Care Home: Serlby Close (11)

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What the care home does well Detailed information is gathered and shared to ensure that potential service users can be sure this home will be able to meet their needs. The home also ensures it obtains good advice from health and social care professionals about how they should support service users who may present behaviours that are quite challenging. Staff are enthusiastic and kind. They help the people living here lead purposeful and fulfilling lives. People enjoy a wide range of activities such as bowling, horse riding and swimming. A social worker who completed a survey said the staff "ensure all service users are actively involved within the community". A service user said, "I like living here. I have made new friends." The staff prepare nutritious, freshly cooked food. People are encouraged to raise any concerns. Staff have also had good training in how to respond to challenging behaviour and this helps to safeguard service users. The home is clean and well maintained and provides spacious, homely accommodation. Service users were able to spend time where they wished. What has improved since the last inspection? Redecoration has taken place. What the care home could do better: At the last inspection it was found that service users` support plans needed to be brought up to date. Similar findings have been made at this inspection. Some risk assessments have been updated but their content does not always accurately reflect the individuals concerned. The care records need to be written in a `person centred` way, which means they will be written in plain language, easy to understand, and accurately describe the needs and wishes of the person concerned. Whilst people`s health care needs are generally well looked after, there seems to be some gaps where people are not getting routine check ups from dentists and chiropodists as often as they should. Medication records are not being kept as accurately as necessary, which increases the potential for mistakes to be made when giving people medication. It also means that the stocks of medication can not be fully accounted for. The Trust should ensure that the employment history of applicants for jobs is fully explored with them at interview. This helps ensure that the right people are employed. The Trust must make application for registration of a permanent manager as this is a legal requirement. The home has had a number of management changes over the past few years and this has had an impact on the home and may account for the issues with medication and record keeping outlined above. Key inspection report Care homes for adults (18-65 years) Name: Address: Serlby Close (11) Coach Road Usworth Washington Tyne And Wear NE37 1EN     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: Janine Smith     Date: 1 9 0 1 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 32 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 32 Information about the care home Name of care home: Address: Serlby Close (11) Coach Road Usworth Washington Tyne And Wear NE37 1EN 01914194162 01914194162 fiona.beattie@nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northumberland, Tyne & Wear NHS Trust Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The house at 11 Serlby Close provides accommodation and care for 8 younger adults with autism. Northumberland Tyne & Wear NHS Trust operates the care service. The home is a modern, 2 storey, purpose-built house owned by Three Rivers Housing Association, which remains responsible for repairs and maintenance to the property. The house is divided into two units that are accessed through a central communal area containing an activities room, staff room and laundry room. Each unit contains a lounge, a dining room, a fully fitted kitchen, 4 good-sized bedrooms, a bathroom, and a shower room. The house is not intended for use by people with a physical disability. However there is level access into both units, and there are good toile and shower facilities and one bedroom on the ground floor in both units. Access around the ground floor would be suitable for any visitor with mobility needs. The house is close to local Care Homes for Adults (18-65 years) Page 4 of 32 8 Over 65 0 Brief description of the care home village facilities such as small shops and pubs. There is a home vehicle for residents use, and there are local public transport routes to Sunderland and Washington centres. The fee for a placement at 11 Serlby Close is £864.16 to £1,012.88 per week. Information about the service is readily available in the home. Care Homes for Adults (18-65 years) Page 5 of 32 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: Before this visit we looked at information we have received since the last visit on 7th and 18th January 2008; how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run; the providers view of how well they care for people; the views of people who use the service and the staff. At the time of the last key inspection in January 2008, the home had no registered manager and there had been a number of management changes over the previous 15 months, which had been unsettling. A manager was subsequent appointed but has since been transferred to another service and the home is currently being managed on a temporary basis by Mr Michael Wakenshaw. It is unclear what the future plans are for the management of the home but the provider needs to make a decision about this and make application for registration of a permanent manager for the home. An unannounced visit was made on 19th January 2010. During the visit we talked with Care Homes for Adults (18-65 years) Page 6 of 32 people who use the service and the staff. The manager was not on duty on the day of our visit. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept and checked that the staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We also checked what improvements had been made since the last visit. Following the visit we told the manager what we found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at signficant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: At the last inspection it was found that service users support plans needed to be brought up to date. Similar findings have been made at this inspection. Some risk assessments have been updated but their content does not always accurately reflect the individuals concerned. The care records need to be written in a person centred way, which means they will be written in plain language, easy to understand, and accurately describe the needs and wishes of the person concerned. Whilst peoples health care needs are generally well looked after, there seems to be some gaps where people are not getting routine check ups from dentists and chiropodists as often as they should. Medication records are not being kept as accurately as necessary, which increases the potential for mistakes to be made when giving people medication. It also means that the stocks of medication can not be fully accounted for. The Trust should ensure that the employment history of applicants for jobs is fully explored with them at interview. This helps ensure that the right people are employed. The Trust must make application for registration of a permanent manager as this is a legal requirement. The home has had a number of management changes over the past few years and this has had an impact on the home and may account for the issues with medication and record keeping outlined above. Care Homes for Adults (18-65 years) Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information needed to make sure the home will meet their needs. Evidence: The Statement of Purpose and Service Users Guide are readily available but need some updating regarding recent management changes. A social worker who completed a survey said the care services assessment arrangements always ensure accurate information gathered and right service planned for people. Another social worker said this sometimes happened. Two surveys were received from relatives who both said the service provided enough information to help them make decisions and both said the service always meets the needs of the relatives who live here. Surveys were also received from eight service users who all said they were asked if they wanted to move here and received enough information about the home to help them make a decision. A care record confirmed a service user had been able to make a number of visits to Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: the home before he decided to live here. A care management assessment and care plan were obtained before his admission but there was a lack of evidence to show that the home had developed its own plan of care for this person. The staff team were provided with training about autism by the NTW Trust to ensure that they had the skills needed. A workshop had also been held before his admission involving all the important people in his life so that Serbly Close had detailed information about him. Two care records were looked at which showed that contracts had been drawn up about the terms and conditions applying to places in the home. Care Homes for Adults (18-65 years) Page 12 of 32 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. The people living in the home are given the support they need to help them make decisions about their day to day life in the home. Evidence: At the last key inspection, it was found that some care plans and goal plans were out of date and had not been reviewed for a couple of years. Keyworker meetings were not being held monthly which means there was no follow up on service users short term goals and risk assessments had also not been reviewed for some time. Before this inspection, we were told by the home that care plans and risk assessments are now reviewed every six months. A social worker also told us in a survey, I think the service is an excellent service. The service promotes independence for service users. They provide individualised packages of support to meet the service users needs. They keep accurate recordings of events and follow protocols. Staff and managers are always professional when meeting with other professionals and carers. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Surveys were also received from two staff who both said they are usually given up to date information about the needs of people they support and the ways information was shared with the staff team usually works well. We looked at three case records and found that detailed assessments of peoples needs had been obtained. Very detailed guidance had also been provided by the local authority about any particular behaviours or risks that may occur and how staff should respond to this. Detailed incident reports were completed when necessary. Assessments had been carried out to comply with recent legislation, known as Deprivation of Liberty. However, some support plans put into place by staff had not been reviewed for some time and one person did not have one at all. The manager is aware that care records need to be updated and has a plan for how this will be achieved. There were risk assessments in place but it seemed that a standardised format had been used in some cases which did not reflect the individual service users particular circumstances. For example, an assessment about a persons risk of choking indicated that they had dysphasia and had no teeth, whereas a support worker said the person did have their own teeth. Their separate support plan for eating and drinking indicates he ate independently and does not describe any of above issues. Some of the risk assessments and support plans were bland and not person centred. Similar findings were made in another record. Service users are encouraged and supported to undertake worthwhile, exciting activities that they enjoy, such as swimming, cycling, go-carting and horse riding. Assessments had been carried out to identify and control any risks arising from these activities. They all go on planned outings every day. They also participated in housekeeping tasks. One person asked about when they could do their laundry. A social worker who completed a survey said the home usually supports people to live the life they choose. Another social worker said this happens sometimes. One also said the care service always responds to the diverse needs of individual people, the other said this was done sometimes. Two staff surveyed both said they usually have enough support, experience and knowledge to meet the different needs of people who live at the home. All eight service users who completed surveys said they could make decisions every day about how they wanted to spend their time. Service users were seen moving about the building as they wished. One was keen to make beverages for visitors and some spoke about the social activities they like doing. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are able to make choices about their lifestyle and are supported to develop their life skills. The staff work hard to help service users access social and recreational facilities that interest and suit them. Evidence: Records, surveys, discussion with staff, service users and observations made showed that service users are supported to enjoy a wide range of activities, which are both enjoyable and stimulating. One service user said he enjoyed horse riding and had been out shopping with staff. Another said he liked going to the pictures. Structured routines have been developed as this is what service users prefer so that they know what they are going to do and when. Service users were heard asking when they would be doing certain things. A social worker commented in a survey that the staff ensure all service users are actively involved within the community. Staff Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: ensure service users have a daily structured routine. Another social worker said the home provides a homely environment and supported the service user to have a structured day of opportunities he values, but needed extra funding via 1:1 support to do this. A service user, who was helped to completed a survey, said they liked structured activities, they have a warm comfortable bed, the house is warm and has a good choice of meals. I like living here. I have made new friends. I am very happy but also said they would like it if staff had more time so they could spend more one to one time with me. Surveys, records in the home and discussion with staff showed that service users are supported to keep in touch with family and friends. One service user said they visited their relative at weekends and kept in touch by telephone at other times. The support staff do lots of home cooking preparing fresh foodstuffs. There were lots of fresh fruit and vegetables available in the home. A choice is provided for breakfast. Lunch is usually a choice between baked potatoes and fillings or sandwiches. The evening meal is varied such as chicken casserole. Lunch was taken with some service users which comprised fresh and nutritious ham and salad sandwiches followed by yoghurt, banana and crisps. Care Homes for Adults (18-65 years) Page 17 of 32 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. Whilst the staff work hard to meet the health and personal care needs of people, there are gaps in routine health care provision and carelessness with medication, that could put people at risk. Evidence: Staff spoken to were well informed about the needs of the people they care for and how they communicate if they cannot verbally say what they want. Two social workers surveyed said that the home always or usually monitors peoples social and health care needs properly and seeks and acts on advice to improve their wellbeing. One said peoples privacy and dignity is always respected, the other said this happens sometimes. Two surveys were received from relatives who say the care service always keeps them informed of important issues and gives the support their relatives need. Surveys were received from two staff who said they were given enough knowledge about peoples health care and medication needs. Care records showed that general practitioners were contacted if service users were Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: unwell and they saw consultants and other specialists when necessary. Of the three records looked at, there was evidence that some people had had routine appointments with dentists, opticians and chiropodists but this could not be found on all. A document, known as the OK Health Check is completed annually but these did not always show that service users had had these routine check ups and the documents had not apparently been reviewed by a manager. It was recorded in one persons records that he had bad breath and bleeding gums, but there was a lack of evidence to show he had seen a dentist recently. A member of staff said that there had been problems accessing chiropody for service users and they were waiting for this to be sorted out. Written protocols are held on individual service users care records to guide staff about when to give specific medications that are only to be given in certain circumstances. Staff were aware that they had to seek advice before giving such medication. It would be helpful if copies of this guidance were also made available next to the persons medication administration records. Medication was discussed with a carer who described appropriate systems for ordering, administration and disposal of medication. A random sample of the medication records were looked at but these were not accurate as they should be. For example, one service user was prescribed two different strengths of the same medication but the dosage to be given was not fully recorded on the medication administration record. He also had a supply of a prescribed skin cream, which was not documented on the record. He had also been precribed some specific medications to be used for a particular purpose. None of these medications had been recorded on the medication administration record, and nor had some other prescribed medications for other people, so it was difficult to account for how they had been used. Handwritten entries on the medication administration record were not signed and dated so it was not clear who had written this information or whether it had been double checked by anyone else. Before the inspection took place, a mistake had been made when someone was given the wrong strength of two different medications, but this information was only received after the inspection took place. This mistake was made whilst someone was being trained to handle medication by another member of staff. The manager has stated that such training must only be given by the manager or his assistant in future. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The home has a small fridge to store medication that requires cold storage, but a support worker felt the fridge was not cold enough. Since the inspection, the manager has obtained another more suitable fridge. No checks had been carried out on the temperature of the fridge or the general storage area. Staff were not aware of any audit checks being carried out on medication, although it had been stated in documentation sent before the inspection that checks are done. The manager has since confirmed that daily checks are made on the quantity of medication held. Staff were not aware of the action that should be taken if a service user wanted or needed medication for something mild, like a headache or whether there was a written policy and procedure for this. This is usually known as the policy for homely medications. The manager confirmed after the inspection that whilst the home had a policy on this specific area, the actual document was not as clear as it should be and is arranging for an updated copy to be provided. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse. Evidence: Copies of the complaints procedure are available in service users care records. One formal complaint had been made to the home since the last inspection, which had been investigated by a senior manager, who took steps to make improvements where necessary. Seven of the eight service users who completed a survey said they knew how to make a complaint, but some would need support to do this. Two relatives and two social workers who completed surveys said the home always responded appropriately if they raised concerns. Staff who completed surveys, said they knew what to do if anyone raised a concern. Staff confirmed they have had safeguarding training and that they had also been trained about how to respond to behaviours which they may find challenging. Each member of staff attends a five day training course about control and restraint. They then complete a three day refresher course annually. this covers behaviours, breakaway techniques and how to safeguard people from harm. All the staff team have completed this training apart from some new in post. The staff said that rotas are planned to ensure that there are always trained staff on duty. Staff have also Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: received detailed advice and guidance from the local authority about the specific needs of individual service users. The organisation also has a system, known as Point of Contact, where experienced staff are contactable on a rota system if support staff need advice about dealing with any situation. Staff said that all incidents of difficult behaviour are recorded and they have a debriefing meeting afterwards to discuss what happened. This is particularly important for staff if they have been hurt during an incident. The staff team help service users manage their money and bank accounts. There is a thorough system in place so that all transactions are recorded and checked each day. Care Homes for Adults (18-65 years) Page 22 of 32 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 physical design and layout of the home enables people to live in a safe, well maintained and comfortable environment. Evidence: The home was toured. It is accessible, with a good standard of facilities. Areas of the home have been redecorated since the last inspection. It was clean and tidy. Service users help with this and one spoke about the hoovering he had done. All eight service users who completed a survey said the home was always fresh and clean. One said, I help to keep my home clean and tidy. The staff have had training about control of infection and have protective clothing supplied. Each service user has their own room. These were personalised with their own belongings and items that interested them. The home has a large garden and an outdoor building which has a sensory room in it. There are two lounges and two dining rooms. Care Homes for Adults (18-65 years) Page 23 of 32 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: The rota and discussion with staff showed that there are usually four or five support workers on duty from 8 am to 8 pm. This is shortly to increase to five or six people when the home becomes fully staffed. Through the night one there is one waking night carer and another sleeps on the premises in case they are needed. Staffing reduces at weekends as not so many activities take place, however service users still have opportunities to go out, for example, to the cinema. A support worker said there are generally enough staff to allow three different outdoor activities to take place at the same time. Two staff who completed surveys said there were usually enough staff to meet the individual needs of people living here. A social worker commented in a survey that the service could be more flexible in staffing ratios or support as complex client group. Discussion with staff and information from surveys showed that staff receive a range of training, such as induction training, food hygiene, first aid, fire safety, health and safety, medication, infection control. 80 of the staff have completed a National Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Vocational Qualification (NVQ) at Level 2 and some have gone on to Level 3. They have also had training in control and restraint, de-escalation strategies, autism awareness, challenging behaviour (6 month course), deprivation of liberty and mental capacity act, safeguarding, multi agency training about the protection of vulnerable adults. Two staff who completed a survey said their induction mostly covered everything they needed to know. Both said they had had relevant training which helped them understand and meet the individual needs of people and kept them up to date. All eight service users who completed a survey said they were treated well by the staff who always listened and acted on what they say. Two social workers who complete a survey said the manager and staff always or usually have the right skills and experience to support people. Two relatives who completed a survey said the staff always have the right skills and experience to look after people properly. Staff confirmed they have regular staff meetings and one to one meetings with their manager to discuss how their work is going. Staff recruitment records were looked at by two inspectors who visited the Trusts Human Resources Department. Records showed that staff only start work