Care Home: Oak House

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What the care home does well The staff were caring and friendly. The health and personal care, that peoplereceive, were based on their individual needs. The staff at the home was respectful of the people. They help maintain the young peoples` dignity and privacy at all times. The home was comfortable and homely. The layout and the design of the home provide the people easy access to all areas of the home without any restriction. It is a small home thereby residents and staff were able to get to know each other well. What has improved since the last inspection? The care plans have been reviewed and the documentation was under review to improve the recordings. The administration and recording of medication given to people has improved and this is monitored regularly by a senior staff that has been given the responsibility. We saw evidence of thechecks and the process was thorough. The fire doors were kept shut during our visit and the residents were in the communal area and did not need individual bedroom doors to be kept open. Work has been carried out in conjunction with the community nutritionist. We witnessed an improvement in the planning and monitoring of meals by the care staff. All care staff working at the home has had training on Safeguarding and Protection of vulnerable adults. Not only there were records of the training but also the staff was able to verbalize their action if they were to witness any type of abuse. What the care home could do better: We have made the following requirements which the home is expected to comply with so that people using the service will be safe. We have also made recommendations which suggest best practice to help the service improve thestandards. The registered manager needs to ensure that copies of the individuals` needs assessments are accessible to the care staff and the individuals` representatives. Since this information provides the platform for organizing and reviewing future care for each person. The information will also help monitor progress and development of the young people. The information about the service should be available in a format suitable for the people for whom the home is intended. E.g. pictures, audio tapes --- etc. The registered manager should make sure that each resident receives a set of terms and conditions (contract) in the format the individuals are able to understand. The registered manager should ensure that all reasonable efforts have been taken to explain what the contracts are for, to the residents by using an appropriate form of communication. The registered manager needs to ensure that there is an effective and efficient system of communication between the relatives, residents and the staff whilst complying with the organizational policies. So that people are able to make informed decisions. The registered manager should ensure that all staff are trained and deemed competent in maintaining resident’s confidentiality, so that residents and relatives know that information about them is handled appropriately and only in the best interest of the residents.The management should make sure there is provision for the care staff to support individuals to take risks as part of promoting independence. The registered manager needs to consult with each resident and their representatives and make arrangements for a programmed of activities having regard to each person`s needs. So that people who live at the home are able to take part in activities and maintain recreation, fitness and training. The mealtimes should be treated as a social occasion. Therefore the staff and the residents should share the experience by eating together. Records must be kept of all medicines leaving the service for disposal. This is to ensure that there is no mishandling of medicines. The staff working at the home should have training on palliative care, dealing with illness and death of residents so that they are able to deal with situations sensitively and support relatives and each other. The registered manager must make available copies of the complaints procedure in appropriate formats. This will help people access and understand the information and therefore use the procedure. The registered manager and all care staff at the home need to actively listen to all concerns and complaints raised. Theymust maintain records of such discussions and the action that was taken in response. This will help management when checking whether there are any themes of issues developing and monitor the handling of complaints. The heating and hot water must be available to all residents at all times. So that people are able live in a warm, safe and comfortable environment and maintain personal hygiene by being able to have baths. There should be provision for maintenance and renewal works on a regular basis so that the home is kept in good condition. The registered manager needs to ensure that the care staff have the skills and experience necessary for the tasks they are expected to do. The training needs to include knowledge of disabilities and specific conditions of residents, understanding of cultural religious and race heritage of the people. This is to enable residents` individual and joint needs to be met by appropriately trained staff. The registered manager needs to ensure that all staff working at the home receive training and are deemed competent. The training must include health & Safety, moving & handling, first aid and Fire safety. So that the residents and staff are safe and also the residents are able to be supported by competent staff. The registered manager must ensure that the staffing levels support the needs of the residents over the 24hour period. Thestaff shifts need to be in the best interest of the people they are supporting and therefore need