Care Home: Mountearl House

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What the care home does well The service provides stability and security to residents, a large number of the staff have worked at the home for some time and are familiar with residents and their ways. It has an excellent success rate with residents, particularly those that had difficulty in living in residential accommodation in the past, and who have a history of placement breakdowns. The residents do not feel restricted and enjoy living in spacious accommodation that is well maintained. Residents feel comfortable and settle well in the home and may on occasions challenge the service . On occasions any such episodes are managed and supported by competent staff, and in accordance with guidance and recommendations made health professionals. Residents receive appropriate support from staff, individuals thrive in the service and develop the confidence to take positive steps in their lives. Residents are supported with leisure activities, they have annual holidays that they choose. What has improved since the last inspection? The service has made sure that up to date assessments are in place for each resident in order to develop appropriate support plans. There are improvements to medication procedures. Recruitment procedures are improving but there are still areas we recommend for further improvement. Health action plans for residents are kept up to date, medication is reviewed regularly. The home has produced a complaints procedure that is more accessible to residents. What the care home could do better: Unfortunately the service for much of 2009 was affected by the absence of a permanent experienced registered manager. Requirements made relate to the shortfalls in the service. The staff team have not progressed as they would have wished to, they have not all received the training and development they require, including safeguarding training. Staff supervision and support lacked consistency. The quality assurance process is not fully developed, it is not using the information acquired effectively, and is not recognising the areas of strengths and where improvements are required. The newly appointed manager has made a considerable impact in a short while, and the direction the home is going is towards improvement. The new manager is qualified and experienced and offers direction and leadership within the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Mountearl House 73 Leigham Court Road Streatham London SW16 2NR     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: Mary Magee     Date: 3 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 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 28 Information about the care home Name of care home: Address: Mountearl House 73 Leigham Court Road Streatham London SW16 2NR 02087690322 02087690859 mountearl@robinia.co.uk www.robinia.co.uk Solor Care Limited care home 10 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Mountearl House is a home registered for ten people with learning disabilities. Some have additional mental health needs. It is located in a large building close to the main shopping area of Streatham. It is managed by Robinia Care who manage several care homes for people with Learning Disabilities. Local amenities are located within a short walking distance away. The house is divided into two main areas, the main premises, and annex area. In the main building is a large well furnished lounge, a dining room and numerous bathrooms. The annex area is detached from the main premises. The annex area has one bedit and two bedrooms, as well as a separate lounge and kitchen and bathrooms. The home has a large garden to the rear of the property. Fees range from £1500 to £2600 per week. 2 0 0 3 2 0 0 9 10 10 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 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: We completed this unannounced key inspection over one day shortly after Christmas. During our visit we met with the newly appointed manager, and staff members on duty. Individual discussions took place with all the staff members over the day. We received a completed AQAA prior to the inspection. We examined a number of records during our visit, these included personnel files for staff and residents. We also viewed the records in relation to the upkeep of the premises and its equipment. We met with six of the residents. We received completed surveys from four relatives, and two residents. We met with and had discussions with one parent while at the home Care Homes for Adults (18-65 years) Page 5 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 28 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 7 of 28 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. Individuals have their needs assessed, appropriate support plans are developed from the assessments. The home has a staff team that have the skills and experience to meet the needs of residents. Evidence: The home has not admitted any new residents since the last key inspection. The manager told us of a referral received, she had visited the prospective resident and completed a needs assessment. We sampled a selection of support plans and needs assessments for residents. Case tracking was used. We received completed surveys from the relatives of four residents. At the last inspection there was a lack of records associated with needs assessments for a resident admitted to the home. We found that this shortfall was addressed. Copies of the needs assessments were available for all residents. From these care needs assessments support plans were developed with each resident. Care Homes for Adults (18-65 years) Page 8 of 28 Evidence: The home has a staff team that are experienced and that are able to communicate with residents. It demonstrates that it is meeting the needs of residents. Both residents case tracked have made good progress, one resident told me about his interview for part time employment. Staff he finds are very supportive. We found that for residents that require additional support such as one to one and two to one for going out in the community this is provided in accordance with agreed support plan. Care Homes for Adults (18-65 years) Page 9 of 