Care Home: Palmer Crescent (1)

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Palmer Crescent (1) 1 Palmer Crescent Rushmoor Ottershaw Surrey KT16 0HE zero star poor service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joseph Croft Date: 2 3 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Palmer Crescent (1) 1 Palmer Crescent Rushmoor Ottershaw Surrey KT16 0HE 01932874478 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Welmede Housing Association Ltd The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Ms Christina Liddington Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of service users who can be accommodated is: 6 Date of last inspection A bit about the care home 1 Palmer Crescent is a large detached bungalow that has been extended to provide accommodation and care to six people who have learning disabilities. The home is owned and managed by Welmede Housing Association Ltd. The home has a large lounge and a smaller lounge, a good sized, homely kitchen and a well maintained, enclosed garden to the rear. All bedrooms are for single occupancy, with two having en-suite facilities. There is a newly refitted shower room and a separate large bathroom. The home provides a comfortable and homely environment for the service users to live in. The home has its own vehicle to facilitate service users activities and there is ample parking to the front of the building. 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: zero star poor 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for the service is Zero star. This means the people who use this service experience poor quality outcomes. The Commission For Social Care Inspection (CSCI) (us,we) undertook an unannounced site visit to the service on the 23rd September 2008 using the Inspecting for Better Lives (IBL) process. The site visit was undertaken by Regulation Inspector Mr Joe Croft and took over eight hours, commencing at 10:00 and concluding at 18:30. The registered manager was on annual leave but attended the home and remained for the duration of the of the site visit. The manager told us that people living at the home prefer to be known as residents, therefore this term of reference is used throughout this report. The inspection process included a tour of the premises, direct observation of practice, sampling of medication records, care plans, risk assessments and healthcare action plans were requested, but these were not in place. Discussions took place with the manager, two members of staff and three parents who were present during the site visit. Due to the complex needs and communication difficulties we were only able to have a conversation with one resident with staff support. This resident was able to convey that they attend a day centre where they take part in cooking, they like to go shopping and likes watching the television. They also go to the local towns, bowling, cafés and pubs. They stated that they like living at the home. Staff were observed to be interacting with residents in an appropriate manner, were aware of residents communication needs, and called them by their preferred names. Staff and residents were observed to be having fun with one another and staff were supporting residents as and when required. Surveys were sent to residents, staff and health care professionals. At the time of writing this report we had received completed surveys from three health care professionals and one member of staff. One issue was raised in a survey from a health care professional that was discussed with the manager. The inspector would like to thank the manager, staff and residents for their cooperation during the site visit. Weekly fees charged are 1604 pounds. What the care home does well People who use the service are provided with information that will enable to make a choice about living at the home. The needs of prospective residents would be fully assessed before being offered a placement at the home. Residents can make decisions with the support of staff. People who use the service are supported to take part in activities of their choosing. Residents are encouraged to maintain contact with their families. Meals are varied and choices are offered ensuring that residents receive an appealing and balanced diet. Staff at the home promotes the privacy and dignity of people using the service. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. People who use the service live in a safe, well maintained and comfortable environment. What has got better from the last inspection What the care home could do better Four requirements made at the key inspection of 2006 have not been complied with. The identified resident must have risk assessments in place for the use of the wheelchair and hoist. Care plans specifying how the assessed needs are to be met must be developed for all residents living at the home. Risk assessments must be produced for all residents living at the home. Residents must have health action plans in place that detail specific information in regard to the health care needs of residents. Staff must receive up to date training in regard to the administration of diazepam to ensure it administered correctly. The arrangements for charging and paying for any services additional to the fees must be included in the Service User Guide. Agency staff must not work at the home unless the agency has confirmed in writing that they have obtained all the information and documents specified in paragraphs 1-9 of Schedule 2 of The Care Homes Regulations 2001 (as amended). The manager must ensure all staff working at the home receive formal recorded one-to-one supervision at least six times per year. The Annual Quality Assurance Assessment must be appropriately completed and the information provided must be a true reflexion of outcomes provided for people using the service. All staff must receive up to date training in regard to Infection Control. 