to be flexible. Therefore sufficient numbers of staff must be allocated at the appropriate times of the day according to needs of the residents. The registered manager must ensure the recruitment process is thorough and she must be able to evidence this. Therefore the people living at the home are protected by the recruitment process. The registered manager must be able to demonstrate that residents, their representatives and the staff views of the service have been taken into account when monitoring and developing the service. This would help to measure the homes success in achieving the aims and objectives. The manager needs to ensure the health; safety and welfare o Key inspection report Care homes for adults (18-65 years) Name: Address: Oak House Oak House Darley Cliffe Upper Sheffield Road Barnsley S70 4AG one star adequate service The quality rating for this care home is: 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: Marina Warwicker Date: 1 6 1 2 2 0 0 9 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. They reflect the things that people have said are important to them: 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 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 Information about the care home Name of care home: Address: Oak House Oak House Darley Cliffe Upper Sheffield Road Barnsley S70 4AG 01226287621 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) : Holly Bank Trust care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Learning disability Code LD Date of last inspection 2 6 0 2 2 0 0 9 A bit about the care home Oak House is a care home registered to care for people who have a learning disability. Oak House can accommodate up to four people. Hallways and corridors are wide for wheelchair users. There is a kitchen area and a large communal sitting room. There are four single bedrooms with ceiling track hoists, specialist beds, and en suite facilities. The Acorns is a separate annexe which can accommodate two people. There is a lounge and a small kitchen area for the residents to use. The service is situated near to facilities such as shops, public houses and a place to worship. The weekly fees ranged from £1470 to £1930. People pay extra for toiletries, clothing, personal effects, some leisure activities, and a contribution towards holidays. Before people arrive we were told that they would be provided with a copy of the service users guide and the homes brochure. 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 Concerns, Complaints and Protection Personal and Healthcare Support Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. An inspection of this care home was carried out on Wednesday 16th December 2009 between 10am and 5pm. The staff, the management, the people using the service or the visitors were not informed of our visit and therefore it was unexpected. All six people who use the service were consulted on the day. We also spoke with six staff that were on duty. We spoke with five relatives on the phone. Comments received from the surveys have been also included in the body of the report. Time was spent observing and chatting with staff and the people using the service. The manager was on leave and we informed the senior staff who were on duty of our findings throughout the day, which helped both parties to verify and start taking action when it was needed. The premise was inspected, which included bedrooms of people using the service and communal areas. Private areas were accessed with the permission of the people and/or the staff at the home so that we respected the peoples wishes. Samples of records such as the care plans, staff recruitment, supervision and training files were checked. We would like to thank the people who live at Oak House, their relatives, the staff who took part and contributed toward this process. What the care home does well The staff were caring and friendly. The health and personal care, that people receive, were based on their individual needs. The staff at the home was respectful of the people. They help maintain the young peoples dignity and privacy at all times. The home was comfortable and homely. The layout and the design of the home provide the people easy access to all areas of the home without any restriction. It is a small home thereby residents and staff were able to get to know each other well. What has got better from the last inspection The care plans have been reviewed and the documentation was under review to improve the recordings. The administration and recording of medication given to people has improved and this is monitored regularly by a senior staff that has been given the responsibility. We saw evidence of the checks and the process was thorough. The fire doors were kept shut during our visit and the residents were in the communal area and did not need individual bedroom doors to be kept open. Work has been carried out in conjunction with the community nutritionist. We witnessed an improvement in the planning and monitoring of meals by the care staff. All care staff working at the home has had training on Safeguarding and Protection of vulnerable adults. Not only there were records of the training but also the staff was able to verbalize their action if they were to witness any type of abuse. What the care home could do better We have made the following requirements which the home is expected to comply with so that people using the service will be safe. We have also made recommendations which suggest best practice to help the service improve the standards. The registered manager needs to ensure that copies of the individuals needs assessments are accessible to the care staff and the individuals representatives. Since this information provides the platform for organizing and reviewing future care for each person. The information will also help monitor progress