28 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. Residents benefit from the support and care arrangements, these are improving with support plans kept under review. The home supports residents with taking risks and to manage these appropriately. Evidence: We case tracked the service for two residents, one has lived at the home for numerous years, the other resident moved there over eighteen months ago. Both residents have named key workers. Each of the residents selected had their needs assessed, from these assessments support plans were developed. The support plan for resident A demonstrated the involvement of the resident in the care plan development. It included important information on what the person considered made his day good, the people he likes to see, the preferred lifestyle. The resident has one to one support in the home and two to one in the community. Support workers assigned to the resident are from a permanent group of support staff supplied by an agency. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: There are copies of up to date risk assessments and guidelines to support the care plans. Some of the risk assessments includes the support required with managing aggression, also are records of incidents. The home had conducted a recent review for this resident, his care manager attended. The review acknowledged the progress made. For the second person resident B we found that appropriate support plans were in place. The key worker was present and rapport with the resident demonstrated the effective working relationship she has established with him. The resident spent some time telling us about his time at the home, he complimented staff on the support he has received particularly with supporting him to take risks. He says that he has learned from his experiences and from mistakes made. He is now feeling confident and has recognised that he is ready for part time employment. The risk assessments have been tailored as time progresses to reflect changes. Overall the other support plans too includes a range of information that is important to those that support residents. There is information about risk assessment, how residents are kept safe, their goals and aspiration. Support plans are now being kept up to date, the manager spoke of the progress with plans, the goal is to to complete the reviews of all support plans within the next month. Support arrangements are backed up by the recording in place. There are daily logs recorded for each resident. The daily records confirm the support given,by who, and also the state of well being of the individual. A monthly summary is completed too for residents by named key workers. There are some inconsistencies in this area, when regular key worker is absent the recording is not always completed of monthly summaries. Care Homes for Adults (18-65 years) Page 11 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Routines are very flexible and residents can make choices in major areas of their life. . Evidence: Residents are consulted on their likes/dislikes, hobbies interests, and how they wish to pursue their goal. Individual support plans reflect the life style choices of the residents. Each resident has a pictorial activity plan as an aid to them knowing what is going on each day. Staff support residents to participate in many activities outside of the home, and use local colleges. We viewed the selection of activities attended, the following are an example, day services, a mens group and an employment service. Of the seven residents at the home four people attend college courses and day centres. The other residents choose not to engage in further education and staff Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: respect their choices. It is recommended that the service considers how to introduce further in house activities for those that choose not to engage in the community. The service has sought to have additional staff with driving skills, it has recruited a new support worker that is a qualified driver, Activities in the community favored by some residents include visits to local pubs and restaurants, trips to the park , city attractions,and to seaside. Individuals are offered annual holidays in which they choose the venue. The availability of staff enables staff support residents to their favored activities. Photographs are displayed in the home of happy residents enjoying their days out and socialising at various venues. Residents are supported to maintain relationships with friends and family. We met with relatives visiting, we also heard from three other relatives in writing. Several residents enjoy weekends away with family and friends. Residents were observed on both visits to engage with staff, spend time with relatives, and participate in viewing magazine and picture books. Pictorial formats are used to enable all residents participate in regular meetings. Residents are able to decide on the menu and choose meals that they like. served, it is to their choice. For residents individual risks associated with eating are recorded and held with support plans. Support staff demonstrate a good knowledge of the risks associated with eating and drinking and nutritional needs. Support workers are present to supervise and assist at meal times. Food is stored safely, with dates of use by and expiry observed. Freezers and fridges are kept in good working order with regular daily checks made of temperatures. The temperature of hot meals is recorded. A record is held of meals taken by residents. Staff encourage and support residents to live valued and fulfilling lives, and are not risk adverse. They aim to ensure that they plan well so that lifestyle choices can be met in a safe and enjoyable way. Care Homes for Adults (18-65 years) Page 13 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run in the interest of residents, services are delivered in a manner that promotes dignity, and privacy and respect. The health and social care needs of residents are recognised, effective management and support arrangements help to respond to individual needs. Evidence: The manager completed the AQAA. In it she stated that residents are supported to attend medical appointments, and that they have regular