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 Joseph Croft 33 Greycoat Street London SW1P 2QF 02079792000 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 www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are provided with information that will enable them to make a choice about living at the home. The needs of prospective residents would be fully assessed before they are offered a placement at the home. Evidence: The home has a Statement of Purpose and a Service User Guide that includes information in regard to philosophy of care, daily activities, staffing, services provided, fees and a summary of the complaints procedure. Photographs are included in both these documents. The manager told us that both these documents are being updated by Welmede Housing Association. The home has not had a new admission since 1999. The manager told us that when a referral is made, she and the project manager from Welmede will undertake the assessment of needs, and a copy of the care management assessments would be obtained. Prospective residents would be encouraged to visit the home to have meals and meet the other residents and staff. A weekend stay would also be encouraged. The manager told us that placements would be reviewed after six weeks. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service do not have care plans or risk assessments in place therefore not ensuring their assessed needs are being met. Residents can make decisions with the support of staff. Evidence: Care files were requested for the purpose of case tracking two residents. These files included service user assessments of physical and mental health, medication, dental care, hearing and sight, foot care , use of toilet, personal hygiene, dressing, sleeping, grooming, walking and posture, eating and drinking, relationships, family, spiritual needs, individuality and behaviour, community presence. These were out of date for one resident, the recorded dates of the last reviews were 18/01/05, 01/12/06 and 15/06/07. One care file included information in regard to the GP, next of kin, likes and dislikes and how the resident prefers to be supported and the staff who they would prefer to be supported by. When a request was made to view the care plans for the two residents, the manager told us that they were not in place. The manager stated that all care plans are currently being produced, but she had not been able to complete this work, therefore it was not possible to evidence if the needs of residents were being met. Discussions took place with the manager in regard to the care plans, as the inspection report of 2006 informs that these were in place and they provided guidance to staff as to the support residents required. The manager told us again that they had not been done, and that the service user assessments in the care files sampled were a summary of where the resident was on the date they were last reviewed, and that care plans are to be produced from these documents. The home maintains individual diaries for each resident where records of activities and health care appointments are recorded. Discussions took place with parents who were visiting Evidence: on the day of the site visit. Parents told us that they had not seen a care plan, however, they attend the annual review meetings. Parents told us that the staff provide good care, and are able to meet the needs of their relatives. A requirement has been made that all care plans, containing the appropriate information, must be produced to enable staff and residents to know how their assessed needs are to be met. The manager and staff told us that residents are offered choices and are encouraged to make decisions for themselves. Staff know the residents very well, and can tell by their body language and facial expressions if they are not happy with a particular choice. This was observed during the site visit. Staff at the home use a communication passport that was devised by a speech and language therapist and staff. This contains pictures that help residents with no communication skills to convey their choices to staff. Risk assessments were requested during the site visit. The manager told us that these documents were not in place. One resident being case tracked had a manual handling risk assessment that was last reviewed on the 16/07/07. This same resident uses a wheelchair and hoist, but risk assessments for these had not been produced. An immediate requirement was made in regard to this. A requirement has been made that risk assessments must be produced for all residents living at the home to ensure that unnecessary risks to their health and safety are identified and as far as possible eliminated. The Annual Quality Assurance Assessment (AQAA) informs, under our evidence to show that we do it well, that individual life plans and risk assessments are in place. This was not the findings on the day of the site visit. Under plans for improvement the manager has identified that person centred plans and more risk assessments need to be completed. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are encouraged by staff to participate in a range of activities. Staff promote contact with family, friends and the local community. A balanced diet is provided to residents. Evidence: The manager told us that no resident is currently in paid employment. Residents attend day centres where they take part in a variety of activities that include cooking, exercises, touch computing and music. One parent told us that their relative also has Makaton signing at the day centre. The home has a daily list of activities each resident attends that includes snoozelem sensory sessions, day centres, shopping and reflexology sessions. Other activities undertaken include walks, Wednesday cinema club, theatre, local pub and day trips at weekends. Staff at the home provide birthday parties for residents, this was evidenced during the site visit for one resident. Their parents and family members were all present to celebrate their birthday with them. Two residents had been away for a weeks holiday in Portugal that they enjoyed. They showed us photographs of their holiday. One resident enjoys going for walks twice a day with staff and/or their relative who visits the home on a regular basis. The manager told us that two residents are supported by staff to attend monthly church services. The manager and staff told us that there are no restrictions on visitors to the home. This was confirmed during discussions with parents who were visiting on the day of the Evidence: site visit. Staff support residents to maintain contact with their families. The manager told us that residents have the opportunity to meet other people at the day centres and when going out into the community. Due to their complex levels of understanding and communication difficulties we were only able to have a minimal conversation with one resident, who was able to convey, with staff support, that they had been on holiday, attend a day centre to do cooking and likes to watch television, in particular a renowned musical they have on a video. Some residents can help with light chores at the home. Residents have been provided with keys to their bedrooms, but only one uses this. We were told that staff always knock on bedroom doors and call residents by their preferred names. Residents were observed to have unrestricted access to all communal parts of the home. The menu was viewed during the site visit. This evidenced that meals provided include meat, fish, pasta, fresh and frozen vegetables. The home uses photographs of meals to help residents to make choices. A large bowl of fresh fruit was available in kitchen for residents. Lunch was observed to be a relaxed unhurried occasion with staff available to provide support as and when required. Staff and residents had a good rapport and discussions taking place included humour. Residents were being encouraged to make choices about the food they wished to eat. One resident was receiving one to one support. The member of staff supporting this resident was aware that they had been seen by the doctor the previous day for an ailment. The member of staff had concerns as the residents health had not improved since and another appointment was made for the resident to see the GP. The manager told us that a dietitian is involved for two residents and advice is sought in regard to the menu planning. All but two staff had attended training in regard to food hygiene and handling in 2008. During discussions visitors told us that they thought the food provided to residents is good, and drinks and snacks are always available. The AQAA informs that there are opportunities for residents to participate in a range of activities. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The privacy and dignity of people using the service is promoted by staff at the home. It was not possible to evidence if residents health care needs were being met due to the lack of documentation. The amount of medication in the home does not accurately match the records held. Evidence: During discussions staff told us that they are able to understand residents preferences in regard to supporting them with their personal care needs. One care file viewed included information in regard to the staff the resident preferred to support them with their personal care needs. The manager told us that only females attend to the needs of the female residents, and for that reason there is always a female member of staff on duty for every shift. The bathroom now has an assisted bath, which was a requirement made during the previous key inspection. There is a hoist available to support residents, however, as mentioned earlier in this report, risk assessments had not been produced for the use of these. From discussions with staff, relatives and records maintained in the individual diaries, it was clear that residents have access to all National Health Care Services that included the GP, physiotherapist, dentist, chiropodist and psychologists. However, there were no Health Care Action Plans in residents care files for the recording of these appointments that would detail the reason for the appointments, the treatment provided or the medication residents have been prescribed. Therefore it was not possible to evidence that residents health care needs were being monitored, or if complications had been identified and referred to the appropriate specialist as required. For example, during the site visit one resident had recently seen the GP, and Evidence: was taking a prescribed medication, this should have been recorded in a health care action plan. The lack of health care action plans was discussed with the manager who told us that she intended setting these up. A requirement in regard to this has been made. It was noted that staff may have to use rectal diazepam, however, there was no evidence that staff had received training in regard to this procedure. Evidence was viewed that some staff had attended training in regard to Epilepsy in 2004 and 2005, and two staff had attended this training in 2008. A requirement has been made that staff must receive up to date training in regard to this procedure to ensure it is administered correctly. The home obtains medication in the original packaging from the local pharmacist, and uses the Medication Administration Record sheets (MARs) for the recording of medication. Medication is stored in a secure lockable medication cabinet. Records of medication received and returned to the pharmacist are maintained. During the sampling of the medication records it was noted that medicines held did not balance with the stock of medication kept. It was also noted that three medications had not been signed for, and no reasons for this had been recorded. An immediate requirement was made during the last inspection in 2006 in regard to this, and it is still not being complied with. Discussions took place with the manager in regard to training in medication for staff as it was noted that this was last provided in 2005. The manager told us that all staff are to attend three modules of training in regard to medication, all of which will be completed by the end of December 2008. The AQAA informs that all residents have individual life plans and risk assessments showing they cannot administer their own medication. This was not the findings during the site visit. Under our plans for improvement in the next twelve months the manager has written to complete Person Centred Plans (PCP) and Health Care Action Plans. 