Care Home: Oak House Residential Care Home

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What the care home does well The atmosphere in the home remains comfortable, homely and relaxed and staff continue to be caring and kind caring to people living in the home. Wholesome, nutritious and well balanced meals are provided in addition to limited inhouse activities and outings. Visitors are welcome at all reasonable times and there is a is a complaints procedure in place. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has gardens to the rear of the property which are tidy and well maintained. What has improved since the last inspection? A significant amount of work has been carried out to improve both the quality of life for residents and the environment. The statement of purpose, service users guide and complaints policy have all been updated as has other relevant documents relating to the running of the home. All residents now have a plan of care, which includes a recent photograph and work has begun on compiling Health Action plans. A complaints record has been created and staffing levels have increased. Staff training has increased and some parts of the recruitment process have improved. Communal areas have been redecorated and new armchairs have been purchased. A fire risk assessment has been carried out and all recommendations have been actioned, in addition to checks being carried out on electrical and gas systems and infection control measures have been put in place. Regular checks are now carried out on emergency lighting, fire alarms and water delivery temperatures. What the care home could do better: The statement of purpose, service users guide and complaints policy need to be produced in a format that enables residents to easily understand them. Care plans need to accurately reflect residents current needs and Health Action plans need to be complete. Risk assessments need to be more detailed and take into account residents individual disabilities and capabilities. The Registered Provider needs to demonstrate that there are sufficient aids and adaptations to meet the needs of current residents and staff training needs to be extended to cover the particular conditions of residents. All new staff must provide a full employment history with an explanation for any gaps and reasons for leaving. Minutes of residents meetings need to be available for inspection and the registered manager needs to receive up to date training to update her skills and knowledge including the Mental Capacity Act and the associated Deprivation of Liberty Safeguards. Key inspection report Care homes for adults (18-65 years) Name: Address: Oak House Residential Care Home 56 Surrenden Road Brighton East Sussex BN1 6PS     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: Gwyneth Bryant     Date: 0 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Oak House Residential Care Home 56 Surrenden Road Brighton East Sussex BN1 6PS 01273500785 01273500785 manager.jan@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Anthony David Sargent Name of registered manager (if applicable) Janice Ford Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 14 The registered person may provide the following category of service only: Care home only ( PC) ot service users of the following gender: Either whose primary care needs on admission to the service are within the following category: Learning disability(LD) Date of last inspection Brief description of the care home Oak House is a privately owned, three storey Victorian semi-detached house providing residential care for up to fourteen adults who have mild to moderate learning disabilities. The providers have owned the home for 24 years. The home is located in a residential area on the outskirts of Brighton, close to Preston Park, local amenities and bus routes into Brighton. Placements are generally long term, with most residents having lived at the home for many years. The home works closely with the Grace Eyre Foundation and accesses Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 14 2 1 1 0 2 0 0 9 Brief description of the care home many of the services offered by them including day care provision. Accommodation is provided over three floors and consists of eleven single and one shared bedroom, therefore the home can accommodate up to thirteen service users. Communal facilities include a sitting room, lounge/diner and rear garden. There are two bathrooms located on the first and second floor and two shower facilities on the ground and first floor. Stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. The home provides personal care and support to service users who are funded by Social Services. The homes fees at the time of this inspection range between £622.00 £705.00 per person per week. Additional costs are charged for hairdressing, chiropody, toiletries, holidays and transport. Prospective service users and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Oak House will be referred to as residents. This was an unannounced inspection which began at 08:00 and ended at 13:30 and the purpose of the inspection was to check compliance with key standards and other standards. There were twelve people in residence on the day of which one was in hospital. Two residents were involved in the inspection in addition to the Registered Manager, one carer, two residents, the deputy manager and the Registered Provider. A number of documents and records were viewed; including personnel files, medication charts and care plans. Ten bedrooms were visited as were two communal bathrooms, two communal toilets and the communal lounge and dining areas. Care Homes for Adults (18-65 years) Page 6 of 32 Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Although this was provided when we asked for it, it lacked