Care Home: Mount Vernon Terrace Care Home

What the care home does well People who want to live at the service have their needs assessed before admission and can be assured that these can be met at the service. People who live at the service have their needs and choices recorded and risk assessed and they are involved in decisions about their life and their care. People lead a flexible lifestyle in accordance with their needs. Personal choice is supported. People`s health and personal care needs are appropriately met at the service. People are confident to raise issues of concern and these are always responded to. People live in a homely, safe and clean environment which meets their needs. Staff are recruited safely and to make sure they are suitable to work with vulnerable people. What has improved since the last inspection? The manager has been on safeguarding training to improve his understanding of procedures to follow in the event of abuse or allegations. Key staff have also done medication training to make sure they understand how to do this safely. The owners have done a lot of improvements to the environment to make it a more pleasant place to live. They have replaced 4 single radiators with doubles to improve the heating. They have; replaced 4 doors and 2 windows, redecorated people`s bedrooms and hallways on request. Fitted a new extractor fan in the smokers room, provided a new TV Ariel, replaced furniture. They have provided new dining furniture, and provided a new outside sign. What the care home could do better: Staff could be provided with information or training so that they understand the Mental Capacity Act and Deprivation of Liberty Safeguards and understand when they should be considering, assessing, recording and referring people on for assessment. To ensure they enable people to make their own decisions where possible and that their best interests are covered. They could review the arrangements within the service for providing people with the opportunity to develop their independence skills in preparation for independent living. They could look at the arrangements for administering medication to ensure staff can concentrate whilst giving out medicines and to ensure they do this carefully and accurately. They could also look at the location of the medication cabinet to see if an alternative could lead to medication being administered in a safer way with less distractions. The staff could have training on what to do if someone abuses a person living at the home so they know what action to take to protect them and prevent it happening again. They must also make sure they let all relevant people know if people hurt someone living at the service. Staff must have the training they need to make sure they can support people with their needs and in a safe manner. They should also make sure that they send requests for references to business and not personal addresses to ensure the integrity of the information and to protect vulnerable people. Improvements are needed to ensure the home is being effectively managed and runs in a way which ensures the safety of people who live there. Key inspection report Care homes for adults (18-65 years) Name: Address: Mount Vernon Terrace Care Home 23-25 Waverley Street Arboretum Nottingham NG7 4DX     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: Linda Hirst     Date: 2 0 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: Mount Vernon Terrace Care Home 23-25 Waverley Street Arboretum Nottingham NG7 4DX 01159784345 01159783822 harun.holmes@ntlworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ahmed Rashid Holmes Name of registered manager (if applicable) Mr Ahmed Rashid Holmes Halima Holmes Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Mount Vernon Terrace consists of two large houses in a Victorian terrace in a residential area of Nottingham City. The home is registered to provide care and support for up to 16 people who have a mental disorder excluding Dementia and Learning Disability. The accommodation spans three floors, including a basement with a games room and a smoking area. There is no vertical lift or other adaptations for people with disabilities at the service and because of this the home may not be suitable for people who have mobility difficulties. There are ten single and three double bedrooms available. Only one of these has en suite facilities. The tramline stops directly outside the home and offers easy transport into the city centre. The home does not have a car park, and the parking restrictions in the area can make it difficult Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 16 Brief description of the care home to visit the home by car. The weekly accommodation charges are £336; the fees do not include cigarettes, hairdressing or chiropody. A copy of the most recent inspection report is available in the home, and the manager told us that people who want to live at the service are given a copy of the service user guide. 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: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this Care Homes for Adults (18-65 years) Page 6 of 31 back from the manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. We also looked at all of the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. One of the people we chose told us they would prefer not to speak with us, and this wish was respected. The people living at the home are from a variety of ethnic communities and we case tracked a person from a minority ethnic group to make sure their needs are being considered and provided for at the service. The staff team come from a wide variety of backgrounds and experiences. We spoke with two members of staff to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. 