Care Home: Russell House

What the care home does well There is information available for service users and their families about the home. There is a comprehensive assessment process and people are encouraged to visit the home and to stay for varying periods before moving to the home. This is a new home and staff worked with families and residents to make the move from their old homes as smooth as possible. Service users choose how they would like to spend their day and are given support to make as many decisions as they are able. The atmosphere in the home is relaxed and carers were observed to be speaking to service users kindly and with respect. When asked what the home does well families said that they appreciated the effort made by staff to support residents to engage in activities on and off the campus. One commented ` my son needs 24 hour care yet he is taken to theatres, on an annual holiday and is given the chance to do things most people take for granted`. There is good healthcare support on the site to meet service users` general health care needs and their needs arising from their epilepsy. There are complaints and safeguarding policies and procedures in place which should protect people from harm and ensure that they are listened to and that their concerns and complaints are addressed. The home is spacious and has been designed to meet the needs of people with disabilities. It is clean and service users are gradually personalising their own rooms to reflect their individual tastes. Families and staff told us that the atmosphere was calmer than in one of the old homes and this meant that residents were happy to spend more time in the lounge. There is an experienced manager and staff team who have created a happy and supportive atmosphere for residents. In general there are sufficient staff to meet people`s needs although the staffing levels in the flats where people need nursing care should be monitored to ensure that there are sufficient staff to support them to go out on a regular basis. What has improved since the last inspection? This is the first inspection of this home. What the care home could do better: Medication management must be improved to ensure that people receive their medication as prescribed. The organisation should audit the application of the medication policies and procedures to ensure they are being implemented correctly and service users receive their medication safely. The organisation should consider using a recognised nutritional assessment tool to assess the risk to service users of becoming malnourished. Service users care plans must be kept up to date and reflect their current needs and wishes. A consistent approach to assessing the risks to service users of everyday activities and minimising them should be developed to enable people to go out and help them to develop their skills safely. Staffing levels on the nursing units should be kept under review to ensure that there are enough staff to go out with residents on a regular basis. The infection control policies and procedures must be updated to reflect current guidance. The policies and procedures guiding staff on the Mental Capacity Act and the Deprivation of Liberty Regulations must be updated and introduced to ensure that people are not being deprived of their liberty unlawfully. The quality assurance monitoring should be enhanced to ensure that all aspects of care are audited on a regular basis, including medication, to ensure that service users receive a consistently high quality and safe service. Key inspection report Care homes for adults (18-65 years) Name: Address: Russell House Chalfont Centre Chalfont St. Peter Gerrards Cross Bucks SL9 0RJ     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: Chris Sidwell     Date: 1 1 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Russell House Chalfont Centre Chalfont St. Peter Gerrards Cross Bucks SL9 0RJ 00000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The National Society for Epilepsy Name of registered manager (if applicable) Mrs Yvonne Elizabeth Patrick Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home Russell House is one of a number of homes on the National Society for Epilepsy (NSE) campus at Chlafont St Giles. It provides accommodation, personal care and nursing care for up to 20 residents with learning and physical disabilities and epilepsy. The home is newly built, spacious and has good access for people with disabilites and who use wheelchairs. The home is divided into four flats. People living at the home have Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 20 20 Brief description of the care home their own rooms with ensuites and share the lounge and kitchen/dining room. There is comprehensive healthcare support available on site and from a local general practitioner. There are some facilities on site such as a small shop and cafe. Local shops are within walking distance. There is local transport to nearby towns. Care Homes for Adults (18-65 years) Page 5 of 30 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: This inspection was conducted over five days and included a review of the information we hold about the service, a two day unannounced visit to the home and the time taken to write the report. Information received about the home since the last inspection was taken into account in the planning of the visit. Questionnaires were sent to the home for distribution to service users, families, staff and other stakeholders. Care staff helped seven service users to complete the questionnaires. Two members of staff and five family members returned the questionnaires. Discussions took place with the manager, lead nurse, senior carer and care staff and some records were checked. Care practice was observed and the care of six residents was followed through in detail. The homes approach to equality and diversity was considered throughout. