Care Home: Penberth House

What the care home does well The home is well decorated and has good natural light. It looks and feels like a normal house without any institutional feel to it. The rooms for residents are ensuite and provide good space and privacy. Residents said they are happy with their rooms and with the facilities in the home. The residents said that staff and the manager are friendly and helpful. They experienced in the sort of care needs residents have and are calm and organised. The food is good and residents are supported to take part in shopping and cooking and to attend a range of activities which are being developed as the residents are relatively new to the home. What has improved since the last inspection? The home now provides the residents with information about their rights and responsibilities and about the cost of their care. Care plans have been improved and now contain much better information about residents care and support needs and about activities for each resident. Risk assessments have been much improved and now better protect residents and staff. Care plans and risk assessments are now being reviewed very often with the involvement of residents. The staffing levels have now increased and staff are fully CRB checked before being employed. Staff are now being regularly supervised by the manager and siad they are happy with the support they receive. The pwner has employed a manager to do monthly checks at the home and to write down anything that needs to be improved. The current manager has been in post for a year now and has sent in an application to register with the Care Quality Commission What the care home could do better: The home must get a full assessment of care needs from social services for residents who are funded by the social services so that they can be sure they are provioding all of the care needed. Some risk assessments need to be improved to show better guidance for staff in how to manage difficult situations. This will better protect the residents and staff. The medication policy needs to be updated to include all the informatuion needed to fully support residents with their medication. This will better protect residents. The home also needs to get written consent from any resident for whom they manage medication so that they are fully included in this decision. The staff must be given a range of ongoing training by the home so that they are able to continue to support residents well. The homes manager needs to complete an NVQ level four qualification in care and management. Key inspection report Care homes for adults (18-65 years) Name: Address: Penberth House 29 Penberth Road Catford London SE6 1ET     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: Sean Healy     Date: 0 9 1 0 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 35 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 35 Information about the care home Name of care home: Address: Penberth House 29 Penberth Road Catford London SE6 1ET 02086974430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Jenny White care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category/ies of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Penberth House is a small care home registered for three people. It is an older house that has been extensively modernised and decorated to a high standard. The property is well located in terms of community facilities; it is well served by public transport and local shops, both within a short walking distance of the home. The home offers single bedroom accommodation with adequate communal space including a garden at the rear of the home. At the time of this inspection there was one vacancy. Information about the service provided is made available to current and potential Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 3 1 4 1 0 2 0 0 8 Brief description of the care home service users in the homes Statement of Purpose and Service Users Guide. The recent CQC report is currently kept at the home in the dining room. The manager agreed to explain its content to residents. At 9th October 2009 the homes fees are set at between 950 pounds and 1800 pounds per week for accommodation and support. The referring social services authority meets the majority of these costs. This includes cost of food. Transport is not provided by the home and any costs are payable by each resident. Residents have to pay for other personal expenses such as hairdressing and personal shopping. The providers email address is j.schoeffer@btinternet.com At the time of the inspection there were two residents living at the home and one resident vacancy Care Homes for Adults (18-65 years) Page 5 of 35 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 quality rating for this service is 1 Star. This means that the people who use this service experience adequate quality outcomes. This inspection site visit took place over one day on the 9th October 2009. The inspection was unannounced and was facilitated by the Manager who has now applied to CSCI to become registered care manager. During the inspection two residents were observed being helped by staff. Two residents planning files were examined and I interviewed one resident and received completed inspection surveys from two residents. Two support staff were interviewed and three staff files were examined to see recruitment supervision and training records. The inspection included examination of records and policies and procedures and a tour of the building. Care Homes for Adults (18-65 years) Page 6 of 35 All of the eleven requirements made at the previous inspection have now been met. Residents seemed to be happy at the home and said the staff are friendly and helpful and the manager is also easy to speak to. There has been much improvement in the care and management provided. The home now has a full staff team and a manager who has been in post for more than a year. The atmosphere was relaxed and friendly. The manager and staff involved Residents and spoke with them regularly. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The home must get a full assessment of care needs from social services for residents who are funded by the social services so that they can be sure they are provioding all of the care needed. Some risk assessments need to be improved to show better guidance for staff in how to manage difficult situations. This will better protect the residents and staff. The medication policy needs to be updated to include all the informatuion needed to fully support residents with their medication. This will better protect residents. The home also needs to get written consent from any resident for whom they manage medication so that they are fully included in this decision. The staff must be given a range of ongoing training by the home so that they are able to continue to support residents well. The homes manager needs to complete an NVQ level four qualification in care and Care Homes for Adults (18-65 years) Page 8 of 35 management. 