appointments for dental, optical and any other support necessary. The home had a change of manager recently, she recognised that health action plans needed to be updated. She informed us that this process was completed. The health action records we viewed for two residents selected for case tracking were found to be up to date. Our findings were that residents are supported to access medical care, they see the doctor regularly, have dental appointments, attend appointments at hospitals. There was a record of appointments with speech and language therapists. Record keeping is improving, with clear evidence that residents keep regular appointments with health care professionals. A number of residents have additional mental health needs. Records were seen of the outcome of regular consultations with mental health consultants, and Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: the CPN. Continuity and consistency is assured by having support staff that are designated key workers. The home has successfully recruited some new staff that includes male carers, it was recognised that more male care staff were needed as the all residents are male. Many of the residents have specialist communication needs, the means of communication is outlined in support plans. Support staff we found are familiar with communication needs, and use communication tools as appropriate to the individual. Working practices and interaction between residents and staff were observed to be appropriate over the visit. The service is delivered in a manner that is individualized, it promotes dignity and privacy, and respects each person in the home. l We found that communication has improved within the staff team, at hand overs when there is a change of staff on duty a full handover takes place, records of these are kept. Daily records are maintained of the well being of each resident, the records also describe the support given and the response to it.. We found that the home has effective systems in place to respond to any changes in individual conditions. We saw examples of the vigilance of staff in monitoring residents well being, and of their prompt response in seeking professional advice when there were concerns about individuals health. Staff we found demonstrated compassions and sensitivity when discussing the recent death of a resident. Recently residents had their swine flu vaccination. The majority of residents require support with their personal care, and every attempt is made to ensure that they are supported with taking an interest in their appearance. Staff support them with purchasing clothing of their choice and make this an activity of daily living. We found that residents appeared well kept, and attire and hairstyles reflected their personalities. Relatives we heard from are satisfied with the care and support delivered. A relative commented on the use of taxis and feels that more effort should be made to encourage residents where possible to walk to a local appointment (this related to her relative). While case tracking we found that for residents with challenging behaviour this issue is considered in the care and support arrangements, if the risk assessment recommends additional one to one support then this is evidenced in the staffing levels allocated. We examined medication procedures. The home experienced some difficult earlier in the year when insufficient quantities of medicine was delivered for two residents. Two Regulation 37 Notifications were received at CQC to inform us that both residents were without one doe of medication. Although tThe home alerted the pharmacist the residents were without the prescribed medicine. This highlighted the need to review medication procedures so that medications are reordered and delivered on time. We feel confident of the actions taken by senior management as a result. There was no re occurrence of this problem with the supply of medicines, the registered provider addressed the issue, and took prompt action to prevent recurrence. For both residents we case tracked we found that that medinces administered were Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: signed for in MAR sheets, medication held was accurate according to records of medicines received. We found that the home acknowledges all medicines received, however we are not satisfied that medication auditing systems were fully robust earlier in the year . The new manager produced a new template that is to be implemented in the home. The majority of staff employed at the home are experienced, they told us that they have received the training that they require for medication administration. There were no records presented at the time of inspection to confirm that recent training in the medication procedures was given. The manager responded to the draft report by stating the following, All staff who administer medication are trained and competent to do so. The shift leader is always a Team Leader and all Team Leaders have attended medication training and have had their competency assessed. We accepted this confirmation for this inspection, and did not request any further evidence of this, it will be evaluated by the pharmacy inspector at the next inspection. Medication reviews are conducted for residents at least annually, and response to prescribed medication is kept under review Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes available to residents in accessible formats details of the complaints procedure. Residents are also supported to put forward their views or concerns at house meetings. Some members of the staff team are skilled and knowledgeable on safeguarding procedures, but shortfalls in training provision means that gaps in knowledge among staff place vulnerable residents at risk. Evidence: We examined the complaints procedure. A new more accessible complaints procedure is displayed in the home. The manager explained that as a result of cognitive impairment that this is not fully understood all residents. Regular residents meetings take place, at this residents are encouraged and supported to express their views. The manager feel confident that the good rapport staff have with residents, and feel that they would be comfortable in making any concerns they have