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Medication management must be improved to ensure that people receive their medication as prescribed. The organisation should audit the application of the medication policies and procedures to ensure they are being implemented correctly and service users receive their medication safely. The organisation should consider using a recognised nutritional assessment tool to assess the risk to service users of becoming malnourished. Service users care plans must be kept up to date and reflect their current needs and wishes. A consistent approach to assessing the risks to service users of everyday activities and minimising them should be developed to enable people to go out and Care Homes for Adults (18-65 years) Page 7 of 30 help them to develop their skills safely. Staffing levels on the nursing units should be kept under review to ensure that there are enough staff to go out with residents on a regular basis. The infection control policies and procedures must be updated to reflect current guidance. The policies and procedures guiding staff on the Mental Capacity Act and the Deprivation of Liberty Regulations must be updated and introduced to ensure that people are not being deprived of their liberty unlawfully. The quality assurance monitoring should be enhanced to ensure that all aspects of care are audited on a regular basis, including medication, to ensure that service users receive a consistently high quality and safe service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 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. The initial assessment process is thorough. Prospective residents needs are assessed carefully with them, their families and supporting professionals to ensure they can be met and that the home is where they wish to live. Residents move to Russell House from their existing homes was managed carefully and it was clear that they had settled in to their new home. Evidence: Russell House is newly built and divided into four self contained flats. Residents moved there from two older homes on the National Society for Epilepsy (NSE) campus, where most have lived for a long period. The manager said that the process was planned with residents and their families and based on individuals needs and wishes. She said that compatibility with other residents was also considered as the new flats were to be their homes. The NSE has a comprehensive admission policy. New residents would be admitted to the home by way of a multi disciplinary team assessment and assessment by the manager of the home. Prospective residents have the opportunity to visit the home for Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: varying periods of time to enable a full assessment of their needs and to see whether they and their families are happy with the support being offered. This is followed by a multi disciplinary team review, which includes the resident and their family. The assessment documentation takes account of potential residents cultural and faith wishes. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of care planning is inconsistent in the home. Care plans are not updated regularly and may not reflect residents current support needs. They are not available in any other format to help people who may have difficulties communicating, to understand and contribute to their plan. Risk assessments should be updated to reflect peoples varied lifestyles and the format that they should take should be agreed to help carers support peoples diverse needs in a safe way. Evidence: The care of six people was followed through. All had care plans although they varied in detail and whether they had been updated regularly or reflected current support needs. Current information about peoples care needs is spread over three large folders, a medication folder and an epilepsy folder which contains details as to the care the resident needed to meet needs arising from their epilepsy. Folder one held pen pictures of the residents, which were generally very good although they were not always dated or signed by the person who drew them up. Folder one also held care plans covering eighteen areas of support needs, some risk assessments and some Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: general information. Folder 2 contained some risk assessments, the key workers records of daily care given, charts which included the seizure chart which also held a record of residents weight. Folder 3 was a traditional hospital style medical record which held current and past information from all health care professionals. Care plans were not signed and dated although those that had been updated regularly did contain the date and signature when they were updated. Most are typed and some had hand written updates, some of which were dated and signed and reflected the current support needs of the resident. In one there was information relating to a residents health care needs in the medical record but not in the care plan and not easily available to care staff. Some care plans had not been updated since the move to Russell House and were last updated in September 2009. Summarised care plans in an easy read format for residents were not available, although some but not all held an easy read contract in pictorial form. There was evidence in one plan but not others that these had been shown to the resident. Some but not all plans showed that the resident and their family had been involved in drawing them up. There is some evidence through detailed likes and dislikes sections in the care plan that residents choices are respected. Risk assessments are undertaken for a range of activities related to daily living although there were no risk assessments related to visits outside of the centre although residents clearly visited local shops, theatres, sports matches, shopping and garden centres. This should be addressed. There is a clear unexplained absence policy. Families who returned the questionnaires said that they felt that their family member always or usually received the support they needed and that the home usually or always gave the support to their family member that they expected and agreed. Care Homes for Adults (18-65 years) Page 13 of 30 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. Residents are supported to