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: Staff could be provided with information or training so that they understand the Mental Capacity Act and Deprivation of Liberty Safeguards and understand when they should be considering, assessing, recording and referring people on for assessment. To ensure they enable people to make their own decisions where possible and that their best interests are covered. They could review the arrangements within the service for providing people with the opportunity to develop their independence skills in preparation for independent living. They could look at the arrangements for administering medication to ensure staff can concentrate whilst giving out medicines and to ensure they do this carefully and accurately. They could also look at the location of the medication cabinet to see if an alternative could lead to medication being administered in a safer way with less distractions. The staff could have training on what to do if someone abuses a person living at the Care Homes for Adults (18-65 years) Page 8 of 31 home so they know what action to take to protect them and prevent it happening again. They must also make sure they let all relevant people know if people hurt someone living at the service. Staff must have the training they need to make sure they can support people with their needs and in a safe manner. They should also make sure that they send requests for references to business and not personal addresses to ensure the integrity of the information and to protect vulnerable people. Improvements are needed to ensure the home is being effectively managed and runs in a way which ensures the safety of people who live there. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have their needs assessed before admission and can be assured that these can be met at the service. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that they ensure all service users needs can be met by assessing them before they are admitted to the home. We looked at the plans of care and found clear evidence of Care Programme Approach assessments, reviews and care plans on the file of each of the people we case tracked. In addition there was evidence of the service doing their initial assessments using information about preferences and routines. Seven people told us in their surveys that they were asked if they wanted to move into the home and six people told us that they were given enough information to decide whether the home was suitable for them and their needs. One of the people we spoke with told us, I have lived here before, about twelve years ago. I moved into Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: my own place but I got ill again so I moved back here. I want to move out into my own flat again though. Another person told us, I came here after staying with a friend, its ok, I thought the position of the home would be ok. Staff we spoke with told us, we have three new admissions coming up shortly. One person is in (a Hospital) the person will visit with their Community Nurse and have a look around. People dont tend to come and stay before admission, but they can do if they want to. One of our new admissions came and had dinner with us, everyone is assessed before admission. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the service have their needs and choices recorded and risk assessed and they are involved in decisions about their life and their care. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that they use the information from initial assessments to write the care plan. He told us that people who live at the service are involved in writing the care plans and that these and any risk assessments are reviewed every six months as a minimum. We looked at the care plans for the people we case tracked to make sure these are clear, cover all areas of need and give clear guidance to help staff in meeting these. The plans we saw cover all areas of identified need and they incorporate peoples preferences and give a sense of the person. There is clear evidence that these are reviewed every six months as a minimum and the reviews are detailed and of good quality. The plans regarding peoples mental health are good and they give clear information about the individual signs of relapse so staff know what to look out for. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We saw consistent evidence that people are involved in care planning. The people we spoke with told us they need minimal help from staff and the care plans reflected this. They told us, I dont need much help from staff. I see to myself, but they monitor me and make sure Im ok, I was very ill...but I have never felt so well as I do now. When we spoke with the staff about the needs of the people we case tracked we found they have a good understanding about their needs, wishes and routines. They told us they find the care plans helpful. (The manager) compiles the care plans and reviews them. I dabble with them when changes are needed I update them. I would always check the care plan if I was uncertain about how to help someone. I think the care plans cover everything, it gives us all of the information we need. People who live at the service told us in surveys that they make decisions about how to spend their day and they also told us the staff listen to them and act on what they say. The people we case tracked confirm that they are in control of their own lives. One told us, I make my own decisions, another, I make all of my own decisions and I manage my own money. The staff dont advise me or tell me not to do things, I do as I want. The staff we spoke with told us, no-one has any formal restrictions in place but we do try and advise some people on budgeting and in some cases try and negotiate agreements to spend so much per day to help them make their money last. No-one lacks capacity, no one has restrictions on their liberty, though I have not had formal training on this. We have formal residents