known. Many residents have strong relationships with their families, some of whom are in the home at least weekly. Management feel that relatives communicate well with staff, and that they would have no hesitation in making their concerns known. There was one official complaint logged, however all the details were not recorded, neither was the name of the complainant recorded. It did not affect the residents as it was from a person in the local neihbourhood. At the time there was no manager in post, staff in charge did not record all the details. There was no evidence that this was acknowledged or responded to by the manager in charge at the time. The new manager is investigating the Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: concern and is endeavoring to gain information on the complainant in order to make contact. She confirmed since the inspection that this was complaint was addressed . Staff should be informed on the importance of recording any issues or concerns raised about the home and following these through in accordance with complaints procedures. The home manager is well acquainted with adult protection procedures and the local authority policy. Some of the regular experienced staff demonstrate a good knowledge of procedures that protect vulnerable adults, for others there was some extensive gaps in knowledge. None of the staff were up to date on recent legislation in relation to deprivation of liberties. We examined a recent record of staff training, we found that nine of the sixteen staff are not up to date on safeguarding procedures, according to records some night staff have received no training on such procedures. The manager was making provision to ensure that this training is delivered to staff in the next two months. Care Homes for Adults (18-65 years) Page 18 of 28 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. Residents benefit from the presence of a safe well maintained premises. They enjoy their surroundings, attractive and comfortable environment are provided, these are kept clean and well furnished. Evidence: We found the home to be pleasant and homely. Residents appeared relaxed and comfortable in their surroundings. All communal areas and four bedrooms were viewed. The decor is attractive, attractive comfortable furniture and furnishings compliment the interior. One resident has his mother present, she was complimentary of the environment. One resident has had several wardrobe replacements due to damage inflicted when the resident is challenging. We heard of further new furniture on order. The home has a good history of replacing furniture and fittings when required. Repairs are attended to promptly. A spacious enclosed garden is provided at the rear of the building. Currently it has a trampoline for residents use, there are plans to develop the garden area further so that residents avail of the opportunity to use it as much as possible. The home was clean and hygienic and odour free. Bathrooms and toilets were viewed. All were in good working order. The temperatures of water in bathrooms and showers Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: continues to be monitored daily to ensure that they are within safe range. Individual space is complimented by a range of communal areas. The main area of the home has a comfortable well furnished lounge with large sofas. In the lounge for residents comfort are a television and music player. A dining room is located off the kitchen on the first floor. It offers a range of dining tables and chairs for people to share mealtimes. The annexe area of the home is detached from the main building. Two residents live there. It offers a separate kitchen and lounge to enable those residents a little more independent use the cooking facilities. The security of the annexe area is no longer an issue as it has one to one staffing for one of the residents. The premises is safely maintained, regular health and safety risk assessments are conducted by staff at the home. The premises is owned by the London Borough of lambeth, who also conduct a check of the homes risk management of the environment. Care Homes for Adults (18-65 years) Page 20 of 28 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. The home benefits from consistency in the service as a result of a stable staff team. Staff are not as skilled as they should be. Working practices may be hindered as a result of the lack of consistent support and supervision. Staff have not received the training and development required to keep their skills and knowledge updated. Evidence: The home has good retention levels for staff. There are many benefits as this means that residents are comfortable with the staff that support them, and who relate well to them. Two new members of staff have started work at the home in the past two years. The service has recently recruited a male member of staff in order to better reflect the gender of the people in the home. We examined the personnel files for both of these staff. We found that vetting procedures used sought appropriate documentation and information before they began employment.The records seen demonstrated that new staff were not given the supervision and support they require especially as a new staff member. The management shortfalls for the majority of 2009 have resulted in poorly organised records and filing systems. The files we found were missing some information, such as relevant work permit. Confirmation was provided by the manager that this was received from head office. The manager has undertaken an audit of staff files, and is addressing the shortfalls by seeking the absent information from the human resources department which is based at head office. It Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: was confirmed by the new manager that the shortfalls were almost addressed. We had some concerns about the references received, and recommend that authenticity of references is verified before employment is offered. This was verified by the manager after the inspection. Areas of training of the staff team have lapsed at the home. We examined the training matrix that had all training provision recorded. The absence of an experienced management team has resulted in lapses in staff