live a varied lifestyle suited to their needs and wishes and are supported to take part in local community activities, bringing interest and variation to their lives. Evidence: The home is divided into four flats. Each has their own distinctive character depending on the residents, their likes and dislikes and abilities. The daily routines are flexible and families are welcomed at any time. The home worked closely with families to ensure a smooth transition for residents from their previous homes on the campus. When asked what the home does well families said that they appreciated the effort made by staff to support residents to engage in activities on and off the campus. One commented my son needs 24 hour care yet he is taken to theatres, on an annual holiday and is given the chance to do thing most people take for granted. Other outings include trips to football matches, shopping, cinemas, bowling and meals out. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Care staff were observed to be respectful towards residents and to address them by their preferred name. The atmosphere was relaxed and happy in all the units. Meals are prepared by the care staff in each unit. There is a varied menu. Most of the shopping is done on line although carers go with residents to the local shops for fresh fruit and vegetables and other extras. The kitchen/dining areas are large enough for residents to be able to help prepare food although this did not seem to be common practice. The worktops were not at a height suitable for people in wheelchairs, which is disappointing given that the building is purpose built. Care staff felt that the dining areas were too small. The home should consider how service users might be involved in the preparation of meals despite the limitations of the design. Mealtimes were flexible depending on residents activities. Care staff were aware of those who required a special diet or who had swallowing difficulties and needed their drinks thickened and food of a consistent texture. Care Homes for Adults (18-65 years) Page 15 of 30 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. Residents health and personal care needs are met promoting their health and well being. They do not always appear to receive their medication as prescribed putting their health at risk. Evidence: Residents are helped to maintain their personal appearance and all were well dressed wearing their own clothes and with individual hairstyles. Personal care is given in peoples own rooms and ensuites which are designed to support those with disabilities. All residents are registered with the local general practitioner for their day to day care but are also under the care of a consultant neurologist for their epilepsy. Records showed that they see a range of therapists including a dietician, physiotherapist and occupational therapist. Dental servics are on site or residents may go to the local hospital if sedation is required. Peoples risk of developing pressure damage or of falling is assessed. There is no formal nutritional risk assessment in place although residents likes and dislikes and an eating plan is found in their care plans. The dietician writes her advice in the multi professional medical notes. One resident was prescribed a reducing diet. The dietician had written change food proportions, reduce carbohydrate, meat, fish and protein, increase veg. No further information as to how Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: to do this was available and this advice was not reflected in the care plan. The resident had not lost weight. Residents are weighed regularly and this is recorded on their seizure chart. It was difficult to track residents weight as some had several charts. Information about peoples weight, dietary needs and recommendations from the dietician or speech and language therapist was spread over three folders and not easily accessible to carers who were preparing meals on a daily basis. The organisation should consider using a formal nutritional risk assessment tool. Peoples dietary needs should be more explicit and be reflected in their care plans. There are medication policies and procedures in place. Care staff have training in administering medication and are assessed to ensure they are competent before they give medication. No one is able to manage their own medication themselves. Carers said medication is never given covertly without the residents knowledge. They said that one person preferred their medication on top of a spoon of yoghurt but that the yoghurt was not to deceive the person, who knew they were taking medication. One resident was taking part in a clinical trial which had been discussed with her and her mother who had signed the consent form. Records are kept of medication received, administered and destroyed by the home. Medication is dispensed by an on site pharmacy. The home is not using controlled drugs at present but has a controlled drugs cupboard should the need arise. The medication administration records were completed in full. However discrepancies were found in the number of tablets received for some residents, the number recorded as having been given and the number remaining in the pack. In some cases there were more left in the pack than would be expected and in some cases there were less. The manager and staff could not account for this and nothing was recorded in the care plans or on the medication administration charts to account for the discrepancy. There have been no audits of medication administration in the home by the pharmacist or manager as part of the homes quality assurance programme. This must be addressed as a matter of urgency. The home must ensure that people receive their medication as prescribed and that their care plans and medication records show clearly why they might not have received prescribed medication. The organisation must ensure by regular audit that their medication policies and procedures are implemented in full. Care Homes for Adults (18-65 years) Page 17 of 30 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. There are complaints and safeguarding