meetings every two months and there are records of these. We looked at the records of residents meetings and found a variety of issues are discussed. The manager has a copy of the Mental Capacity Act Code of Practice in his office, and there is evidence in the care plans to show that he considers peoples capacity in relation to key decisions and records his findings. The people we case tracked have a good understanding of their mental health diagnosis and they understand the risks they face if they become unwell. People understand they should not smoke in certain areas of the home. The staff we spoke with told us that trying to get people to smoke in the designated Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: areas is an ongoing issue. They also told us some people are at risk of contact with the Police because of their behaviour. There are also risks associated with peoples mental health if they do not take their medication. The staff told us, Risk assessments are done on everyone. One or two display challenging behaviour care staff monitor peoples behaviour in the daily reports but we also discuss this verbally on handover. Some people have run ins with others, we liaise with their care managers. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead a flexible lifestyle in accordance with their needs. Personal choice is supported. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that there are no restrictions on people living at the service. People have the freedom to do what they want. He states that they welcome visitors and people are encouraged to maintain relationships with people who matter to them. He also told us that they encourage people to be part of the community and to go out. They plan to improve by arranging day trips and outings. The people we spoke with told us they have the freedom to come and go as they please, to meet with their family and friends and to live the lifestyle they choose. One person told us, I would like to do an Open University course, get married and have Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: children. I have information on an English course upstairs and I have tried the open university before but it was too much pressure for me. I dont want to go to a day centre. I sit and chat with the others, we go for walks and have a smoke. I dont go out on the trips. I see (my family) regularly. Another person told us, I go to the ACNA centre three or four times a week to see my friends. I like to go shopping, I see my family and friends when I like, they could visit me here if they wanted to. Staff we spoke with told us, No-one attends day services, college or groups at the moment. Most people go out though, usually into town, to the shops or for a walk. They like to visit relatives. We do an annual holiday to Skegness which people enjoy, the place was chosen by service users. We do need to spend more time doing local trips out and I think we could encourage people more. The service is not set up for independence training in all areas with a view to developing skills prior to people moving on, though people could use the laundry facilities themselves and one person who lives at the service uses the kitchen to prepare culturally appropriate meals. People we spoke with told us, there is no kitchen for us to make drinks and snacks, the main kitchen is closed off to us so we have to ask staff for a drink which is a shame. Another said, I want to be more independent and have my own place, I cook and I clean, I like doing it. Staff we spoke with told us, we wash for them but they can wash their own clothes if they want. They are asked to keep their rooms clean and some are quite tidy but if they want we will do this for them. One person likes to make (their) own food and buys the ingredients. We supervise the cooking, another person chooses to buy their own microwave meals. People told us that routines (apart from mealtimes) are flexible, the routines are pretty flexible but meal times are fixed. They like to know you have had three meals a day. The food is good and we get plenty, I had a bacon roll this morning, we like the food and get lots to eat. I go to bed when I want and get up when I want, I go to my room when I like and I go out if I want. I have the freedom to do what I want. Staff we spoke with told us, We can be flexible around meals, if they want a late dinner we will save them one. We offer alternatives. We have a curfew of 11 oclock at night. We like people in by then for safety but they can stay up as late as they like. Care Homes for Adults (18-65 years) Page 17 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. Peoples health and personal care needs are appropriately met at the service, but the arrangements for the administration of medication are not safe and people cannot be assured they will receive their medication as prescribed by their Doctor. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that they support people with their personal hygiene without pressurising them. The people we case tracked told us they maintain their own personal hygiene, one person uses special products for their skin and hair and told us, I dont need help with my personal care. I but special skin and hair care products to keep me looking good. The manager told us in his Annual Quality Assurance Assessment (AQAA) that staff accompany people to see their Doctor and Care Programme Approach reviews if requested. People we spoke with told us their health is good and they are well looked after in this Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: respect. I have a Community Nurse who visits, in fact Im waiting for a visit from her now. Another told us, I am well and healthy, If I need the Doctor I set it up myself. Staff we spoke with told us, people have annual checks from their Doctor. Some people have regular blood checks because of the medication