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents have all of the information they need to help them to make informed decisions about where they live. Prospective residents individual aspirations and needs are being assessed by the home but full core needs assessments from social services are needed. Residents have detailed contracts informing them of their rights and responsibilities as required. Evidence: The home has an up to date Statement of Purpose and Service Users Guide. These contain all of the required information and these have been given to residents and are used when any new referrals are made. Fees and charges made at the home are included and the services provided and staff arrangements and qualifications are included. The home principally provides support for younger adults with enduring mental health support needs. The Statement of Purpose and Service Users Guide need to have more clear inclusion of the dates of when they were first published and Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: reviewed. (Refer to Recommendation YA1) I examined two residents care assessments. One resident had been placed at the home by Bromley Primary Care Trust and the other by Southwark social services. Both residents have been living at the home for approximately seven months and they said that they had been consulted about whether they wanted to move in and also that they were happy with the home and staff. Both had a care assessments provided by the mental health teams involved in their care which had details of the care and support needed in health care and social care with particular focus on mental health care needs. These were used to develop care plans and risk assessments for each resident which in turn were used for care reviews. However there were no full core assessments provided by the two local authorities and these must be requested by the home for the resident placed by social services in order to plan for the full range of care needed. (Refer to Requirements YA2) The home has provided both residents with a contract showing their rights and obligations including the cost of their care and who pays for it. Fees range between 950 pounds and 1800 pounds and the reason for variance is explained. Care Homes for Adults (18-65 years) Page 12 of 35 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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be sure that all of their assessed needs and personal goals are reflected in their individual plan and they do get help to make decisions about their lives. They are supported to take assessed risks which enable them to be more independent. Evidence: There was a requirement made at the last inspection for the home to ensure that residents have a care plan showing health social educational and leisure needs. Tis requirement was met. I examined two residents care plans and risk assessments. These were well organised and reflected the needs of these residents well. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: Each of these residents has a personal profile and a personal care plan which has been regularly updated. There is also a life plan explaining a bit about their backgrounds. Both residents said they had been asked by the homes staff and management about their care needs and that the staff communicated well with them. Areas of support needs around personal care and health care were very clearly identified and there is evidence of full involvement from relevant mental health care professionals in the care planning and review meetings in keeping with the Care Programme Approach in mental health support. Physical care support is also an area of support provided by the home and the resident concerned is supported to be very independent by the staff doing as much as is possible without support. This is reflected in the care plan for this resident. Each resident has an allocated Keyworker responsible for coordinating care and support and both residents said they are happy with how care is planned. There are weekly activities plans for each resident to encourage participation in household tasks and in going out in the community. Care plans are reviewed monthly by the relevant keyworkers. A range of guidelines for support of some residents in areas such as personal care travel in the community and behaviour management are in place. Good systems are in place to enable residents to fully make independent decisions about their lives. Residents are responsible for their own money social benefits and bank accounts. Each resident has a full range of risk assessments which have been reviewed as part of the care planning review process. These are being regularly reviewed at least every six months by the home but usually monthly by the keyworker. This shows good attention to protecting and safe guarding residents and staff. These are also discussed with relevant mental health team staff at reviews. However one set of guidance regarding aggression need more in depth details and guidance for staff as to what is meant by aggression and the steps staff need to take to avoid it and to reduce its impact when it occurs. (Refer to Requirement YA9) Care Homes for Adults (18-65 years) Page 14 of 35 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. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents have appropriate activities and are part of the local community. They have good relationships with family and friends and their rights are respected and responsibilities are recognised in their daily lives. A healthy diet is provided for and meals are provided at times which suit residents best. Evidence: There was a requirement made at the last inspection for the home to make better provision for residents to access social leisure and educational opportunities and to have these included in their care plan. This requirement has now been met and care plans for residents have improved and include a range of activities for each resident. For one resident these include helping with shopping and going to the shops regularly Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: to buy fresh fruit and milk going to church weekly voluntary work at Barnardos and doing laundry visiting family and going out to meet friends. Other activities included going to the cinema and parks and library and to local pubs. Residents said that they felt the home is a nice place to live and that the staff are good at helping them to plan their day. It was suggested that the range of leisure activities should be improved and the home has developed a weekly planning system for each resident to build up activities in a planned way over a period of time which suits each resident. From discussion with staff and