Care Home: Palmwood Court Care Home

What the care home does well People who want to live at the service have appropriate information and have their needs properly assessed before admission. People are involved in planning the care and support they receive. Risks are assessed so that people can be supported to be as independent as possible. People take part in some varied activities and they told us the food was always well cooked and on time. "Food is always prepared to a high standard." There was always a vegetarian choice and additional snacks were available. The complaints procedure is clear for people and they told us feel safe in the home. People like the way the accommodation is designed and we were told "its a nice place to live". A sufficient competent staff are available to meet basic care needs and all new staff are recruited safely. The majority of staff have a National Vocational Qualification at level 2 or above and people were satisfied with the staff available, "Staff are alright". Health and safety are given priority by the manager, who makes sure all tests and servicing of essential equipment are completed at the required intervals. What has improved since the last inspection? Support workers have now taken on key working responsibilities and are involved in keeping support plans up to date. Records of complaints are on the computer system. Requests for improvements in the premises have been listened to and people have been pleased with the improvements so far. There was new flooring in bungalow 17 and recently new furniture had been installed in two of the bungalows. The bathroom floor had also been replaced in bungalow 17 and in bungalow 14 the bathroom was recently converted into a wet room suitable for people using wheelchairs. One of the kitchens has been replaced. What the care home could do better: Increase the availability of staff for people to pursue more individual activities in the community. People told us "We need more time away from the building" and "more time one to one with staff away from home". Ensure all staff follow procedures for the recording, handling and safe administration of medicines in the home. This is so that people receive their medicines as prescribed and their health and welfare are safeguarded. We recommend they put a system in place to closely monitor the administration of medicines. Upgrade the kitchen in bungalow 14 to maintain safe and comfortable accommodation for people living there.Replace the garden furniture to provide comfortable seating outside. Someone told us "can`t sit on that, we need a new one". Review staffing levels at all times of the day and provide sufficient staff to meet people`s holistic needs. People wanted more time individually with staff in the home as well as for outside activities. Nottingham Community Housing Association must arrange for an appropriate representative to visit the home on a monthly basis, interview people, inspect the premises and provide a monthly report to the manager and for the Commission about the conduct of the home. This is to ensure the quality of the service is regularly monitored and that it is being run in the best interests of people living there. A report should also be provided for people living in the home of any survey conducted by Nottingham Community Housing Association about the service provided. Key inspection report Care homes for adults (18-65 years) Name: Address: Palmwood Court Care Home 14/17 Palmwood Court, Highbury Vale Bulwell Nottingham NG6 9BZ     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: Meryl Bailey     Date: 0 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Palmwood Court Care Home 14/17 Palmwood Court, Highbury Vale Bulwell Nottingham NG6 9BZ 01158443679 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: myvonneh@ncha.org.uk Nottingham Community Housing Association care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users shall be within category MD To allow one named service user of 67 years of age to reside at Palmwood Court Date of last inspection Brief description of the care home 14 / 17 Palmwood Court is a purpose built care home for up to twelve adults with a mental health needs. There are three bungalows, each one accommodating up to four people. There is another bungalow for the admininstration, office and staffroom and there is a large lounge for everyone to share. Each bungalow has its own kitchen and bathroom facilities as well as a private garden that people living at the service are actively encouraged to maintain. The home is located in a quiet cul-de-sac in the residential area of Bulwell and is close to local amenities and bus routes into Nottingham City Centre. The fees for accommodation and support are dependent on individual needs and Care Homes for Adults (18-65 years) Page 4 of 28 1 1 1 2 2 0 0 8 12 Over 65 0 Brief description of the care home Continuing Care funds are available. Further information is given to people during the assessment period. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We ask managers to complete their own assessment about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. This is called the Annual Quality Assurance Assessment (AQAA). We use this to help us review the service each year. We received one from the manager of Palmwood Court in October 2009. It was mostly completed and we used the information to plan the inspection visit and write this report. We have also reviewed all other information we have received about the home since we last visited. We sent survey forms to people who live in the home and we have used information in Care Homes for Adults (18-65 years) Page 6 of 28 the four that were returned to us. The main method we used when we visited the home is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We read other documents as part of this visit and the shared parts of the premises were seen in order to form an opinion about health and safety. With peoples permission we saw a small sample of individual rooms. