Care Home: Richmond Lodge

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What the care home does well People have a pre-assessment provided for them. This is to ensure that the staff will be able to meet their needs.People are encouraged to make choices and to have a lifestyle that they prefer.People live in a homely, comfortable environment.People at the home have confidence in the staff who care for them.There is a complaint procedure, which is available for people to use and procedures for staff to follow if they suspect anyone is not being properly treated. What has improved since the last inspection? A new controlled drugs medicines cabinet has been bought to house medicines in the correct way.Health related tasks are now mostly undertaken after consultation with the District Nurses. What the care home could do better: Staff do not always recognise when they should seek further help, advice or training so that they can deliver better care.There is an insufficient number of staff who have received training to protect people from abuse.The complaints procedure is not written in an easy to read format for people at the home, who may wish to use it.The recruitment procedure should be improved to ensure that people at the home will be protected by the policies and procedures.The overall management of people at the service has changed and people at the home are not always having their needs met. Key inspection report Care homes for adults (18-65 years) Name: Address: Top Coxmoor Farm Richmond Road Kirkby in Ashfield Nottinghamshire NG17 7PR 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: Lesley Allison-White Date: 3 0 0 9 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 38 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 38 Information about the care home Name of care home: Address: Top Coxmoor Farm Richmond Road Kirkby in Ashfield Nottinghamshire NG17 7PR 01623750620 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Blue Sky Care Ltd care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning disability - Code LD. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Top Coxmoor Farm is registered to provide care for up to 5 people with a Learning Disability. The home is a detached, adapted and extended farmhouse. It has 5 bedrooms that offer at least 12 sq m of useable space and the main communal areas are in excess of the National Minimum Standards. The home has level access and there is a ground floor wet room with rails and a raised toilet seat for people with a disability. There are brochures and information about the facilities and services the home offers. This is available at the reception point in the Care Homes for Adults (18-65 years) Page 5 of 38 home. The weekly costs are, £1,160.00 and any additional staff support that may be required following assessment are charged at £11.00 per hour. Care Homes for Adults (18-65 years) Page 6 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 38 How we did our inspection: This is what the inspector did when they were at the care home This is an over view of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is on outcomes for people using the service and their views on the service provided. This service was last inspected on 12th August 2008. Prior to the visit an analysis of the Care Homes for Adults (18-65 years) Page 8 of 38 agency was undertaken from information gathered including information from the Annual Quality Assessment (AQAA) completed by the provider. Surveys were not sent out and other pieces of information was used as part of the evidence gathered. The site visit lasted seven hours and the main method of inspection used was case tracking which involved looking at the records of two people in detail and the third record was seen to confirm what the inspector saw of that person. Although there was some communication with the people who live at the home, details were obtained from observation, by checking their records, minutes from meetings, thank you cards sent to the home by relatives and discussing aspects of care with staff. Care Homes for Adults (18-65 years) Page 9 of 38 A discussion with the Registered Person, the deputy manager and brief discussions with other staff took place to provide further information as required. Care practises were observed at inspection. The premises were looked at and there was evidence of security to ensure that confidential information is protected. The current Registration certificate was displayed but the copy of the Employers liability certificate was out of date. Care Homes for Adults (18-65 years) Page 10 of 38 What the care home does well People have a pre-assessment provided for them. This is to ensure that the staff will be able to meet their needs. People are encouraged to make choices and to have a lifestyle that they prefer. People live in a homely, comfortable environment. People at the home have confidence in the staff who care for them. Care Homes for Adults (18-65 years) Page 11 of 38 There is a complaint procedure, which is available for people to use and procedures for staff to follow if they suspect anyone is not being properly treated. Care Homes for Adults (18-65 years) Page 12 of 38 What has got better from the last inspection A new controlled drugs medicines cabinet has been bought to house medicines in the correct way. Health related tasks are now mostly undertaken after consultation with the District Nurses. Care Homes for Adults (18-65 years) Page 13 of 38 What the care home could do better Staff do not always recognise when they should seek further help, advice or training so that they can deliver better care. There is an insufficient number of staff who have received training to protect people from abuse. Care Homes for Adults (18-65 years) Page 14 