residents it seemed to be worth considering providing internet access to residents. (Refer to Recommendation YA12) I spoke with one resident and received responses from two residents to the inspection surveys. I asked about the opportunities residents have for leisure education and for contact with their families and friends. I also asked about the processes for shopping and cooking in the home. I found all of these areas are well planned and organised by the home and that residents felt that they were able to have a full and active life including having opportunities for improving their education employment and to have full personal and family relationships. Residents have full access to activities in the local community and further afield in London. Staff provide support when necessary but also enable residents to go out independently when they are able to. Daily records are well completed and showed that staff do work well and creatively to involve residents in the daily running of the home in order to foster their abilities as much as possible. Both residents have a active keyworker who meets with them monthly and reviews the development of their care plan with them. Both residents confirmed that this is the case and that they felt able to say what they needed and that they were listened to. Residents have regular family who come to see them where possible and one resident visits her mother each Saturday. Residents said that they see their family as much as they liked to and that the staff help them to do this. Residents have their own rooms which are for single occupancy and are ensuite. Staff respect service users right to privacy and only enter the room with permission. Two residents said staff are very respectful and do not come into their rooms without being asked. Currently none of the residents have a key to the front door and while their are valid concerns about maintaining safety and security it is recommended that the home review this for each resident as part of an individual risk assessment process to decide whether it is possibly for residents to have their own keys to the home. (Refer to Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: Recommendation YA16) Residents are involved fully in shopping and cooking and are offered choices of food on a daily basis. Good records of menus are kept and the manager reviews these to see that good food is being offered. The residents spoken to said they choose what they want to eat and the food is good. Care Homes for Adults (18-65 years) Page 17 of 35 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. 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and their physical and emotional needs are being met. Support with medication is appropriate for the residents but the homes medication policy needs to be updated to include key areas and authorisation to give medication is not yet included in care plans Evidence: I examined the personal care plans and health and medication records for three residents and found these to be well organised with detailed plans showing the care to be provided in these areas. All Residents files examined showed health care needs are well managed with good input from a range of health care professionals. Residents are registered with a GP and with a dentist and chiropodist. There is support provided by psychology and Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: psychiatry in the area of communications and motivation. Residents files showed that there is full involvement from psychiatry and community mental health support teams in assessing and monitoring that both mental health care needs are being planned for and met and also that more holistic support such as provision of activities and development opportunities are being provided for. Healthcare and medication is being reviewed by the home every three months and the keyworker also carries out monthly reviews with their resident. This is a good standard of monitoring for this home and shows a significant improvement from previous inspections. All of the residents have mental health support needs and there are also high physical support needs in the care provided. There are some challenges presented in providing support in personal care but the home has a clear idea of how to enable residents concerned with the right support but also allowing them to be as independent as possible. The personal care plans are well written showing what areas residents need support with and what they should be left to do for themselves. The staff showed a good knowledge of these areas and the care plans for residents in how to provide the support needed are very detailed. This enables a very good level of understanding by staff in the support needed. The home has a written Medication policy which needs to be updated to include information about who can give medication and the assessment of residents to self medicate and definition of full and partial administration and storage arrangements and who can give medication and staff training. This list is not exhaustive and the home needs to consider all areas relevant to the home and ensure the policy reflects current best practice. (Refer to Requirement YA20) The home must also ensure that all residents who receive full administration of medication support from the home have given their written consent for the home to do this and that a copy of this is on relevant residents files. (Refer to Requirement YA20) In the interests of providing adequate monitoring of affects medication on residents it is recommended that the home provide care staff with information about side affects and contraindications so that they are better equipped to monitor the affects on residents. (Refer to Recommendation YA20) All residents are using prescribed medication. Medication is stored in a locked steel cabinet in the office area and this is safe and secure. A local Pharmacy blister pack system is used to administer medication. Records are well maintained with minimal omissions recorded. Medication is delivered every 28 days. All of the care staff have Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: been trained in administration and management of medication. The manager feels that staff are competent in administering medication and in understanding its effect on residents. Interviews I had with staff show that they have good previous experience in managing medication. Care Homes for Adults (18-65 years) Page 20 of 35 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. 