detail parts and practice on the day did not always reflect what was claimed within the AQAA, however the information is included in this report as necessary. Five members of staff returned surveys sent out by CQC in addition to three returned by residents which staff assisted them to complete. Care Homes for Adults (18-65 years) Page 7 of 32 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 8 of 32 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 9 of 32 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. Pre admission processes are satisfactory but the statement of purpose and service users guide need to be produced in a format that is suitable for the client group. Evidence: The statement of purpose and service users guide have both been updated since the last inspection but are yet to be produced in a format that enables residents to understand them. Following the site visit the registered provider pointed out that staff or residents families and friends would read and explain these documents to the residents. There have not been any new admissions since the last inspections so the pre admission assessment process could not be evaluated. However, information in the AQAA indicated that current residents would be involved in new admissions to ensure that current and new service users are compatible and a full needs assessment would take place. Care Homes for Adults (18-65 years) Page 10 of 32 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. Improvements need to be made to all parts of the care planning process, risk assessments and ensuring service users are empowered to make decisions and choices for all aspects of their daily lives. Evidence: Three care plans were viewed in depth and one other looked at briefly to cross reference with other information. The plans now include a recent photograph of the individual which facilitates identification but not all parts were completed therefore crucial information may not be recorded. There were improvements noted in all parts of the care planning systems and work had begun on providing a basic plan in a pictorial format. One resident spoken with said they had not seen their care plan but the deputy manager disputed this and said that the plan had been created with input from both the resident and a relative. However, there was no evidence in the plan to show that a relative had been involved in compiling it. Good practice suggests that it would be better for the deputy manager Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: not to contradict residents in public as it may make them feel embarrassed to be told they have forgotten something. Care plans remain inconsistent in parts and did not always match with other information such as that in the Health Action Plans. Two care plans showed that the residents could present challenging behaviour but they did not clearly outline distraction techniques that staff need to use. An incident sheet for one person showed they threatened a carer and another carer blocked the resident. Such action by staff may inflame the situation or put the carer at risk of injury, therefore clearer records needs to be created. Following the site visit the registered provider clarified that the carer blocked the door opening to prevent the resident gaining access to the carer. Care plans still do not outline any particular responsibilities such as cleaning their rooms or making their beds as claimed in the AQAA. Judgemental comments were still in evidence in the daily notes with comments such as not in a good mood. Discussion with staff and the manager found that residents do a range of activities and assist with the running of the home but daily notes do not reflect this. It is important to ensure these notes are comprehensive to both facilitate the care plan reviews and to provide evidence that needs are met as outlined in care plans. In one plan there was very good information in respect of dental needs, chiropody and eye sight tests, however the plan stated they need six weekly visits from the chiropodist and the last entry was dated 15/6/09 and although they should visit the optician every six months the last entry was dated 12/5/09. This indicates that either these healthcare needs were not met or improvements need to be made to the record keeping process. One person who has epilepsy had very good details outlining the onset of a seizure and clear direction to staff in dealing with such a situation. Improvements were noted in the risk assessment process but shortfalls remain. For example, one person who smokes holds their own lighter but the risk assessment does not cover the risks associated with inappropriate use or if other residents can access it. One person goes out alone but there is no information in respect of whether or not they have good traffic awareness or if they are likely to get lost. Following the site visit the registered provider sent information indicating that they did not feel a risk assessment was necessary as this person has been going out alone for over 40 years but one has been created in addition to one for the resident who smokes. At the start of the site visit a carer and the deputy manager discussed the personal Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: care needs of one resident in the presence of another resident and as the discussion took place near the dining room door it would have been overheard by other residents in the lounge. As the residents were leaving to go to the day centre a carer was overheard to say to the minibus driver its like having a load of kids. Each of these incidents indicate that staff do not respect residents privacy and dignity, therefore rigorous staff training needs to be provided in these matters. The manager, her deputy and care staff had a good understanding of the needs of individual residents but care plans do not always reflect this. This system relies on staff communication and good memory and therefore there is the danger that residents needs will not be met consistently. Care plans still do not include detailed information on residents in respect of wearing make-up, religious preferences, use of aftershave and similar personal preferences. One person who has swallowing problems was given yogurts during the day to improve their nutritional intake which indicates that care staff are aware of this need and take action to address it. Comments in surveys returned by residents included they make sure I am clean; they give me good food; they take care of me very well and I like all the staff and all the food. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to ensure service users have a varied programme of daily activities based on their preferences and ensure they are empowered to make decisions about their daily lives. Evidence: The increase in staff allowed care staff to spend one-to-one time with residents, with one carer assisting a resident with colouring in a book and another to work on their care plan. It would be good practice for staff to carry out the work on care plans in the privacy of residents rooms or in an area of the home where personal details cannot be overheard by other residents. At the start of the visit residents were having breakfast and there was a trolley in the dining room with a choice of cereals, however residents said they did not make their own breakfasts or lunch boxes and again residents said they were not allowed in the Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: kitchen. Information in the AQAA indicated that residents are encouraged to participate in making meals and this was confirmed by the manager. This was discussed with the manager who agreed to ensure all staff encourage residents to prepare their own meals. It was good to note that all residents were now given individual pots of tea/coffee and milk/sugar to enable them to pour their own drinks. During the visit one person was observed to be enabled to make their own sandwich at lunchtime so improvements have been made to promote residents independence. It was of concern that one resident who is noted to have a small appetite was refused a second yogurt on one occasion and on one other occasion was refused this snack between meals. This was discussed with the manager who confirmed that residents should be given a second yogurt and able to have snacks between meals. There was evidence of one carer discriminating against one resident as the daily notes were negative on each occasion. It was also this carer who refused the resident a second yogurt, therefore staff need to be trained in non-discriminatory practice. The incidents were discussed with the manager who agreed to take action to remedy these shortfalls. The plan for the person with diabetes states they need to have a low sugar and low fat diet but there were no further details as to how this will be achieved nor any information on input from a specialist in diabetes. Following the site visit the registered provider told us that their is dietary information in the kitchen and that inhouse training has been arranged. The AQAA indicated that residents are more involved with the running of the home and that their independence is encouraged in respect of cleaning their own rooms but this was not reflected in the daily notes nor was there evidence of this taking place on the day. Menus were viewed and they showed that meals are varied and well balanced with an alternatives offered at each mealtime. Four residents do not visit local day centres during weekdays but all residents have an annual holiday. Due to the age of the residents they may no longer wish to seek further education but there was no information in care plans in this matter. Following the site visit the registered provider told us that if residents wanted to attend education courses this would be arranged through the day centres. One person wants to find paid work and this was reflected in their care plan. This was discussed with the manager who said she is in the process of contacting a range of organisations to this end but there were no records of this in the residents care plan and the only reference was that one of their aims is to find a job. Following the site visit the registered provider told us that this person has been found some voluntary work to Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: update his work record. There continues to be a lack of evidence to show that staff actively encourage residents to have a basic understanding of politics and enable them to exercise their right to vote. Following the site visit the registered provider told us that all residents voted in the General Election on 5th May. One care plan indicated that the person likes to shred paper but there was no information to indicate advice had been sought to find other more fulfilling activities. Care plans included an activity record but two were completely blank so it was not possible to determine whether or not individual leisure preferences were met. In house activities remain limited with the daily programme in the hallway of the home listing the weekday programme as mostly consisting of watching television/films or relaxation and board games or listening to music. The only variation were one morning they play Wii games and one afternoon is painting. There were no activities listed for the weekend. There was a list of outings on the noticeboard in the home but these were provided by an outside organisation rather than by the home. It is important to ensure a varied range of both in-house and outside activities are organised and provided by the home to ensure residents have a good quality of life. One survey returned by a resident indicated that the home could provide more activities. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to support service users in respect of their personal and healthcare needs and all aspects of the safe handling and recording of medication needs to be improved. Evidence: All residents had a Health Action Plan but not all were completed and one was left blank despite their complex needs related to their dementia. However, this persons care plan did include detailed information to demonstrate advice had been sought in respect of their swallowing difficulties and where appropriate pictorial information to direct staff in this matter. One care plan included information on the individuals healthcare problems such as eczema but this was not in the Health Action Plan. Two care plans showed that the residents could present challenging behaviour but they did not clearly outline distraction techniques that staff need to use. Good practice suggests that all staff need to be clear on how to defuse incidents. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Residents said that they are given money for drinks at the day centre and the manager confirmed they also take responsibility for their own money when out shopping. This needs to be recorded in care plans as it demonstrates that action is being taken to enable residents to be more independent. Some residents had their fingernails painted and they confirmed this was done by staff in the home. It was good to note that one person prefers to stay in bed later than the other residents and this was supported with staff preparing their breakfast later. This same person said they did not want to prepare their own meals as thats what staff were paid for. This decision needs to be recorded in their care plan and additional information to demonstrate that they are periodically offered the opportunity to change their mind. Medication administration records (MAR) were viewed and there were significant shortfalls, with gaps, signatures scribbled out, signatures overwritten with code letters and a lack of explanation when code letters are used. These indicate that staff do not follow good practice and may sign for medication prior to its administration. The AQAA indicated that residents are encouraged to administer their own medication and there was evidence to support this on the day. However, the appropriate assessments were not in place. For example, one persons daily notes showed that they were given their morning medication at night so they could take it early in the morning but staff were signing the MAR to indicate they had administered the medication. Later notes showed that the medication could not be found and the manager explained that the resident had taken it and forgotten and therefore the practice had been changed. All staff must follow good practice in respect of medication to ensure it is clear whether or not medication has been taken and explanations given for any gaps and code letters when required. One resident goes out alone and it was good to note that they are given their medication to take with them to enable them to be more independent but there was no risk assessment in place for either going out alone or for medication. These issues were discussed with the manager and she agreed to take advice with a view to enabling the resident to hold their own medication within a risk assessed framework. Care Homes for Adults (18-65 years) Page 18 of 32 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. Imrprovements need to be made to the format of the complaints policy and to staff training in safeguarding adults and non-discriminatory practice. Evidence: Information in the AQAA indicated that there are up to date policies and procedures on both complaints and safeguarding adults. The complaints procedure was seen to have been updated but has yet to be produced in a format that is easily understood by residents. Since the last inspection the manager has created a complaints folder to ensure all complaints are recorded and include outcomes and actions taken. In addition a suggestion box has been provided in the hallway of the home but there was no evidence to demonstrate that residents have been told how to use it. One complaint had been recorded and it had been investigated under the safeguarding adults protocols. The outcome was that it was not substantiated. Although the AQAA claimed that staff are updated on safeguarding adults only four of the eleven care staff have received training in safeguarding adults and this must be addressed to ensure all staff are aware of what constitutes abuse and how to protect residents. For example, the daily notes for one person showed that they had been refused a snack even though the care plan states that they are a poor eater. Refusing to give a resident food could be regarded as abusive unless there are good reasons Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: why an individual should not have a particular food. A resident stated that one carer shouts at service users and that if one particular person opens the drawers/cupboards in the dining room staff tell her off; she really gets it in the neck. The manager needs to address these allegations to ensure no one in the home is subject to abuse. Care Homes for Adults (18-65 years) Page 20 of 32 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. The standard of decor within the home is good, providing people living in the home a safe, homely and comfortable environment but improvements need to be made to the provision of adaptations and aids to daily living. Evidence: Ten bedrooms were visited in addition to the kitchen, laundry and communal lounges and dining room. The communal lounge and hall has been redecorated