they take. We offer dental checks but lots of people decline these. We will accompany people to any outpatient appointments. We dont have any extra health care professionals involved at the moment, other than the Community Nurses. The manager told us in his Annual Quality Assurance Assessment (AQAA) that 2 staff have attended Boots training, 4 others have attended Primary Care Trust training. A new medication cabinet has been provided and fixed to the wall as has a Controlled Drugs cabinet. There are written reminders to care staff to give people their medication on rising. We looked at the storage of medication and found this to be safe and secure. The Medication Administration Record has a list of signatories and a list of codes to be used if medication is not given, allergies are recorded to make sure staff have the information they need to keep people safe and healthy. We looked at the Medication Administration Record and there were no gaps present. We observed the lunchtime medication round and this seemed both busy and chaotic, with the staff member trying to administer medication and concentrate with people constantly coming up to him and asking for their tablets first. The person we observed seemed to lose concentration in the midst of this and took medication to a person who lives at the service who told him that he was giving him two tablets when he only takes one at lunchtime. The staff member then took the medication away and checked the Medication Administration Record, giving him the correct dose. We spoke with the staff member and asked the person to explain their actions. The staff member told us, there was lots of pressure, (a person I usually take tablets to) came to the cabinet and wanted medication and I dont usually do lunchtime medication. The person whose medication I got wrong takes two of the tablets on the rounds I usually do. I know I was wrong and I corrected the error. People we spoke with were happy with the arrangements for medication, one person told us, I know I have to keep taking my tablets or I risk getting ill, so I take them every day. Another person told us they look after their own tablets. I take them sometimes. Care Homes for Adults (18-65 years) Page 19 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. People are confident to raise issues of concern but they are not safeguarded at the service by staff who know and follow the correct safeguarding procedures. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that they take action when complaints are received about the service. The complaints procedure is displayed near the main entrance so that people who live at the service can see it and know what process to follow if they want to complain. We have received an anonymous complaint about the service since our last visit. This raised concerns about people wearing clothes belonging to others, about certain foods not being provided and about a particular person being treated disrespectfully. We referred these issues to the owner to investigate and he has taken action to address the issues raised. The people we spoke with indicated these are not issues of concern any more. We looked at the record of complaints and concerns. These are well recorded, and there is clear evidence that issues raised are investigated and action taken to address these. People told us in surveys that they all know who to speak to if they are unhappy with Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: any aspect of the care and they also said they know how to make a formal complaint. The people we spoke with told us they know how to complain, but one told us, I have never complained, I have nothing to complain about, I like it here. The staff we spoke with know they must record all complaints and told us they feel confident the manager would deal with any issue. The manager told us in his Annual Quality Assurance Assessment (AQAA) that they follow the correct procedure in the event of abuse allegations. They have improved by sending the manager on a Safeguarding training. We looked at the record of incidents. These are very well recorded and clearly state what happened before and after the events. However, when we looked at these records we found evidence that four incidents of service user on service user abuse have not been referred to Adult Social Care staff, and in total there were 7 incidents which should have been notified to us using a notification form, none of which have been. This means that the correct procedures to keep people safe and enable our monitoring have not been followed. People who live at the service told us, I have never seen staff be bad to people. Sometimes there are arguments about people taking their medication, but they have to take their tablets to keep well. One of the staff we spoke with is in charge of the home in the managers absence and he told us he had not received safeguarding training. He said, I feel pretty confident I could deal with safeguarding. The manager is always on hand, even when he is on holiday. However, when we spoke in more depth to this staff member, their knowledge of procedures is not adequate. Training is needed to make sure staff take the correct steps to protect people living at the service. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, safe and clean environment which meets their needs. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that they listen to people who live at the service and they continue to refurbish the home to give it a fresh feel and a modern look. They have upgraded and redecorated several areas of the home and a full list of improvements is referred to in the summary of this report. The upgrade to the heating system has made the home feel much warmer and more comfortable. People told us in their surveys that the home is usually fresh and clean. People we spoke with told us, I like my bedroom, they do spend money on the place, trying to make it better for us. We had a residents meeting recently about tidying up and doing our cleaning, some people are better than others though. Another person told us, the home is ok, lovely, homely and clean but a bit big and I want my own flat. Staff we spoke with told us, the environment is homely. We provide all of the basic things they need , TV, DVD, films, a darts board, pool table. Its generally clean and tidy. We do our best for them. 