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place, and staff do record complaints brought to their attention and action taken to address them. Procedures on safeguarding vulnerable adults are in place to help protect people living in the home but more ongoing training is needed. Evidence: The home has a good complaints policy in place that was last reviewed in 2009. There is a good relationship between the staff and residents and the staff spoken to showed a good awareness of how to deal with complaints. There have been no complaints since the last inspection. All staff have had training on how to deal with complaints. Residents spoken to said they felt able to speak with staff and the manager if they were unhappy in any way. There have been no adult protection issues since the last inspection. Copies of the organisations procedures and social service procedures are available in the home and these were last reviewed in 2009. All staff working in the home had received induction training in relation to Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: safeguarding adults as part of the staff induction. However the home had not yet provided more robust training in this area and needs to provide staff with this in as part of the homes training schedule. Comments received suggest that this would be welcomed by staff. (Refer to Requirement Standard 35) Two staff I interviewed showed a good understanding of how to respond to suspicion of abuse which showed they would be effective in protecting vulnerable people. The manager too was aware of her responsibilities. Care Homes for Adults (18-65 years) Page 22 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 24 26 27 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The environment is safe comfortable homely and clean and residents bedrooms are suitable for their needs. Evidence: The home is provides good facilities for three residents. It is an older property which has been extensively modernised and decorated to a high standard. It is near to public transport and local shops and provides single bedroom accommodation for each resident. There are good communal spaces within the home with a well maintained garden at the back of the home. The owner has added ensuite facilities to three of the bedrooms and all bedrooms are for single occupancy. The house is open bright and well decorated and maintained. It has a modern central heating system and access to the garden from the ground floor. There is a modern kitchen on the ground floor with a ground floor toilet and a separate bathroom on the first floor. The home is very clean throughout and is well maintained and the owner pays good attention to maintaining high hygiene standards. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Both resident said that they are very happy with the homes facilities and are happy there. Care Homes for Adults (18-65 years) Page 24 of 35 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. Standards inspected: 32 33 34 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staff are qualified and there are enough of them to ensure they meet the needs of residents effectively. Residents are now protected by the homes recruitment practices. Staff training planning needs to be improved to ensure that residents individual and joint needs are met. Staff receive regular supervision. Evidence: There was a requirement made at the last inspection for the home to ensure that there are enough permanent staff employed to provide care to residents. This requirement has nowbeen met. There were two further requirements made for the home to ensure that all care and management staff are CRB checked before starting employment and that they receive adequate levels of formal supervision. These requirements were met also. The current staff team consists of a manager and four and a half care staff all of whom are women. This is appropriate as the resident who need personal care support is female and the male resident does not need close personal care. All of the staff Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: posts are filled. The cultural backgrounds of the residents are not equally reflected in the make up of the staff team but staff have received equal opportunities and diversity training and plans are in place to repeat this training. The staff levels provide support each day as follows. 8am to 6pm 2 care staff 5pm to 9pm 1 care staff with a 2nd sometimes for evening activities 9pm to 8am one night waking care staff with support from on call management The last inspection the staff say that they feel they are able to do their job with this level of staffing. They said the manager is available to provide extra support a number of days a week and also does shift work with the residents I interviewed two staff who showed they understood the care needs of the residents and said they felt that the home was a good calm environment for residents and that there was good teamwork with regular supervision from the manager. I inspected three staff files and interviewed two staff and found that two satisfactory references are now on file for all staff and identification such as copies of passports and birth certificates are also being taken up. Enhanced CRB disclosures are also being taken up before commencement of employment. Staff said that they had been formally interviewed and that they felt they had a good induction. Three staff had an NVQ2 qualifications which meets the 50 qualified staff target for this home. The homes records showed that all new staff underwent a structured induction and that records of these are being kept. Training and development plans however are not sufficient and none of the staff had benefited from any training apart from induction since they had started work at the home. However most staff had only started employment in the past 8 months and were experienced and brought proof of training they had in previous employment which was relevant. The provider must ensure that training and development plans are agreed with each member of staff and there is a training plan showing training scheduled so that all care staff have at least five paid training days per year. (Refer to Requirement YA35) The home has good detailed forms available which have largely been completed recording the information about staff recruitment police and POVA checks references and health checks. There are induction schedules completed for each member of staff and held on the file showing a good and detailed induction has taken place. The staff employment information held at that the home has improved significantly and now is of a good standard and better protects residents. Staff confirmed that they are receiving regular supervision from the homes manager at least every six weeks but usually more often. Examination of staff files showed that this is the case and good Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: detailed supervision notes are being maintained which had been agreed by the supervisee. Care Homes for Adults (18-65 years) Page 27 of 35 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. Standards inspected: 37 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Management at the home is now stable but the manager needs to gain the required qualification and register with the Care Quality Commission. Residents are consulted by the management and staff regarding their views. The health and safety of residents are now protected by the homes practices. Evidence: A requirement was made at the last inspection for the provider to ensure that monthly management monitoring visits take place and this requirement is now met. There was also a requirement to submit an application to register the manager with the Care Quality Commission and this too also was met. There was also a requirement to ensure that the home have an annual quality audit system and development plan. This requirement was also met. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Management at the home has been stable now for the past 12 months. The manager of the home is experienced and submitted an application for registration with the Care Quality Commission. She also has the NVQ3 qualification in care and has enrolled on an NVQ4 course in management and care. The manager must complete the NVQ4 qualification in management and care. (Refer to Requirement YA 37) The homes rota shows the manager is doing few office shifts and is doing extra hours to cover staff support shifts. This can lead to some confusion as to when the manager is available to provide support for residents and when she has allocated time for management duties. It is recommended that the manager identify clearly on the homes rota when she is available for providing care and support and when she is doing management duties including staff supervision and training. (Refer to Recommendation YA37) Feedback from residents and from staff stated that the home is well managed by a manager who is able to listen and was willing to act to sort out any problems quickly. Staff are consistently supervised and said that they feel well supported by the manager to do their work. However the management of staff training needs significant improvement. (See Standard 35) Monthly visits to the home are now carried out by a person appointed by the registered provider and reports are kept at the home showing a reasonable level of detail of what was looked at and what needs to be done to make necessary improvements. The home carries out surveys of residents and their families views on how the home is run. The Care Quality Commissions Certificate of Registration currently displayed in not correct and shows the previous manager as the registered manager. The manager and provider must get a copy of the correct document showing the post as vacant or with the new registered managers name if one is appointed and ensure that it is displayed at the home. (Refer to Requirement YA37) The management of staff recruitment has been improved and the documentation required to show that this is happening safely regarding CRB checks is now available at the home. (See Standard 34 of this report) There is a written development plan in place showing proposed improvements to the home which the manager has produced. Health and safety within the home is well managed, and all residents have appropriate risk assessments in place for their protection. There is good clear documentation in place regarding health and safety fire safety food hygiene staff training and electrical and gas certification. All of this documentation is up to date. There were no health and safety incidents or concerns raised by residents or staff. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 35 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 2 14 The registered manager and provider mustrequest a full core assessment of needs from the relevant social services for the residentplaced by social services. This is to ensure that the full range of care needs are being planned for by the home. 31/03/2010 2 9 13 The registered provider and 26/02/2010 manager must ensure that the risk assessment referred to in this report are supported by appropriate and detailed guidance for care staff in how to manage risk. This is to protect residents and staff from potential injury 3 20 13 The registered provider and manager must ensure that for residents who receive 31/03/2010 Care Homes for Adults (18-65 years) Page 31 of 35 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 medication administartion support from the home there is written authorisation from the resident or their representative to authorise them to carry out this task. This is in order to protect the rights of the resident 4 20 13 The registered provider and 31/03/2010 manager must ensure that the homes medication policy is updated to include all areas required by this standard as discussed in this report. This is to ensure that residents are fully protected by the homes medication policy 5 35 18 The registered provider and manager must ensure that there is a training and development plan in place for each of the care staff and that each benefits from at least five paid training days per year This is to ensure that residents continue to be supported by staff qualified and trained to do so 31/03/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 6 37 9 The registered provider must ensure that the homes manager becomes qualified to NVQ4 as discussed in this report This is to ensure that the home is well managed by a qualified and competent manager 31/12/2010 7 37 7 The registered provider and 31/03/2010 manager must ensure that the correct details are shown on the homes CQC Certificate of Registration as discussed in this report. This is to ensure that residents and others are fully aware that the home is correctly registered 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 1 The registered provider and manager should include more clearly the dates of publication and review of the homes Statment of Purpose and Service Users Guide The registered provider and manager should consider providing internet access at the home for use by residents The registered provider and manager should consider providing keys to the home for residents for their own use as part of the risk assessment process The registered provider and manager should provide staff with information about the side effects of residents Page 33 of 35 2 3 12 16 4 20 Care Homes for Adults (18-65 years) 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 medication so that they can be fully aware of how to monitor the positive effects of medication prescribed and to identify where problems may be arising 5 37 the homes manager should identify clearly on the homes rota when she is available for providing care and support and when she is doing management duties including staff supervision and training as discussed in this report. Care Homes for Adults (18-65 years) Page 34 of 35 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. 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