policies and that their concerns and complaints are addressed. Evidence: The organisation has complaints and safeguarding policies in place. Families told us in the questionnaires that they knew who to speak to if they had concerns and that they knew how to make a formal complaint. There is no easy read version of the complaints procedures available for service users. This should be considered. Complaints are monitored as part of the organisations quality assurance programme. The manager said that there have been three complaints since the last inspection. Records were seen to show that these had been investigated and appropriate action taken. She said that any concerns are usually raised verbally and are dealt with immediately. The atmosphere in the home was relaxed and happy supporting this approach. There are safeguarding policies and procedures in place. The home has a copy of the local multi agency procedures. Staff have had training in safeguarding vulnerable adults from abuse and knew how to raise a concern. We have not been told of any concerns about safeguarding issues raised with the local authority, which is the lead agency in these matters. Residents have locked storage in their rooms for personal cash and valuables. The Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: manager said that records were kept and receipts were given for all expenditure. Residents personal allowance records are checked by the manager as part of the quality assurance programme. These were not checked at this visit but will checked at the next visit. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is spacious and designed to meet the needs of people with disabilities. It is a comfortable, clean and safe place for people to live. Evidence: The home is newly built and is spacious and has generally been designed to meet the needs of people with disabilities. It is easily accessible for people who use wheelchairs and there is space to use a hoist to help those who cannot move unaided. It is divided into four flats. Residents have their own rooms with ensuites. Staff and families are in the process of personalising them. The care team on one flat has bought individual linen to personalise residents rooms. There have been some initial snagging concerns and the lift has broken down. Families expressed concern about fire evacuation and how people would get out for activities when lift was out of action, one said I would like to have a clear idea of the evacuation and lift policy for residents on the first floor. The lift has now been repaired and an emergency call out of less than four hours agreed with the company. One family member had some concerns about the design saying my sons room has three door all the same wood colour, not easy to find the toilet. The home should consider how to help people identify their toilets and ensuites. In general though residents, staff and families were pleased with the new building. Staff told us that because of the space it appeared calmer than the old homes. One resident who spent most of the time in her room in the old home now Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: spent most of it in the lounge. The home was clean and tidy on the day of the unannounced visit. The laundry area is separate from the kitchens and has washing machines which have specific programmes to meet disinfection standards. Residents have their own hoist slings and sliding sheets. Staff do not wear a uniform but have access to protective clothing and gloves when giving personal care. There are infection control policies and procedures in place although they need updating to reflect the latest guidance. Staff were not sure about the policy for using alcohol hand rub which does not seem to be in use in the unit at present. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff with the right skills to meet peoples individual needs although the staffing levels in the nursing units should be reviewed to ensure people can go out regularly. Recruitment procedures are thorough and should protect people from unsuitable carers. Evidence: The staff team have transferred with the residents from their previous homes on the campus. This has ensured continuity of care for residents at a time of change and staff felt that this contributed significantly to the successful move. There is a minimum of two carers and a team leader, or registered nurse on the nursing units, on duty in each flat. Some residents in the non nursing units had one to one care which meant that the staffing levels on those units was generally higher than the nursing units. Relatives told us that there were always or usually enough staff to meet peoples individual needs although one felt that there were not enough staff on one of the nursing units to ensure that residents could go out regularly. Only two members of staff returned the questionnaires. One said that they felt there was enough staff on their unit although one felt that there was only sometimes enough staff and that it was difficult for residents to go out as often as they wished as there would not be enough staff left in the flat to care for the other residents. The manager said that she was reviewing the staffing levels on the nursing unit. Our guidance states that if the Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: registered manager of a home which provides nursing care is not a registered nurse then a nurse lead must be appointed. This is the case in this home. The guidance describes one of the responsibilities of the lead nurse lead as being to agree the staffing levels required to meet the needs of people requiring nursing care. The manager and lead nurse should review the staffing levels and deployment of staff in the nursing units to ensure that they can meet the individual needs of residents and to ensure that they can go out regularly. The recruitment files of three members of staff were selected at random and checked. All had the required documents. There was evidence of the staff members identity and work permits were in place where necessary. Criminal Records Bureau disclosures