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. Staff are recruited safely but they may not have the training needed to ensure that they are competent in their role and in suporting people who live at the service safely. Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that three staff have achieved their National Vocational Qualification Level 2, and this almost meets the 50 target. He feels they could improve by making sure all staff are up to date on mandatory training. (See YA 23). Three people are booked to undertake First Aid Training, and some people have done medication training and the Common Induction Standards as well as Food Safety and training on Mental Health needs. People who live at the service told us, the staff are good, they care for us and they do their best. They could do with a better understanding of mental health breakdowns, especially for new people but they mean well. Another person told us, the staff are ok, they seem good and kind. The staff we spoke with told us, there are definitely enough staff. I have done Fire training recently but I am waiting for a certificate, that is all I have done in the past year. I have my First Aid training, but my food hygiene has run out, I have done my National Vocational Qualification Level 2 and medication training. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: We looked at two staff files and found they contain all of the information and documentation required by Law to make sure they are suitable to work with vulnerable people. However we did notice that in both cases, work references had been sent to peoples personal rather than work addresses. This may compromise the factual content of the references and this method is not recommended. Staff we spoke with confirmed they have had Criminal Records Bureau checks and provided two written references. 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. Improvements are needed to ensure the home is being effectively managed and runs in a way which ensures the safety of people who live there. Evidence: The manager is also the owner and demonstrates a strong commitment to improving his service for the benefit of people living there. However, there are some areas of weakness which need to be properly addressed to secure the improvements he wants. (See YA7, 16, 20, 23, 35.) People who live at the service told us, the home seems to run fine, no problems. I like it here, I am happier than I have been for ages, they provide good care. Staff we spoke with commented, we work as a team, we complement each other, we always communicate. The home runs well. We looked at the last quality assurance for the service and found that the manager has written an action plan to address all areas of concern. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The manager told us in his Annual Quality Assurance Assessment (AQAA) that they do all safety checks at the required intervals. We found this to be the case. 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 20 13 The arrangements for 31/05/2010 administering medication must be reviewed to ensure staff can concentrate whilst giving out medicines and to ensure they do this carefully and accurately. To ensure people receive their medication as prescribed by their Doctor 2 23 37 Going forward, all incidents of service user on service user abuse must be notified to CQC in writing To enable appropriate monitoring of the service and ensure good outcomes for people who live at the service. 31/05/2010 3 23 13 All incidents of service user on service user abuse must be referred to Adult Social Care staff under safeguarding procedures 31/05/2010 Care Homes for Adults (18-65 years) Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure people are protected from harm and abuse. 4 23 13 Staff must be given training on safeguarding which covers the local procedures To ensure they know what action to take in the event of an incident to keep people who live at the service from harm. 5 35 18 Staff must have the training they need to make sure they can support people with their needs and in a safe manner 6 37 9 The areas of concern from this report must be addressed To ensure the home is managed effectively and runs in a way which ensures the safety of people living there 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 17/07/2010 17/07/2010 17/07/2010 1 7 Staff should be provided with information or training so that they understand the Mental Capacity Act and Deprivation of Liberty Safeguards and understand when 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 they should be considering, assessing, recording and referring people on for assessment. To ensure they enable people to make their own decisions where possible and that their best interests are covered. 2 16 Review the arrangements within the service for providing people with the opportunity to develop their independence skills in preparation for independent living. The location of the medication should be reviewed to see if this can lead to medication being administered in a safer way with less distractions. References in respect of former employment should be sent to business and not personal addresses to ensure the integrity of the information and to protect vulnerable people. 3 20 4 34 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. 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