staff maintain robust records the intake of food and fluid. Page 28 of 31 Care Homes for Adults (18-65 years) 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 so that people receive their care in line with their individual assessed needs and this can be monitored and any changing needs acted upon. 3 35 18 The registered person shall ensure that persons employed at the care home receive training to the work they are to perform. There must be a rolling training program in place that ensures staff are fully trained and are deemed competent in meeting the needs of the service users. This is so that people can be confident that staff are able to meet individual and complex needs. 4 41 17 The registered provider shall 31/07/2010 maintain accurate records in respect of each service user. In that current information is available to staff. This is so that people can be confident that staff are aware of their needs. 31/08/2010 Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 33 it is recommended that the registered provider ensures that staff levels and deployment within the home are kept under review so that any changing needs can be met. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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