once a Criminal Records Bureau disclosure is obtained, along with two written references and a satisfactory health clearance. Some staff had not provided a full employment history in their application form and there was a lack of evidence to show that this had been explored with them. Care Homes for Adults (18-65 years) Page 25 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of improvement are needed but overall the home is being managed reasonably well but there needs to be management stability to enable the home to progress. Evidence: At the time of the last key inspection in January 2008, the home had no registered manager and there had been a number of management changes over the previous 15 months, which had been unsettling. A manager was subsequent appointed and registered with the Commission but has since been transferred to another service. The home is currently being managed on a temporary basis by Mr Michael Wakenshaw. It has not yet been decided what the future plans are for the management of the home but the provider needs to make a decision about this and make application for registration of a permanent manager for the home. It is likely that the changes in management have had some impact on the running of the home and may account for the issues with medication handling and records highlighted earlier in this report. Staff said the new manager was making some Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: changes in the home but was approachable and willing to listen to staff. The manager was off duty on the day the inspection took place and it was therefore difficult to get full information on quality assurance. Staff said they receive visits by senior managers in the organisation who are both very supportive and approachable. The last documented visit made by a senior manager to comply with the law that could be found was 29th July 2009. These visits should be made monthly. In the information provided by the home before this inspection took place, they confirmed that regular meetings are held with service users and they also support them to complete surveys as a way of obtaining their views about the services they receive. Staff meetings are also held and the home develops an annual plan as to how it needs to develop each year. Staff said they all had allocated jobs and use sheets to record safety checks, such as hot water and fridge temperatures, tests of the emergency lights. Discussion with staff and information from surveys showed that staff receive a range of health and safety training, such as food hygiene, first aid, fire safety, health and safety, handling of medication, infection control. A fire extinguisher was being used to hold open one door in this building and a tin of paint was being used to hold open another, which is contrary to fire safety advice. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 26 The Provider must carry out and report on Regulation 26 visits at least monthly. This is to ensure that the Provider is fully aware of the homes operations. 01/03/2008 Care Homes for Adults (18-65 years) Page 28 of 32 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 An appropriate and up-to31/05/2010 date plan of care must be put in place for each person, after consultation with each service user or their representative. This helps ensure that the staff team are fully aware of each service users needs, wishes and goals and what steps are to be taken to help support them. 2 19 12 Service users must be supported to have routine check ups from dentists and opticians and chiropody at appropriate intervals. These check ups and their outcomes must be documented in their care records. This helps ensure that peoples health needs are monitored and appropriate 31/05/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 treatment provided when necessary. 3 20 13 Each persons medication administration record must accurately describe the strength and dosage of all the medications they need. An up to date medication policy and procedure must be available to staff and the manager must be sure that they have read and understood it. This ensures that staff know what medications to give and a clear record is kept of when this has been done, which helps ensure service users receive the correct medication when they need it. 4 39 26 Monthly unannounced visits 31/03/2010 must be made to the home by an appropriate senior person in the organisation who must provide a report of their visit to the manager. This is so that the organisation running the home can make checks on the quality of care provided and make any improvements where necessary. 31/03/2010 Care Homes for Adults (18-65 years) Page 30 of 32 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 9 The risk assessments put into place should be reviewed to ensure that they accurately describe the needs and risks to the person concerned. They should be reviewed at appropriate intervals to ensure that they remain up to date and the date and outcome of the review should be recorded. A copy of specific guidance about when individual service users should be given a medication which is only required in particular circumstances, should be kept with their medication administration record. This helps ensure that the guidance is readily available to staff when needed. When staff have to record the details of prescribed medications on the medication administration records, they should sign and date what they have written. It is also advisable for another trained person to check what they have written, to help prevent mistakes. The temperature of the medication storage area and the fridge used for medications should be monitored daily and a record kept of this and any action necessary. This is to ensure that medications are kept at the correct temperature so that they do not deteriorate in quality. Regular spot checks should be made on all aspects of the medication system to help identify any problems which need remedying. This helps to protect service users. 2 20 3 34 Ensure gaps in employment shown on application forms are fully explored and this is clearly shown within the record of interview. This helps to protect service users. Care Homes for Adults (18-65 years) Page 31 of 32 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. 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