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Increase the availability of staff for people to pursue more individual activities in the community. People told us We need more time away from the building and more time one to one with staff away from home. Ensure all staff follow procedures for the recording, handling and safe administration of medicines in the home. This is so that people receive their medicines as prescribed and their health and welfare are safeguarded. We recommend they put a system in place to closely monitor the administration of medicines. Upgrade the kitchen in bungalow 14 to maintain safe and comfortable accommodation for people living there. Care Homes for Adults (18-65 years) Page 8 of 28 Replace the garden furniture to provide comfortable seating outside. Someone told us cant sit on that, we need a new one. Review staffing levels at all times of the day and provide sufficient staff to meet peoples holistic needs. People wanted more time individually with staff in the home as well as for outside activities. Nottingham Community Housing Association must arrange for an appropriate representative to visit the home on a monthly basis, interview people, inspect the premises and provide a monthly report to the manager and for the Commission about the conduct of the home. This is to ensure the quality of the service is regularly monitored and that it is being run in the best interests of people living there. A report should also be provided for people living in the home of any survey conducted by Nottingham Community Housing Association about the service provided. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have appropriate information and have their needs properly assessed before admission. Evidence: The manager told us in her Annual Quality Assurance Assessment that all new people are referred by the continuing care panel and full assessments are supplied. Suitable people were invited to visit the project and a further assessments were completed. The manager told us she was extending the assessment tool to include further information about specific needs. We saw examples of comprehensive initial assessments on a sample of peoples files and some people told us they had visited with family members before moving in. There was a guide to the service in each bungalow and some people had kept a copy in their own rooms. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in planning the care and support they receive. Risks are assessed so that people can be supported to be as independent as possible. Evidence: The manager told us in her Annual Quality Assurance Assessment that they had started person centred planning and that all people living in the home were involved in this. An action plan she had also sent to us stated The key worker system has been revamped. Support workers have now taken on key working responsibilities, rather than senior staff multi working. Hence 1:1 with service users, therefore keeping support plans up to date. During our visit we saw that one of the staff was involved in a task of reviewing and updating care plan files. We saw one good example of Person Centred Planning, but other plans we saw were yet to be completed. There were differences in the quality of existing plans and assessments. Risk assessments were included and were mostly comprehensive. However, for one person we looked at in detail, there was no risk assessment relating to particular aspects of mental health. The deputy manager worked on this during the inspection visit to ensure all staff had Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: direction about action that might be needed. The manager told us she was arranging for all Support Plans to be checked to make sure they all contained the essential information. Following this inspection, the manager contacted us and informed us that all care and support plans were being sorted on Monday 9 November 2009. People told us they had access to their own Support Plans and they had signed their agreements to assessments and action plans. Those we spoke with knew their key workers and said they discussed things with them regularly. One of the staff told us that having been away from the service for several weeks it was possible to quickly catch up with current needs as all daily notes were up to date on the computer system. We saw a sample of these, which demonstrated that staff were skilled in recording using the computer. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Palmwood make their own choices and take part in varied activities, though they would benefit from more individual activities. Meals are enjoyed. Evidence: In the Annual Quality Assurance Assessment the manager described a range of activities and said that social inclusion was a priority. People told us that they had previously been out with staff for walks and used to do gardening activities. One staff member told us this had not been possible lately due to staff absences, but was about to start again. Often the staffing levels were not sufficient to do individual activities. Two of the four people that completed our survey forms also said this: We need more time away from the building and more time one to one with staff away from home. We have also addressed this in the staffing section of this report. Otherwise people told us they could chose what they did around the home and two said we like to watch TV especially the Dave channel. Some had regular visits fro family members Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: and went out with them. A social club was held in the main lounge once a month and other group activities had been arranged. There had been a group outing to Skegness. People told us that they do some of the chores around the home to maintain their independence and life skills, I like to do the pots in my bungalow and I do my own washing, but the staff do the cooking and cleaning for us. There was a housekeeper employed. People told us they had a choice of meals, but were not involved in preparing meals as much as they would like. Again this was due to staffing numbers in the evening. However people told us the food was always well cooked and on time. Food is always prepared to a high standard. There was always a vegetarian choice and additional snacks were available. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied with the personal and health care support they receive, but the current management of medication puts people at risk of not receiving their medication as prescribed for them. Evidence: The care plans we saw specified the support needed where assistance with personal care was indicated. Some people required some prompting, but other people told us they had no needs in this area. We found evidence in peoples care plans that assistance was given for people to receive treatment to maintain health and wellbeing. There were records of blood tests and regular weight checks. It was clear there had been regular input from healthcare professionals in terms of maintaining the mental health of people who live at the service, and we saw evidence of regular Care Programme Approach reviews. People told us that they thought their health was well looked after. Medication was held securely in each bungalow. When checking the records we found some ommissions and discrepancies. One person had clearly not received one dose of Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: an antibiotic that was prescribed and no reason was given. Another person had not been given an antipsychotic drug. The records suggested more had not been given, but the deputy manager counted and checked to find that there were some occasions when medication had been given but not always recorded. There were 10 occasions when O was put into the record and the key stated this meant medication was not given for other reasons. However the reasons were not clarified. On other occasions reasons were given as refused. On one persons plan it stated S to be given medication as prescribed by psychiatrist. Staff to give S prn med when necessary. In another case it was stated Prn to be given for agitation. In both cases there was no clear direction for staff to respond specifically to the presenting behaviour. On the day following the inspection visit the manager informed us: all staff have been reminded about sigs(signatures) on drug cards, prn has been altered to give clearer instructions for use (and regarding the antipsychotic drug, we are) still trying to make a usable check sheet. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their views are respected and they feel safe in the home. Evidence: The complaints procedure was in pictorial format and on the wall in each bungalow. There was also a grumbles and appraise policy leaflet. Records of complaints were on the computer system. People told us they knew how to make complaint and would speak to the manager or deputy manager if they had any concerns. Requests for improvements in the premises have been listened to and people have been pleased with the improvements so far. All staff had received training in Safeguarding Adults and we saw copies of certificates on their files. They had also been trained in the Mental Capacity Act. A safeguarding policy and a copy of the local safeguarding procedures was available in the main office. Staff we spoke with understood their responsibilities to keep people safe. One concern expressed by a neighbour was responded to appropriately. People told us they felt safe and one person told us told us Everybody likes each other and we get on well. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied with the accommodation provided. Evidence: People are accommodated in three bungalows and a fourth is used for staff and offices. There is also a large shared lounge with a pool table available. All areas were found clean and there was a laundry equipped with industrial machines. There was new flooring in bungalow 17 and recently new furniture had been installed in two of the bungalows. The bathroom floor had also been replaced in bungalow 17 and in bungalow 14 the bathroom was recently converted into a wet room suitable for people using wheelchairs. We saw two bedrooms and they were individualised. People told us they had everything they wanted in their own room. One kitchen had been replaced, but the kitchen still needs replacing in bungalow 14. The manager told us there is not enough money in the budget and it will not be done before April 2010. The same response was given for new garden furniture as requested by one person for the rear garden at bungalow 15. The existing garden furniture was old and unclean and the person said cant sit on that, we need a new one. Otherwise, we were told its a nice place to live. We noticed that, as at the last inspection there were considerable leaves that had not been cleared from the garden and the guttering was full of debris affecting drainage. The manager started to follow this up on the day of the inspection Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: visit and on 17 November 2009, she informed us that all the leaves have been cleared. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A sufficient competent staff are available to meet basic care needs, but not sufficient at all times of the day to meet each persons holistic needs. All new staff are recruited safely and people benefit from the support received from trained staff. Evidence: The staffing rota showed which staff were working during four overlapping shifts. There were two staff on each shift, which meant that there were three staff for main part of the day (9am to 4.30 pm) and two at other times and throughout the night. Management hours were in addition to this. Staff told us there was always a handover meeting when new staff arrived for a shift and that these meetings were very useful as well as the communication book and staff diary, so that all staff had up to date information. People told us Staff are alright, but they also said they would like more staff so that they could have more individual support to go out more often. In the evenings there were two staff and people told us this meant the evening meal was cooked in one of the bungalows and taken to the others. Some people said they would prefer more staff to be available so that they could be more involved in preparing meals with staff. We checked the records of four staff and found evidence that references were sought and checks through the Criminal Records Bureau had been carried out before new Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: people started at the home. Some of the previous records about this were held centrally at another office, but there was a system in place for the manager to verify that she had seen original evidence that checks had been carried out. Some forms for this were not fully completed when we visited, but the manager confirmed during the following day that these had now been completed in full. The manager told us in the Annual Quality Assurance Assessment that 15 out of 16 staff have a National Vocational Qualification at level 2 or above. We saw records to show that all staff had been trained in the Mental Capacity Act during last year and there were also certificates on staff files about other training within the year. This included Food Hygiene, Diabetes, Sensory Deprivation and Safeguarding Adults. Refresher training in Moving and Handling was booked for 24 November 2009 and there were older records of previous training. All staff had recently received information about E training. They were selecting areas they wanted to develop and using the Internet to work at their own pace. Staff said that they had a lot of support with training and had regular supervision meetings. There were records of these meetings. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate management arrangements are in place, but the lack of formal monitoring of the service by the registered provider does not ensure the service is always run in the interests of people living there. However, health and safety are given priority by the manager and staff. Evidence: The registered manager was present at the inspection visit. She told us she is based at Palmwood for the first half of every week and based at another care home for the second half of the week. This is a temporary arrangement until another manager is appointed at the other home. There is a deputy manager, who was also present during our visit. Staff said that there was always someone available when they needed support either in person or by telephone. The manager returned the Annual Quality Assurance Assessment (AQAA) to us at the time we requested. For the most part it was completed in detail, but the sections relating to the management of the home were left blank. At the inspection visit we asked for these to be completed and have given extra time, but we have still not Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: received them. The manager told us that the provider, Nottingham Community Housing Association (NCHA), conducts quality monitoring surveys each year and that this was carried out recently. There were no results available and people living at Palmwood said they had not seen any. The manager said that there were monthly meetings held on Sundays between staff on duty and people living in the home. We saw notes of the last one that was held on 6 September 2009. Five of the twelve people living there attended and discussed food and activities. There had been no meeting in October 2009. Some people told us that there was not always a monthly meeting as it depended on the staff that were available. There were no monthly reports available for us on behalf of the provider organisation. The Care Homes Regulations stipulate that an employee of the organisation who is not directly concerned with the day to day conduct of the home shall visit once a month, interview people, inspect the premises and provide a written report about the conduct of the home. The manager explained that, since the last inspection, NCHA had asked a support worker employed at another home to act on their behalf. One visit had been made in May 2009, but this person was also supervised by the manager and did not feel able to continue to fulfill the role. No alternative arrangement had been made. The report of that visit could not be found, but following our inspection, the manager contacted us and sent us a copy of the report, which focussed only on activities and lifestyle. The manager confirmed that no monthly visits had taken place since May 2009. Information given in the AQAA showed that tests and servicing of essential equipment had been completed at the required intervals. There were certificates and records on staff files to show that they had completed training in safe working practices, including recent Food Hygiene training for some staff in October 2009. Refresher training in Moving and Handling was booked for November 2009 and January 2010. The manager was concerned about some people who continued to smoke in their own bedrooms and there were risk assessments in place for each person that smoked. Outside shelters were provided and people were frequently reminded to use them. All bedroom doors were fire doors and were kept closed. The Fire officer had been contacted and offered no further recommendations. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 26 The monthly reports on behalf of the provider must contain the views of people living at the service, any visitors and staff To meet legal requirements and to show that the service is listening and responding to the views of the people who use it. 30/01/2009 Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Ensure all staff follow 29/01/2010 procedures for the recording, handling and safe administration of medicines in the home. This is so that people receive their medicines as prescribed and their health and welfare are safeguarded. 2 39 26 Nottingham Community 26/02/2010 Housing Association must arrange for an appropriate representative to visit the home on a monthly basis, interview people, inspect the premises and provide a monthly report to the manager and for the Commission about the conduct of the home. This is to ensure the quality of the service is regularly monitored and that it is being run in the best Care Homes for Adults (18-65 years) Page 26 of 28 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 interests of people living there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 13 20 24 24 33 39 Increase the availability of staff for people to pursue more individual activities in the community. Put a system in place to closely monitor the administration of medicines. Upgrade the kitchen in bungalow 14 to maintain safe and comfortable accommodation for people living there. Replace the garden furniture to provide comfortable seating outside. Review staffing levels at all times of the day and provide sufficient staff to meet peoples holistic needs. Provide a report for people living in the home of any survey conducted by Nottingham Community Housing Association about the service provided. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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