of 38 The complaints procedure is not written in an easy to read format for people at the home, who may wish to use it. The recruitment procedure should be improved to ensure that people at the home will be protected by the policies and procedures. The overall management of people at the service has changed and people at the home are not always having their needs met. Care Homes for Adults (18-65 years) Page 15 of 38 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lesley Allison-White Care Quality Commission East Midlands, City Gate, Gallowgate, Newcastle upon Tyne. NE1 4PA. Tel 03000 61 61 61 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 16 of 38 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 17 of 38 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 18 of 38 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 at Top Coxmoor Farm have their needs assessed before they move into the home so that staff will be able to meet their needs. Evidence: People are admitted to the home after having their needs assessed. As part of the pre assessment process they are visited and consulted about their likes and dislikes so that when they finally decide to stay at the home the staff will be made aware of how to meet their needs and to help them to settle into the home more easily. We saw copies of a Statement of Purpose and Service Users Guide in the home. This information about the home used pictures and words to describe an event. It included a photograph of key staff members who people could go to if they had any concerns about their treatment or care. A copy of the last inspection report is available on request also. Information about the terms and conditions of occupancy is also included. Each person has an agreed contract. Care Homes for Adults (18-65 years) Page 19 of 38 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 encouraged to make choices and to have a lifestyle that they prefer. Evidence: People have their needs assessed needs and their personal goals are reflected in their individual care and support plan. One person enjoyed going swimming in the local swimming baths and was escorted by staff members when they went out. They were supported by two staff each time, swimming aids and devices and were used at the baths on less busy days as this person did not like crowded areas or places. Another person went out using the transport provided by the home to do personal shopping, sometimes his choices included watching a local sporting event or watching an event on television. Another person used the sensory room provided by the home to relax. We saw copies of peoples care and support records, looked at minutes of meetings with staff and with people at the home. We saw records made by the staff and updates of information provided by the keyworkers where people were involved in making decisions according to their preferences. Some decisions were simple such as when to get up and when to go to bed. Others were directed by staff such as places to visit and places for a Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: holiday. People are supported to take risks and to have an in dependent life style in small ways such as making a drink for themselves, going out to the local shops with a staff member, going out for walks with staff. The management of risk takes into account the specialist needs and age of the people by providing activities that are age appropriate. One activity involved one person washing small amounts of laundry for themselves with assistance someone else went to the swimming baths and used the pool. Each care plan has a comprehensive risk assessment that is reviewed as required. Peoples limitations are documented and are shown to be in the persons best interests. People are encouraged to take part in activities within the home this includes using the craft room or the sensory room and are also encouraged to pursue interests outside the home. An activities room is provided where people can develop their skills using arts and crafts. The Annual Quality Assurance sent in by the provider tells us: We are developing the multi sensory room and an arts and crafts room, one person has indicated that he likes arts and crafts and so this facility has been added to our resources. We are re developing the garden area so that one of the residents can use their bicycle around the garden, this will involve laying a new and wider paved area and re-fencing an area of the garden to make it safer. We saw that this had been done and that people used the new facilities when they wanted to do so. The AQAA tells us: A visual aid system to improve communication and use of sign language with specific individuals is offered. This has helped the home to re-design the menu choices, to include the wishes of the people who live at the home. We saw copies of the new menus and they included something nutritious at each meal time such as fresh vegetable or fresh fruit. All meals were served with a drink. Care Homes for Adults (18-65 years) Page 21 of 38 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 are supported by staff to take part in a lifestyle of their choosing. Evidence: People are given the opportunity to take part in a variety of activities both within the home and within the community. People go swimming, watch cricket matches and attend events that they prefer. Top Coxmoor Farm care home is able to provide transport to take people to their places of interest. Policies and procedures promotes individual independence and the right to live in a flexible environment where choices about individual routines and activities are met whenever possible. People dress in a style that suits their age group and dress appropriately for weather conditions. People are encouraged to go shopping