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 who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are protected from abuse through the homes provision of staff training and policies and procedures in regard to Safeguarding Adults, however, an issue in regard to charging must be resolved. Evidence: The Commission For Social Care Inspection has not received any concerns, complaints or allegations in regard to the home since the last inspection of 2006. The home follows Welmede Housing Association Policy and Procedure in regard to complaints that was last reviewed in September 2007. This document included the timescales for responding to complainants and the correct contact details for the Commission For Social Care Inspection. The manager told us that they have not received a complaint since the last inspection. All staff have been informed that complaints received must be reported to the manager of the home. The home has a complaints file where complaints would be recorded and included information in regard to the details of complaint, action taken by the manager, and if the complainant was satisfied with the outcome of the investigation undertaken. During discussions parents told us that they know how to make a complaint, and they would talk to the manager if they needed to. Staff told us that they can tell by residents body language, moods and behaviour if they are unhappy. The home follows the organisations policy and procedures in regard to Safeguarding Adults that was last reviewed in October 2008, and has a copy of the most recent Surrey Safeguarding Procedures. The training matrix provided by the manager evidenced that staff, including the manager, attended training in regard to Safeguarding Adults in 2008. The manager had previously attended the Surrey Multi-Agency training on the Protection of Vulnerable Adults in 2005. Scenarios in regard to situations of abuse were discussed Evidence: with two members of staff and the manager. They had a good understanding of the procedures to be followed, and staff told us that they had read the organisations Whistle Blowing policy and procedure. The manager was aware of her role in regard to the reporting of Safeguarding issues. The manager told us that no person working at the home has power of attorney for residents finances. Each resident has a building society account, and the home holds monies for residents that is kept in a secure locked cabinet. Money held for residents is checked by staff at each handover meeting. Two residents records were viewed . Records maintained by the home balanced with the money held in the individual tins. Receipts for shopping were maintained, however, it was noted that two residents had paid for members of staffs lunches when they took them to a local pub for lunch. There is no information in regard to this practise in the Statement of Purpose or Service User Guide. This was discussed with the manager and a requirement has been made that the arrangements for charging and paying for any services additional to the fees must be included in the Service User Guide. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service live in a safe, well maintained and comfortable environment. Evidence: A tour of the premises was undertaken. The home is a large bungalow that has been extended to provide accommodation to six residents who have a Learning Disability. The accommodation includes six single bedrooms that are appropriately furnished and include residents personal possessions such as family photographs, televisions and stereos. Two of the bedrooms have en-suite facilities. There is a lounge that has a large screen television, DVD, video and suitable seating for residents. The rest of the accommodation includes a smaller lounge, laundry room, kitchen, communal toilets, bathroom and a shower room. Communal areas had liquid soap and paper towels. The accommodation was clean, tidy and had a homely feel to it. Residents have unrestricted access to all communal parts of the home. As stated earlier in this report the bathroom now has an assisted bath and there is a hoist available to support residents in regard to their needs. Identified issues in regard to the environment were discussed with the manager. The fluorescent light in the kitchen requires cleaning. The laundry room was unlocked and the Control Of Substances Hazardous to Health (COSHH) had not been locked away, however, the manager attend to this. One bedroom requires attention to the ceiling as it has some water stains. The manager told us that there had been a leek and contractors had repaired this, however, they are now waiting for the water to completely dry before the ceiling is repaired. Evidence that this is being attended to was seen. Evidence: There is a large fish tank in the entrance to the home that enhances the homely atmosphere that is created by both staff and residents living at the home. On the day of the site visit the home was very clean and free from offensive odours. A requirement made at the last inspection in regard to the patio doors has been complied with. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are supported by a stable staff team. Recruitment practice at the home continues to require improving to ensure residents are fully protected. Residents do not benefit from staff having appropriate supervision that would support them to carry out their jobs. Evidence: The duty rota was viewed during the site visit. This provided evidence that there are three members of staff on each shift, one of who is always a female. Two staff cover the waking night shifts. Staffing at the home consists of the manager, deputy manager, three team leaders and five care staff. The manager told us that Welmede Housing Association have their own bank staff that are used at the home to cover staff shortages, but the home has used agency staff. Discussions took place with the manager in regard to obtaining evidence from the supplying agency that the appropriate recruitment checks, including Criminal Record Bureau checks had been undertaken. The manager told us that these had not been requested. A requirement in regard to this has been made. Discussions took place with the manager in regard to NVQ training. The manager told us that only one member of staff holds the NVQ level 2. One member of staff is to commence the NVQ level 3 training on the 25th September 2008, and another two staff are to commence NVQ level 3 in May 2009. A recommendation has been made that the manager should develop a plan of how the home is to achieve 50 of the staff employed at the home to hold minimum of an NVQ level 2. The home follows the Organisations recruitment policy and procedure. The manager told us that Welmede had re-employed the staff from the Primary Care Trust in April 2008. Three recruitment files were sampled during the site visit. Two files included an application form, two references, proof of identification, health screening and records Evidence: of notes taken during the interview. The third recruitment file did not have any of the information required. The manager told us that she had all this information but could not locate it. A requirement was made at the last inspection that the registered person must not employ a person to work at the care home unless the person is fit to work at the care home and the information and documents as specified in Schedule 2 of The Care Home Regulations 2001 (as amended) have been obtained in respect of that person. This had not been complied with on the day of the site visit. We did go back to the care home forty eight hours after the site visit. At this time the manager had the documents required, but there were no reasons recorded for the gaps in employment for this person, therefore this requirement had not been fully met. Records of Criminal Record Bureau check reference numbers were maintained in a separate file for all staff. The manager told us that new staff attend induction training that included all mandatory training, Safeguarding Adults and policies and procedures that have been produced by the organisation. One new member of staff is currently undertaking this training, however, we were not able to evidence the induction record as the member of staff had taken the induction pack home with them. The manager told us that the induction training takes six weeks to complete and is in line with Skills for Care Council. Personal development plans for staff are included in staff appraisals. Staff had individual training and development files, however, the manager told us that these require updating in regard to training and development. Other training undertaken by staff includes dementia, autism awareness and confidentiality. It was noted that staff may have to use rectal diazepam, however, there was no evidence staff had received training in regard to this procedure. A requirement in regard to this has been made. During discussion with staff it was not clear how regularly they were receiving formal one-to-one supervision. One member of staff stated they were receiving supervision every six months. This was discussed with the manager who told us that supervision is not being undertaken as required. A requirement in regard to this has been made. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has an experienced and qualified manager, however, the home is not being managed in the best interests of people who use the service. Evidence: The manager has been managing the home since 1994 and is a Registered Nurse for Mental Health. She completed the Registered Managers Award (RMA) in 2006. The manager told us that other training undertaken has included training and assessing, performance management awareness, appraisal, clinical supervision, confidentiality and report writing. The manager must attend to the issues identified in the report in regard to the care plans, risk assessments, health care plans, medication, residents finances, staff supervision, recruitment, quality assurance and staff training to ensure the home is managed appropriately. Due to the level of the residents complex needs and communication difficulties, they are not able to convey their views of the quality of the service provided at the home. A requirement was made at the last inspection that the home must have a system for reviewing and improving the quality of care provided. The system must provide for consultation with residents and their representatives, and a copy of the findings must be provided to the Commission For Social Care Inspection. This has not been complied with. Monthly Regulation 26 visits are being undertaken at the home, and copies of these reports were available at the home. Evidence: Discussions took place with the manager in regard to the lack of information in the AQAA. This is a legal document and the information provided in this must be an accurate reflection of the care home. The manager was