since the last inspection and new armchairs purchased each of which has improved the environment. Bedrooms were clean and tidy and there was evidence to show that residents are able to bring in their personal possessions. Two bedrooms were malodorous and this needs to be addressed to ensure they remain comfortable. One communal toilet still lacks a hand wash basin but the registered provider and information in the AQAA indicated that there is an intention to extent the bathroom into this area therefore there will not be a need to install a wash basin. When asked, one resident confirmed that they were choosing the decor and pictures for the communal rooms. The registered manager confirmed that she and the deputy manager chose the pictures and colour scheme. Residents need to have the opportunity to be involved in the running of the home and to be consulted in such Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: matters. Four staff have been trained in infection control and other measures were in place with the provision of soap and towels in all communal toilets and antibacterial hand gel for use by all visitors. The AQAA indicates that there is a rolling programme of improvements planned including redecorating residents bedrooms and communal areas. Good practice would be that the registered provider has the premises and facilities assessed to ensure the home is able to continue to meet the needs of those residents whose mobility has decreased. Care Homes for Adults (18-65 years) Page 22 of 32 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. There are sufficient staff deployed but improvements need to be made to staff training and to the recruitment practice to ensure that the needs of people using the service are met and that they are protected. Evidence: Staffing levels have been increased since the last inspection and a cleaner has also been employed which allows care staff more time with residents. This was in evidence on the day with one carer spending one-to-one time with a resident. Information in the AQAA stated that staff are given appropriate training to meet individual residents needs and a staff training programme has been created but the training records showed that they have yet to be trained in epilepsy, diabetes and dementia care. The AQAA shows that specialist training is where the service could improve but this was a requirement at the last key inspection. The service needs to ensure it adheres to the timescales set in their own improvement plan and the last inspection report. The AQAA states that the service has improved by encouraging staff to gain more training to understand the ageing process and dementia but there was no evidence of this on the day. The AQAA states that the recruitment process has been reviewed but there remain Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: shortfalls that may put residents at risk. The recruitment records for the last two people to be employed were viewed and although all had an Independent Safeguarding check and two written references, neither had provided a detailed employment history with an explanation for any gaps. The staff training that has been provided is that of the total of eleven care staff not all had been trained in all the necessary aspects of care to ensure they have the skills and knowledge to meet residents needs. The manager said that the deputy manager has been trained in Makaton but this was not reflected in her training records. Some staff have been trained in equality and diversity, medication, manual handling, infection control, first aid, food hygiene and safeguarding adults. Only the manager, her deputy and one carer have been trained in dementia care. The lack of detail in care plans, risk assessments and comments in the daily notes suggest all staff need to receive training in these matters. The manager and deputy confirmed that all new staff undergo an induction programme that meets the current guidance but the records were not available on the day as staff had taken them home. The AQAA also indicated that the three new members of staff are in the process of completing induction training. Good practice suggests that summaries or copies are held in the home to ensure they are available for inspection. In order to fully comply with the latest guidance each member of staff should have a training needs assessment to ensure they have the skills to meet residents needs in full. The AQAA showed that of the eleven care staff five have achieved at least National Vocational Qualifications at level 2 in care and one other is in the process of gaining this qualification, therefore the home is on target to exceed the required 50 of staff with this qualification. Returned surveys indicated that staff were positive about all aspects of the service provided and felt that they received sufficient training to enable them to meet residents care needs. Comments included we enjoy ensuring that the home has a warm, welcoming and homely atmosphere and the staff team are experienced and work well as a team and the home could ensure that all relevant paperwork is up-todate and continually added to as and when the need arises. Three members of staff believed that there are usually enough staff to meet residents needs. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the management of all parts of the service to ensure residents benefit from a well managed service and that all aspects of their welfare, safety and health are protected and promoted. Evidence: The AQAA was returned on time but was brief in parts and did not give detailed information about the service. There was limited evidence to support the claims made within it. This indicates a lack of understanding of the importance of the AQAA and this needs to be addressed. Although improvements were noted in all parts of the service information in the AQAA and the improvement plan did not match the practice on the day. For example, the improvement plan stated that all personal care plans would be completed by 28 March but on the day this was not the case. The improvement plan stated that all staff would receive specialist training in to meet residents special needs but staff have yet to receive training in dementia care, diabetes and epilepsy. It is crucial that the timescales in the improvement plan are adhered to and that the information in the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: AQAA accurately reflects the services offered. The AQAA states that the local authority would be consulted in the event of an incident related to the Mental Capacity Act or Deprivation of Liberty Safeguards but there is no evidence that the manager has the appropriate training so may not be clear when such legislation applies. One care plan stated that the individual had agreed to staff administering their medication but it was not clear if the person had capacity to make an informed decision. Following the site visit the registered provider told us that training in the Mental Capacity Act and Deprivation of Liberty Safeguards has been booked for both the manager and her deputy. Although information in the AQAA states that regular residents meetings are carried out, the minutes of such meetings were unavailable on the day. Minutes of staff meetings were available and they demonstrated that staff were consulted on the running of the home. There was evidence to show that electrical appliances have been tested and the registered provider confirmed that a full check on the gas and electrical systems has been carried out to ensure they are safe. In addition there was evidence that regular checks are carried out on fire alarms, water delivery temperatures and emergency lighting. A fire risk assessment has been carried out and all recommendations have been met in full which ensures staff and residents are not at risk in the event of fire. The fire safety manual also include personal evacuation plans for each resident which gives staff clear guidance as to the level of assistance residents need in the event of fire. One new member of staff has yet to be trained in Moving and Handling but there personnel records do not stipulate that they do not move residents until they have been trained. This needs to be rectified to ensure it is clear that no staff can assist in transferring residents until they are trained to do so safely. A safeguarding incident was raised and investigate by the home but the manager failed to notify the Commission as she is required to do. This was discussed with her and she explained that she believed the local authority would notify the Commission. She agreed to ensure she is familiar with the regulations in respect of notifications to ensure correct action is taken in future. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 That the statement of 09/06/2010 purpose and service user guide be produced in a format suitable for the client group. To ensure prospective service users can understand what services to expect prior to admission. 2 6 15 Care plans must be complete, consistent and include the individual care needs of service users, including dietary needs, their goals and aspirations and be regularly reviewed. To ensure service users needs are documented and staff directed in care delivery. 09/07/2010 3 19 13 That all service users have a 09/06/2010 fully completed Health Action plan and that risk assessments be more detailed for service users Page 28 of 32 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action who go out alone and those who smoke. To ensure healthcare needs are identified, actioned and that service users are not at risk. 4 20 13 That medication adminstration records are clear, accurate and up to date and that service users are supported to self medicate within a risk assessed framwork. To reduce the risk of medication errors and promote service users independence. 5 22 22 That the complaints 09/06/2010 procedure be produced in a format that is understood by service users. To ensure they know how to make a complaint. 6 32 18 That all care staff are provided with specialist training where service users have a particular condition and to include nondiscriminatory practice and safeguarding adults. To ensure staff have the skills to meet service users individual needs. 09/06/2010 09/05/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 7 34 19 That all new staff provide a 09/06/2010 detailed employment history with a written explanation for any gaps. To ensure service users are not at risk. 8 37 9 That the registered manager 09/07/2010 recieves training to update her skills and knowledge including the Mental Capacity Act and Deprivation of Liberty Safeguards with particular emphasis on the service user who locks themselves in their bedroom. To ensure she is aware of the latest guidance and legislation. 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 3 4 12 14 32 35 That work to find education or work for service uses be recorded in their care plans. That evidence is provided to demonstrate the activity programme is based on service users preferences. That all care staff receive training in good record keeping and risk assessments. That a summary of staff induction programmes be held on the premises to ensure they are available for inspection at all times. Care Homes for Adults (18-65 years) Page 30 of 32 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 5 39 That the minutes of residents meetings are available for inspection. Care Homes for Adults (18-65 years) Page 31 of 32 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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