to buy their own clothes. We saw that people were encouraged to keep in contact with their family and friends. Some people told us that they will get support from staff to use the telephone to talk to Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: family members. People at the home are able to say how they wish to decorate their rooms and we saw that rooms were decorated to suit individual peoples tastes. One persons room has been fitted with blinds to create further privacy at the window and staff check that the blinds are used when he is in his bedroom. We saw people having a lunch of hot dogs, onions, sauce, salad and fruit. We noticed that not everyone ate their salad. However, the menu has been re-designed to include something nutritious in every meal and for people to be encouraged to eat something of nutritional value everyday. The new menus were not in picture format but this was to be added once completed. Opportunities are provided for people at the home to be invloved in menu planning. The meal time observed was pleasant as staff assisted people who needed help with their meals by reminding people to cut their meals into smaller portions and to ensure that people who did not take a good diet at meal time were offered food supplements as perscribed. In this way peoples nutritional needs were being monitored. For people who use sign language as a means of communication some staff are able to communciate in this way with them and alternative means such as the use of pictures are also used as a means of enhancing communications between individuals. Care Homes for Adults (18-65 years) Page 23 of 38 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. Health and personal care is based on peoples individual needs however staff do not always recognise when they should seek further help, advice or training so that they can deliver care in accordance with the principles of dignity and privacy. Evidence: Staff observed that one person took at poor diet at meal times and requested a visit by the doctor so that when they did not eat well they could be given a food supplement that would ensure that their daily nutritional requirements were still being met. We saw records of people being visited by the Doctor and other health care professionals when required. For people with specialist needs such as the management of epilepsy staff were given guidelines to follow. However, for another person with complex needs including behaviour and physical needs the staff were unable to respond appropriately as they failed at all levels to seek advice from the specialists available in the community such as continence advisors and were content to use full length continence pads. This may be an awareness and training issue. A hospital information booklet for people with Learning Disabilities was seen. It used the traffic light system to describe the most important care needs to the less important needs, preferences or wishes. In this way someone from the home admitted to hospital would have a clear outline of their needs ranging from the most important to the least Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: important needs or wishes. This would be useful for the hospital staff to have and refer to when providing treatment or care. The system is based on a traffic light system, red being very important, to amber to green. The red section includes contact details, important medical information such as past illnesses, current medicines, allergies and conditions. Amber details are details that are important to the person such as how the person communicates, what they need to help others understand them, eating and swallowing, drinking and swallowing, going to the toilet, how they move around, taking medicines and express pain. In the green section the likes and dislikes are included about the person. This is an effective way of helping someone when they are admitted to hospital and should reduce any anxieties that they may have about being in an unfamiliar environment. The AQAA tells us: staff prompts residents to do as much for themselves as possible and that residents access a range of health care services including dentists, doctors, psychologists, opticians and chiropodists. On medication we were told we use the Boots system and staff administer medication following training and assessment which is updated annually. Training is provided inhouse using recognised training material in the safe handling and administration of medications. Medicines were stored in medicine cabinets compliant with the guidelines relating to the storage of medicines. We observed that medications were signed when given. A monthly audit of medications is carried out at the home. The homely remedies policy of stock kept at the home was out of date as it did not reflect the medicines that we saw being stored in the cupboard for homely remedies, neither was the sheet signed or dated by a doctor. This was discussed. The deputy manager agreed to have this updated to ensure that this area of medication was made safer. There were no Controlled Drugs on the day of inspection. (Controlled Drugs are medicines that have special precautions in the way that they are managed). Care Homes for Adults (18-65 years) Page 25 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an insufficient number of staff who have received training to protect people from abuse. The complaints procedure is not written in an easy to read format for people at the home, who may wish to use it. Evidence: In the information provided by the provider we are told that: There have been two complaints received by the care home and no safeguarding.Both complaints were resolved within 28 days as per policy and procedure. However, the Commission has received information