advised to look on the CSCI website for information in regard to completing this legal document. A requirement has been made that the AQAA must be appropriately completed and the information provided must be a true reflexion of outcomes provided for people using the service. The training matrix provided evidence that some mandatory training had been undertaken by staff that included fire, manual handling and food hygiene and handling. It was noted that training in regard to first aid had not been provided to care staff. This was a requirement made at the last inspection and has not been complied with. Staff have not received training in regard to Infection Control and a requirement in regard to this has been made. The following health and safety records were sampled during the site visit. Fire risk assessments, dated 16th July 2008, last fire drill on the 31st August 2008, testing of the fire alarms 21st September 2008, servicing of the fire extinguishers on the 11th April 2008. The gas safety certificate was dated the 20th March 2008, Legionella testing on the 2nd October 2007, and the Environmental Health Officer visited on the 9th July 2008. 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 1 20 13 The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Specifically, the amount of medication held must accurately match the record held. 17/10/2006 2 34 19 & 17Schedules 2&4 The registered person must 17/10/2006 not employ a person to work at the care home unless (a) the person is fit to work at the care home and (b) the information and documents specified in Schedule 2 have been obtained in respect of that person. The records relating to persons employed at the care home as specified in Schedule 4, must be retained in the care home. 3 35 18 Staff must receive training to 19/01/2007 enable them to fulfil their role. Specifically, staff must receive first aid training to ensure that at least one member of staff on each shift is qualified in first aid. 4 39 24 The registered person must 19/01/2007 establish and maintain a system for reviewing and improving the quality of care provided at the home. The system must provide for consultation with service users and their representatives and a copy of the report from any review must be provided to CSCI and made available to service users. 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 1 9 13 The registered person shall 28/10/2008 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The identified resident must have risk assessments in place for the use of the wheelchair and hoist. 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 6 15 Unless it is impracticable to 28/10/2008 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. Care plans specifying how the assessed needs are to be met must be developed for all residents living at the home. 2 9 13 28/10/2008 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Risk assessments must be produced for all residents living at the home. 3 18 18 The registered person shall, 31/10/2008 having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. Staff must receive up to date training in regard to the administration of rectal diazepam to ensure it is administered correctly. 4 19 12 The registered person shall 28/10/2008 ensure that the care home is conducted so as to promote and make proper provision the health and welfare of service users. Residents must have health action plans in place that detail specific information in regard to the health care needs of residents. 5 23 5 The registered person shall produce a written guide to the care home (in these 28/10/2008 Regulations referred to as the service user guide) which shall include the arrangements in place for charging and paying for any services additional to those mentioned in sub-paragraphs (b) and (ba) of Regulation 5. The arrangements for charging and paying for any services additional to the fees must be included in the Service User Guide. 6 34 19 The registered person shall 23/10/2008 not allow a person to whom have regular contact with service users at the care home unless the person is fit to work at the care home, and the employer has obtained in respect of that person the information and documents specified in paragraphs 1-9 of Schedule 2, and has confirmed in writing to the registered person that he has done so. Agency staff must not work at the home unless the agency has confirmed in writing that they have obtained all the information and documents specified in paragraphs 1-9 of Schedule 2 of The Care Homes Regulations 2001 (as amended). 7 36 18 The registered person shall 31/10/2008 ensure that persons working at the care home are appropriately supervised. The manager must ensure all staff working at the home receive formal recorded oneto-one supervision at least six times per year. 8 39 24 At the request of the Commission, the registered person shall supply to it a report which describes the extent to which, in the reasonable opinion of the registered person, the care home provides good quality outcomes for service users. 31/10/2008 The Annual Quality Assurance Assessment must be appropriately completed and the information provided must be a true reflexion of outcomes provided for people using the service. 9 42 18 The registered person shall, 28/11/2008 having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. All staff must receive up to date training in regard to Infection Control. 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 32 The manager should develop a plan of how the home is to achieve 50 of the staff employed at the home having a minimum of an NVQ level 2. Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.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) Commission for Social Care Inspection (CSCI). 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. 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