support and training provision for a time in 2009. Staff told us that training opportunities were limited in the past year, some spoke of the cancellations of planned sessions and that none were rescheduled. According to records some night support staff have received very little training since working at the home, this has not been recognised. We found from records that staff have not received all the training they require, much of the mandatory training is overdue. We spoke to five staff members, many are experienced and enjoy their role. A good number of staff have achieved NVQ qualifications but this has not been complimented by a well coordinated plan of training. The newly appointed manager has began arrangements to address this. It was unclear if all the induction was given to new staff as records were absent to confirm this. Some staff said that the induction was very basic. Records were absent to confirm that the full induction training programme. It was confirmed that both new staff members had attended the specialist training for people with learning disabilities. It is recommended that evidence of the full induction programme is held on staff files. Numbers of staff according to rotas appeared appropriate to needs and numbers of current residents. We found evidence that appraisals, support and supervision has lapsed too. Records show these to be sporadic. Staff spoken to told of the lack of support received. On records both new staff members had infrequent support and supervision during the probationary period. Care Homes for Adults (18-65 years) Page 22 of 28 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. Inconsistencies were experienced in the leadership and direction in the service up to November 2009.The home was affected by the absence of a registered experience manager. The home provides a safe well maintained environment for residents where health and safety is promoted. Evidence: The home experienced inconsistencies in management for a long period in 2009. This impacted on the service, staff did not get the leadership and direction they required. Staff training and development needs were not addressed.. A new manager came into post in November 2009. She is experienced and qualified, and was a registered manager in another service. So far there are positive signs that the new manager is addressing some important issues in relation to the service. In this short period since appointment there are improvements to recording, with records dated and more accessible. There are improvements too in communication with better hand overs taking place. The manager has begun auditing both staff and resident personnel files, and is Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: addressing shortfalls. The majority of residents have had recent reviews. Training plans have begun for the staff team, we were told of night time unannounced visits that have taken place since the inspection. These to monitor working practice and appraise staff. There are positive signs that the new manager is making an imact in the standard of the service. However due to the short period of new management it was not possible to evaluate fully the outcome of management changes. We will examine this outcome area at the next inspection. The organization has not notified officially the Commission of the new managers appointment, and registration with CQC has yet to take place. The home has a form of quality assurance, this includes sending surveys to relatives, next of kin. It is not fully developed and there is a need to have a more developed system. The home operates a rota which supports the needs of the residents and there is always an identified shift leader on duty, who is either the deputy manager or a team leader. The shift leader is responsible for all medication administration, finance and ensuring that activities and appointments all take place as necessary. The home is audited via Regulation 26 visit reports, Lambeth fire officers, the environmental health agency, pharmacists, and Robinias health and safety officer. According to records included on the AQAA the policies and procedures were not reviewed for some years. A previous recommendation remains in relation to quality assurance. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 34 19 Recruitment procedures must 30/04/2009 be robust, all staff need to be fully vetted before employment begins. The service must ensure that the authenticity of references is verified. references To safeguard vulnerable residents. 2 35 33 Staff must receive the required training and development they need. So that all have staff are equipped for their roles. 31/07/2009 3 39 35 The service need to develop and operate a quality assurance system based on including the views of residents and stakeholders. So that the service operates in the best interest of residents 29/05/2009 Care Homes for Adults (18-65 years) Page 25 of 28 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 23 13 Staff working at the home must receive training on procedures that safeguard vulnerable adults, including information on deprivation of liberties. So that are knowledgeable and implement robust procedures to respond to suspicions or evidence of neglect or abuse. 28/02/2010 2 36 18 Staff must be given the supervision and support they require. To support and promote good working practice 26/02/2010 3 37 29 The registered provider 26/02/2010 must inform the Commission of the change in management and the new managers appointment. In accordance with Regulation. Care Homes for Adults (18-65 years) Page 26 of 28 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 2 6 22 monthly reviews should be consistently maintained, and not interrupted by the absence of the regular key worker. Staff should be informed on the importance of responding to complaints received, and the recording any issues or concerns raised out the home. It is recommended that evidence of the full induction programme completed is held on staff files for verification. The training matrix should include evidence of induction training. Policies and procedures should be reviewed. 3 35 4 40 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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