and development of the young people. The information about the service should be available in a format suitable for the people for whom the home is intended. E.g. pictures, audio tapes --- etc. The registered manager should make sure that each resident receives a set of terms and conditions (contract) in the format the individuals are able to understand. The registered manager should ensure that all reasonable efforts have been taken to explain what the contracts are for, to the residents by using an appropriate form of communication. The registered manager needs to ensure that there is an effective and efficient system of communication between the relatives, residents and the staff whilst complying with the organizational policies. So that people are able to make informed decisions. The registered manager should ensure that all staff are trained and deemed competent in maintaining resident’s confidentiality, so that residents and relatives know that information about them is handled appropriately and only in the best interest of the residents. The management should make sure there is provision for the care staff to support individuals to take risks as part of promoting independence. The registered manager needs to consult with each resident and their representatives and make arrangements for a programmed of activities having regard to each persons needs. So that people who live at the home are able to take part in activities and maintain recreation, fitness and training. The mealtimes should be treated as a social occasion. Therefore the staff and the residents should share the experience by eating together. Records must be kept of all medicines leaving the service for disposal. This is to ensure that there is no mishandling of medicines. The staff working at the home should have training on palliative care, dealing with illness and death of residents so that they are able to deal with situations sensitively and support relatives and each other. The registered manager must make available copies of the complaints procedure in appropriate formats. This will help people access and understand the information and therefore use the procedure. The registered manager and all care staff at the home need to actively listen to all concerns and complaints raised. They must maintain records of such discussions and the action that was taken in response. This will help management when checking whether there are any themes of issues developing and monitor the handling of complaints. The heating and hot water must be available to all residents at all times. So that people are able live in a warm, safe and comfortable environment and maintain personal hygiene by being able to have baths. There should be provision for maintenance and renewal works on a regular basis so that the home is kept in good condition. The registered manager needs to ensure that the care staff have the skills and experience necessary for the tasks they are expected to do. The training needs to include knowledge of disabilities and specific conditions of residents, understanding of cultural religious and race heritage of the people. This is to enable residents individual and joint needs to be met by appropriately trained staff. The registered manager needs to ensure that all staff working at the home receive training and are deemed competent. The training must include health & Safety, moving & handling, first aid and Fire safety. So that the residents and staff are safe and also the residents are able to be supported by competent staff. The registered manager must ensure that the staffing levels support the needs of the residents over the 24hour period. The staff shifts need to be in the best interest of the people they are supporting and therefore need to be flexible. Therefore sufficient numbers of staff must be allocated at the appropriate times of the day according to needs of the residents. The registered manager must ensure the recruitment process is thorough and she must be able to evidence this. Therefore the people living at the home are protected by the recruitment process. The registered manager must be able to demonstrate that residents, their representatives and the staff views of the service have been taken into account when monitoring and developing the service. This would help to measure the homes success in achieving the aims and objectives. The manager needs to ensure the health; safety and welfare of the residents and the workers by making sure all staff are trained and competent. All staff must be aware of what and to whom they need to report when accidents, incidents and injuries occur to the people. In the absence of the manager, staff must be made responsible for reporting incidents to the appropriate authorities. This arrangement will not only promote the health, safety and welfare of the residents and the workers; but also protect people. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Marina Warwicker St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of availability of the needs assessments of the individuals, questions the relevance of the care plans. Evidence: We assessed this outcome area using the comments from the people who were using the service and the staff who were working at the home. We also checked the documents to verify the facts. There were copies of the statement of purpose and the service user guide for people who wanted to view them. These were available in a range of formats, i.e. using Mayer Johnson symbols. We with the help of one of the senior care staff searched to find copies of the individuals needs assessments by the placing authorities, before they were admitted to the home. We were unable to locate them and it was concluded that they were kept at the head office. We spoke with the relatives of the residents, who informed us that at first they were confident that Holly Bank Trust would meet their needs since the representatives from the company promised them the best care. They also said that since the local service was new they expected some teething problems but did not have any history to go by. We were informed by both the staff and the relatives that the residents were given at least 6 weeks as settling in period. Evidence: One of the senior staff following discussions with the head office informed us that all the residents were either funded by health or social services or both and that the contracts were kept at the head office. We did not see any evidence of terms and conditions within the documents belonging to the individuals. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals and their representatives are on the whole disappointed that they are not given opportunities to get involved in decisions about their lives. Due to lack of communication between the management and the relatives there seems to be a lack of involvement when planning the care and deciding on the support residents receive. Evidence: All six care plans were checked for information about the residents. We spoke with care staff and the residents. We also spoke to the relatives of the residents to get their views. The care plans needed to reflect a person centered care programme approach. The individuals personal goals were not specified and followed through by care staff. There was a lack of evidence that the care plans had been drawn up with the involvement of the residents together with their representatives and that they were kept under review by staff. A requirement was made in the last inspection surrounding this area and there was a lack of progress made. However, one relative spoken with stated staff understand my relatives needs, they have been very willing to help and listen These were some of the comments we received about this outcome area. The care staff dont seem to know much about the residents. When we have spoken to the senior staff they keep saying that due to confidentiality not everyone is informed of the peoples circumstances and their needs. There are no key workers everyone seem to look after everybody. Care plan are kept by the staff and not readily available to us. We have not been involved with the reviews or Evidence: the planning of care. Difficult to ask without feeling that we are interfering. We were informed by the staff and the relatives that residents were often not consulted and the decisions were made by the senior staff at the home. Risk assessments were in place so that people are able to take risks and maintain an independent life style. However, we were informed that the staff did not enable people to take risks since it was perceived by the relatives that the staff were not competent and therefore not confident to allow people to take risks. The comments we received from the relatives and the staff raised concerns about the management interpretation of maintaining confidentiality. We were informed that staff got information about the residents on a need to know basis. This was due to maintaining confidentiality. Relatives too commented that when they request information often they were told that due to confidentiality they were unable to discuss matters with them. The management need to inform the relatives and the staff about the company policy on sharing information and maintaining confidentiality. 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. On the whole people who use services are able to make choices about their lifestyle, and receive support.. Evidence: We spoke with most relatives, staff and residents. We also checked the documents available at the home relating to this area. One person said my relative is involved with preparing food, making cups of tea with support, playing games, having nails painted, staff are supportive on a one to one basis during the day. Information from the provider states there are a number of therapeutic interventions which include hydrotherapy, speech therapy and a range of activities. The care plans did not specify areas for development for each resident. There was a lack of professionally validated interventions, therapy and opportunities for the people. Some comments from the relatives highlighted the above. Although the relatives were assured by the management that there were facilities at the main site at Holly Bank Trust the families believe due to having to organise transport between the sites the residents did not access them often enough. These were some of the comments. We were informed that the people had once yearly review or sometimes more but we were not included. We were told that there will be a carer who will be our son/daughters key worker.I have formed links with certain staff whom I feel confident and comfortable to ask for Evidence: information. Dont know who the key worker is. We thought they will sort these things out once the home is settled. When C from the company came to see us at the home we were promised so much. The first year we thought that they were new and things would improve. We dont know what our son/daughter can do or is allowed to do. The staff should be able to help with choosing activities and fill the days with interesting things to keep the young people busy. Not much seems to happen especially in the evenings. We feel the resident’s daily routine is planned around the staff availability. Sometimes we like to take the residents out to give them a break from being in the house. But often our suggestions are misinterpreted as an excuse for not wanting to do the house work. We noticed that the daily routine was flexible and promoted individual independence. However on the morning of our visit around 10am, there were four residents being supported by two care staff. We witnessed two residents were clothed and ready, one