that issues from the complaints are not fully resolved and new concerns have been raised by the Police who are concerned about the staffs ability to protect themselves and the general public when out in the community with one particular person from the home. However, the person of concern has now left the care home and will not be returning. This is now subject to a review and a meeting with relevant parties will take place. There is a Compliments and Complaints procedure at the service. However, the Service User Guide and the Statement of Purpose should include under complaints, the address and contact details for Social Services and the new address and contact details for the Care Quality Commission in Newcastle. In this way people who live at the home, their relatives and all staff at the home will be able to contact people external to the organisation should they have any issues that have not been dealt with by the care home. Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: The complaints procedure is not in an easy to read format and could be reviewed to do so. In this way people at the home will be able to understand and use it. This is particularly important for the people at the home who were unable to explain what they would do if they had a concern. We looked at staff records we saw that training had taken place for eight out of sixteen staff, this is not sufficient considering the vulnerability of people who receive care at the home and six staff had received current challenging behaviour training. The acting manager was included in theses numbers. The complaint procedure is available towards the back of the entrance and in the separate out building of the office. We checked the monies of all three people at the service and although the amounts were correct only one signature was present, this does not provide sufficient protection for peoples monies or for staff. Care Homes for Adults (18-65 years) Page 27 of 38 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 live in a homely, comfortable environment. Evidence: We saw two bedrooms both were kept according to the persons wishes. Window restrictors were in place and a blind to one window facing neighbours to enhance privacy when using this room. En-suite facilities were provide for both rooms. The main bathroom was clean and pleasant. The home is kept clean and tidy by the staff and one of the people at the home as part of an activity. This person told us that they like to live and work there. The home provides outbuildings for people at the home. We looked at the outbuilding facilities. These included a small arts and craft room, a laundry room, a storage room and the office. The outside area included a paved path for one of the people to use who enjoyed riding his bike safely within the grounds. A smoking area is provided for anyone who smokes and a clinical waste bin for clinical waste. A small sensory room is being developed for people at the home to use when they need it. Recently there have been some issues with regard to noises coming from the home made by the people who live there, this continues to be monitored by the relevant authorities. The layout of the home allows for small clusters of people to live together, in a non institutional environment. Care Homes for Adults (18-65 years) Page 28 of 38 Care Homes for Adults (18-65 years) Page 29 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home have confidence in the staff who care for them and the management is aware of the need to provide staff with more training so that they can continue to do so. Evidence: We saw a copy of the weeks rota. Three staff were provided in the morning shift, two staff in the evening, one staff awake at night and another staff member in the building who slept on the premises and was available should the waking staff member need help with anyone. A manager was also available during the days or on call if needed. We saw the training records for staff although an insufficient amount of relevant training was currently being provided for the the newer staff members. On occasions the rota had female staff only to cover the afternoon shift with an occupancy of all male residents. This is unnecessary when both male and female staff are employed by the service. This can place female staff at risk as shown in one care record that stated that one of the people at the home responded more favourably to males. In this way the diverse needs of the people at the home were not always being met. We saw staff records that had short falls in the recording of information and a lack of checking information at interview. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: The AQAA tells us that : There are six people with a National Vocational Qualification (NVQ) in care at level 2 or above. We have revised our training policy and managers now deliver the training where appropriate to ensure new staff always have access to training when required, for example food hygiene or infection control, we use BVS training packs to assist in this delivery. We saw records of seven staff with food hygiene and four staff with infection control training. The number of staff listed was sixteen. The acting manager is included in these numbers. We saw that staff received supervision sessions that were recorded on their records. Two people who spoke with the inspector said that they were supported by the staff at the home. Staff told us that they felt supported by the organisation. We saw copies of staff meetings and staff present were encouraged to raise issues that concerned them. The registered person produced a list of training that was planned for staff this year and is aware that there are gaps in the training. Care Homes for Adults (18-65 years) Page 31 