had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. Two references had been sought for each prospective staff member, one of which was from the persons last employer. There was evidence that staff had had an induction programme and had a formal programme of supervision. Staff told us that they were given the opportunity to attend training and the training records showed that staff had had training in safe working practices and care of people with epilepsy. The manager stated on the Annual Quality Assurance Assessment that two of the thirty three care staff had achieved the National Vocational Qualifications (NVQ) in Care at level 2. Twenty eight staff have completed the foundation induction course and the manager said she was hoping to build on this to support more staff to achieve the National Vocational Qualifications in Care. Care Homes for Adults (18-65 years) Page 23 of 30 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 home is well managed in the interests of the residents. The quality assurance programme should be developed and implemented in full to ensure that the care residents receive is of high quality and is safe. Staff should have access to up to date policies and procedures which reflect current best practice guidance to support them to give good quality and safe care to residents. Evidence: The manager and lead nurse are experienced in the care of people with epilepsy and know the service users well. The atmosphere in the home was relaxed and staff spoke openly to the manager, lead nurses and team leaders. The registered manager holds the National Vocational Qualifications in Care and Management at level 4. She said that she is supported by senior managers of the National Society for Epilepsy. The organisation has recently introduced a quality reporting tool which has been completed by the home. The tool is still being developed and standards for care planning and audit have not yet been incorporated into the tool. The tool did not appear to include any systematic audit of medication management although the Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: manager said that she could ask the pharmacy for an audit. The organisation does not have a systematic organisation wide way of seeking the views of residents, families and other people with an interest in the service. The manager of Russell House holds regular residents meetings with an advocate present and holds family meetings on a three monthly basis. She said that she was in the process of developing a questionnaire for families and other stakeholders, to give people who cannot come to the meetings an opportunity to comment on the service. There are health and safety policies and procedures in place. The training records show that staff have had training in safe working practices, including moving and handling. They have the appropriate hoists to help those who cannot move unaided. The Annual Quality Assurance Assessment (AQAA) shows that some of the policies in use by the organisation predate the latest guidance and legislative changes. The infection control policy is dated 2005 and the disposal of waste policy is dated 1995. These should be updated to reflect guidance published by the Department of Health in 2006 and the recent Code of Practice for Health and Adult Social Care on the prevention and control of infection, published by the Department of Health in December 2009 and due to come into force in October 2010. The AQAA does not show that the organisation has a pressure relief policy or continence promotion policy. The physical intervention and restraint policy is dated 2005 and has not been not updated to reflect the recent Deprivation of Liberty regulations. Guidance for staff on the Mental Capacity Act and associated Deprivation of Liberty regulations, which came into force in April 2009, is still in draft. These out of date and draft policies and procedures must be updated to ensure that care staff have access to current best practice guidance about the care of service users. Care Homes for Adults (18-65 years) Page 25 of 30 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 26 of 30 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 6 15 Service users plans must be kept up to date and reflect the care and support that they need. To ensure service users receive the care and support they need. 23/04/2010 2 20 13 Medication administration records must be accurately maintained and the reasons for non administration of medication must be recorded and clearly explained on each record. To ensure that a record is kept and appropriate action is taken if people do not take their medication. 25/03/2010 3 20 13 Records of medicines received, administered and leaving the home must be kept and their accuracy must be checked. 25/03/2010 Care Homes for Adults (18-65 years) Page 27 of 30 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 To ensure residents receive the correct medication in the prescribed doses. 4 20 13 Arrangements must be 25/03/2010 made to ensure that medication is administered as directed by the prescriber to service users. To ensure service users receive the correct medication 5 39 24 The home must introduce a programme for reviewing and improving care, including medication and care plan audits. To ensure residents reliably receive high quality and safe care. 6 40 12 The policies related to the 28/05/2010 Mental Capacity Act 2005 and Deprivation of Liberty Regulations 2009 must be developed and implemented. To ensure that staff have access to the latest guidance and can support vulnerable residents safely and within the law. 23/04/2010 Care Homes for Adults (18-65 years) Page 28 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 42 13 The infection control policies 28/05/2010 and procedures must be updated to reflect the latest guidance from the Department Health. To ensure that staff have access to the latest guidance to protect residents from acquired infection. 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 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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