person having breakfast and one person in bed needing help with personal hygiene. The staffing level was inadequate. One of the afternoon staff came in early since we had arrived. Staff were friendly and interacted with the residents well. The staff entered the bedrooms of the residents with their permission. Those residents who wanted privacy were supported by the staff and they made sure that the visitors too respected the wishes of the residents. The young people were able to access all parts of the home without restriction. We were around at breakfast and at lunchtime. People were able to have what they asked for breakfast. Five residents were present at lunchtime. Of those we were informed four had meals and that one of them had tube feeding due to their condition. Two people needed help and the other two needed encouragement to eat. We asked why the staff that were not helping with meals did not join in and eat with the residents. Staff said that they could not eat the food the residents ate since it would be stealing. We explained that mealtime should be a social occasion where residents and staff should share and celebrate. We asked the staff to bring this up with the management. One of the senior staff informed us that they were in the process of involving the community nutritionist to review the meals for residents and to ensure they receive a good diet. We witnessed work done so far between them. We also observed care staff documenting what each person ate at mealtime. This is good practice. 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 follows. 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 health and personal care that people receive are mostly based on their individual needs but not always fully met. The staff at the home respect the people, maintain their dignity and privacy at all times. Evidence: Our findings confirmed that the young people were able to choose their own clothes, hairstyle and makeup if they so wish and were able to reflect their personality. Personal support and intimate care was provided in private by care staff who were known to the residents. To maximise mobility and independence the residents and staff had access to technical aids and equipment. One comment from a relative was “physiotherapy, occupational therapy take place on a regular basis which is really beneficial. My relative’s healthcare needs are met by staff that are willing to help and listen. One young person said that it had been sometime since they had a bath due to the lack of heating. We made an immediate requirement to rectify the problem with heating and hot water. It was rectified within 24hours. Please see section under environment for further information. This is a care home and the health care needs were met by the GP and and the community health team. Care staff informed us that the GP visited the home when requested or the residents saw the GP in the surgery. One of the senior staff on duty informed us that medication was handled by the senior staff who had received training on safe handling of medicines. None of the residents Evidence: were able to self medicate and therefore the care staff administered their medication. MAR (medication administration record) sheets were used to evidence medication management. One of the senior care co-ordinators was responsible for medication audit and there were records to evidence this. The cupboard where medication was stored was cluttered with items which did not belong in there. We were unable to check the records of medication disposal since the record book had been lost. The staff said that they were expecting the pharmacist to supply a replacement book. We explained the reason why losing the documentation which evidenced their handling of medicine was unacceptable and on a later date when the registered manager returned from leave we contacted her and requested an investigation as to how the records had been lost and inform us of the outcome. Staff said that they had not had any training on palliative care or death and dying. The records of training confirmed this. 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 able to voice their concerns but there was a lack of response from the management. The management had taken action by ensuring that the staff are trained so that people are protected from abuse through staff training. Evidence: The information for the residents as to how they were able to raise concerns or complaints was not in a format which was user friendly. The staff knew how they were to handle complaints by the residents or relatives. We were informed that there had not been any formal complaints since they had been registered two years ago. Therefore we did not see any records. However, when we spoke with the relatives they told us that they had raised several concerns with the manager and the staff. The general feeling was that they (the relatives) did not feel that they were listened to and the management did not take any action following them raising matters. Some relatives said that they were afraid to make complaints since they did not have any options for their son/daughter to live. We spoke with staff and checked training records. Four staff files we checked, all have had training on safeguarding. The staff were able to explain how they would proceed if they were to witness any untoward behavior by colleagues or residents. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout is homely and enable people who use the service to live in a generally safe and comfortable environment, which encourages independence. Repairs and maintenance are not undertaken in a timely way which causes problems with the comfort of the people living at the home. Evidence: The two houses were well thought out buildings with good facilities for the people. Relatives said, It’s a lovely place. When we saw it last year we were so happy that our son/daughter has got a good place to live. The units are small and work well for the residents. They have all the equipment they need. We cant fault the building. The residents took us to their bedrooms and proudly showed us their rooms. They were personalized and kept safe and tidy with the help of the staff who work at the home. During the tour of the premise we noticed the home looked clean and smelt fresh. When we visited the Acorn building it was very cold and one of the residents said that s/he was unable to have a bath for some time. We found out that the heating system in this building had been faulty for some weeks and that very little had been done to rectify the problem. We asked the senior staff to find out what the company was planning to do. We also instructed the staff that they carry out a risk assessment, provide free standing heaters in the house and ensure that a member of staff was in the house at all times whilst occupied by residents. This was in place when we left the home. We checked on the following day and we were informed that the fault was repaired within 24 hours and the residents had the facilities reinstated. We noticed some maintenance jobs outstanding. We were informed that the service Evidence: shared a maintenance person and they had to wait their turn for the jobs to be done. It would be useful if the reporting of faults were dated and monitored to make sure faults were attended to within a reasonable time scale. The door to the general bath was sticking and it was difficult to open. Door frames and parts of the wall had been damaged by the use of wheel chairs. These areas need repair and prevention of further damage. 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 working in the home are caring and supportive however they need training on specialist areas so that they will develop the necessary skills. The staffing numbers did not reflect the parts of the day when residents needed additional support. Evidence: We spoke to the relatives, the staff, we observed people directly on the day, we checked the relevant records when assessing this outcome area. These were some of the comments. “My relative has one to one care during the day, staff are helpful and always listen”. Are the care staff trained on looking after people with learning difficulties. I have my doubts since some dont know how to interact with the people. The information we get depends on who we speak to. Sometimes what is said can be contradictory. Especially when I want to know what my son/daughter has been doing during the week. Some senior staff are very secretive and refuse to share information. We ask so that we can know what had happened. Often staff dont like discussing this. We dont think care staff are skilled and get proper training in how to look after these young people. The senior ones who are good at the job seem to get promoted. Then they are in the office and the basic hands on care is left to the inexperienced staff. There is a lack of support and supervision of junior staff Evidence: The care staff are not attached to residents as they said that they would be. The care staff seem to get on with the days jobs when they come on duty. Some spend time with residents but mostly they have their jobs like cleaning cooking, doing paperwork and they seem to be too busy. On the morning of our site visit the staffing levels were inadequate. On questioning the staff and checking the staffing rota it was deduced that although there were enough staff around each day the shift patterns and the timing of staff on duty needed review. During the rest period for the resident which was between 2pm and 4pm there was an overlap of staff but in the morning around 10am there were just 2 care staff were on duty looking after four people. We explained our concern to the senior staff on duty. Some staff were on training but were available if any concerns arose. We inquired from the staff about the system they used when allocating staff to residents. There was a confusion as to the role of a key worker. The manager confirmed a key worker system is in place which is currently under review. We observed that the staff worked well as a team but there was a lack of organisation as to whom they were to support on the day. We checked the recruitment process of four staff. We found that the staff ID including recent photograph was not available. One staff did not have evidence of two references. We were informed that this information may be held in the main office. At the last inspection we made a requirement relating to this area and it has not been complied with. The four staff training folders we checked had the following gaps. One person out of the four has not had training on health and safety and another has not had training on moving and handling. However, most residents needed assistance with moving and handling. Therefore lack of staff training could put people at risk. Two staff have had training on first aid and one staff on duty has had training on fire safety. On questioning about fire safety at the service the senior staff on duty showed us evidence that all staff had taken part in fire drills and therefore they knew what to do if there were to be an incident of fire. The staff helped preparing food and there was no evidence of staff having had training on basic food hygiene. A requirement was made at the last inspection site visit with regards to this standard and we did not witness any changes to the staff practice. It was difficult for us to confirm the lack of staff training on the mandatory topics since the staff whom we spoke with were not sure whether they have had the training and the documents kept at the managers office were not sufficient to support. Evidence: Three care staff said that they had received supervision and explained the process. We saw two sets of written supervision records. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager of the home needs to review the day to day running of the service to ensure that the home is run in the best interest of the young people who occupy. The manager and the responsible individual need to use the quality assurance systems to measure progress and introduce plans to make improvement. The lack of evidence of staff training does not promote health safety and welfare of the people who live and work at the home. Evidence: The manager has been registered with The Commission for 2 years, she has experience in caring for people with a range of conditions, and is supernumerary for 2 days per week. We spoke with the residents, some of the relatives and the staff. One relative said “the manager is friendly and approachable”. We also checked the documents available to us to assess this area of outcome. The responsible individual had been visiting the service regularly and reported on her findings to the manager. However, our overall findings of this key inspection indicated that the monthly monitoring may need to change emphasis therefore the outcome from the monitoring visit need to report on the views and the standard of care provided by the service from the staff, residents and relatives. The staff told us that they had regular meetings with the management and raised issues. However the matters were not always followed up by the management. We also found out that the relatives often asked for information or made suggestions to improve the quality of life for the Young people at the home but very little notice was taken by the management. The relatives said that they had attended one meeting since the home opened two years ago and that they had asked the staff whether they could have more regular meetings(i.e. relatives, staff and residents meetings). Since they all felt useful Evidence: and supportive. The records maintained by the staff were kept securely. But not all necessary records were kept at this site. Please refer to outcome area 1 choice of home & 7 staffing for detail. Safe working practices include all staff receiving induction and regular mandatory training and maintaining staff competency. Also risk assessment and measures taken by the management to reduce risk to people live and work at the home. Our findings concluded that the management had not fully complied with the above and therefore the residents and the staff were placed at risk in some areas. For example, lack of staff training on moving and handling, health & safety and fire safety. When we inquired from the staff about reporting of incidents and notifying CQC the staff were not sure. We have not received any notices about incidents, injuries and accidents at the home. Are there any outstanding requirements from the last inspection? Yes 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 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 Description 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 Description Timescale for action 1 2 14 17/02/2010 The registered manager must ensure that individuals’ needs assessments are completed and accessible to the care staff and the individuals representatives. Since this information forms the platform for organising and reviewing future care for each person. 2 7 12 17/02/2010 The registered manager must ensure that there is an effective and efficient system of communication between the relatives, residents and the staff whilst complying with the organisational policies. So that people are able to make informed decisions. 3 22 22 17/02/2010 The registered manager must actively listen to all concerns and complaints. She must maintain records of 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 Description Timescale for action such discussions and the action that was taken in response. The registered manager must make available copies of the complaints procedure in appropriate formats. So that management is able to check whether there are themes and monitor the handling of complaints. 4 24 23 The heating and hot water must be available to all residents at all times. 17/02/2010 So that people are able live in a warm, safe and comfortable environment and maintain personal hygiene by being able to have baths. 5 32 18 17/02/2010 The registered manager must ensure that the care staff have the skills and experience necessary for the tasks they are expected to do. The training needs to include knowledge of disabilities and specific conditions of residents, understanding of cultural religious and race heritage of the people. This is to enable residents individual and joint needs to be met by appropriately 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 Description Timescale for action trained staff. 6 34 19 17/02/2010 The registered manager must ensure the recruitment process is thorough and she must be able to evidence this. So that the people living at the home are protected by the recruitment process. 7 35 13 17/02/2010 The registered manager must ensure that all staff working at the home receive training and are deemed competent. The training must include health & Safety, moving & handling, first aid and Fire safety. So that the residents are able to be supported by competent staff. 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 24 There should be provision for maintenance and renewal work on a regular basis so that home is kept in good condition. Records must be kept of all medicines leaving the service for disposal. 2 19 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 3 33 The registered manager must ensure that the staffing levels support the needs of the residents over the 24hour period. Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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