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The previous manager has left the service and the overall management of people at the service has changed resulting in people at the home not aways having their needs met. Evidence: The Registered Manager of the home left this service in November 2008 and CQC were informed at the time. The proposed acting manager subject to approval by CQC was also named by the provider and the induction period for this person was covered by a director of the service. At the time of inspection there was no evidence of the new manager having applied for registration with the Commission. We saw a copy of the new acting managers Criminal Records Bureau (CRB) check and Protection Of Vulnerable Adults (POVA) first check, at inspection and they were satisfactory. However, since inspection an application form has been received by CQC and an interview date provided. We did not meet the acting manager at inspection. External agencies raised issues of concern about the change of management at the home and the ability of the management team to deal with issues. The Police notified the Commission about two incidents that was brought to their Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: attention. The Commission was not notified about any of the incidents and no Regulation 37 was went in by the manager. A Regulation 37 is a notice sent to the Commission when there is a death, illness and any other event that adversely affects the well being of anyone at the home. The person causing the disturbance has since left the home and again the Commission has not been notified. The AQAA tells us that: The home has regular monthly 26 visits where they are assessed against certain criteria and managers are offered support and supervision on a regular basis. We have requested copies of them as part of the on going support for the new manager and staff. The registered person explained that he is a regular visitor to the home. We saw a handwritten letter from a relative dated July 2009. It explained: Having seen our relatives new home and talked with staff we have no qualms about Xs welfare. We feel that he is being taken care of and very well, thank you very much to everyone. Weekly fire test are carried out by the staff and a contingency plan has been developed by the company for any untoward incidents so that staff will know what they need to do. External companies are used to ensure that gas, electric and fire safety extinguishers are safe to use. There was no evidence of an external company being used to carry out a Legionnaires test for the pipe work in this old building and this is something that the provider should consider as part of the safety checks at the home. A copy of the Employers Liability certificate was seen dated 22nd Jan 2008 and a copy has been requested for this inspection. A copy of the current registration certificate provided by the Commission was seen in the office. Checks show that records are generally up to date although some gaps are found in recording. People were observed at the home when they returned from activities out in the community and they appeared happy and contented and the staff were observed interacting well with them. Care Homes for Adults (18-65 years) Page 33 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 19 13 The registered person must 30/11/2009 ensure that the health care needs of service users are assessed and recognised and that procedures are in place to address them. When staff receive up to date information and advice they will be better able to meet peoples privacy and dignity needs. 2 22 22 The registered person must 30/11/2009 ensure that the complaints procedure is written in a format that is suitable for people to use who live at the home. By providing information that is easy to use people at the home and their relatives will feel able to use it. 3 22 5 A copy of the address and 30/11/2009 Page 35 of 38 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action telephone number for the Commission must be available for people to have. This is because people at the home should have access to the Commission should problems be unresolved by the Providers of the care home. 4 32 18 Staff must gain the skills and 30/11/2009 experiences necessary for the tasks that they are expected to do. Improvements in training for all staff will ensure that they are better able to meet the needs of everyone at the home. 5 34 19 The registered person must 30/11/2009 check that employees records comply with the Care Standards Act 2000. Service users at the home will be fully protected when all employment checks are complete. 6 37 37 30/11/2009 The registered person shall give notice to the Commission without delay on the day to day operations of the home. This includes informing the Commission of any death, illness and other Page 36 of 38 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action events that has an effect on the care provided to people who live at he care home. It is a legal requirement to inform the Commission of anything that impacts on the care of people within any registered service. 7 37 10 The acting manager must apply to be registered with the Commission so that we can assess their suitability. 30/11/2009 By becoming a manager registered with the Commission we can offer further support to ensure that the service is being well run and that service users will benefit from this. 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 20 The supply and storage of homely remedies medicines should match those of the policy. They should be signed and dated by the doctor for the care home. Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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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