Care Home: The Beeches

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What the care home does well People told us that they are happy living in the home and with the level of support that they receive. People are supported to undertake risk and activities of their own choice- this includes work and leisure, supporting people to live their lives as they choose. If they wish to people are supported to undertake paid employment which can be in their local community, helping people achieve greater autonomy. People are able to access a variety of different leisure activities that include both activities within their own home and going out into the local community. People live in a clean and comfortable home; they told us that they like their rooms. People are supported by a staff team that are employed through good recruitment practices that help to make sure staff are suitable and safe to work with vulnerable people. What has improved since the last inspection? Risk assessments are in place for individuals. These provide a basis of support to assist people to live their lives as they choose whilst taking risks. Adequate records are kept of all medicines received, administered and disposed of in the home. Providing a clear audit trail and promoting peoples well being. There is a quality assurance system in the home that includes questionnaires for people who use the service. This allows people the opportunity to be involved in the review and development of the home that they live in. What the care home could do better: People must be assessed before they move into the home. This helps to identify their current needs and wishes and how these are to be met. this gives the staff the necessary information to follow to meet these needs. People must have a plan of care that details their needs and how they are to be met, providing staff with detailed information and the opportunity for review to make sure that the support provided is as up to date as possible. The complaints procedure must include the details of the CQC and how to contact them so that people may access this additional support if they wish to do so. The complaints procedure should also be available in different formats for the people who live in the home so that anyone, regardless of ability, may use this procedure to raise concerns. The fire risk assessment must be kept up to date to make sure that it accurately reflects the latest information on how to protect people from the risk of harm from a fire in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: The Beeches Frodingham Road Brandesburton Driffield East Riding Of Yorks YO25 8QY     The quality rating for this care home is:   two star good 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: Sarah Rodmell     Date: 1 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Beeches Frodingham Road Brandesburton Driffield East Riding Of Yorks YO25 8QY 01964542459 01262424563 jekcunning@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Charles Kunning Name of registered manager (if applicable) Miss Emma Jayne Kunning Type of registration: Number of places registered: care home 11 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 Beeches is a care home providing care and accommodation for up to 11 people under the age of sixty-five who have learning difficulties. The home is located on one of the exit roads from the village of Brandesburton, close to local amenities and within easy access of public transport. The home has been registered for a number of years and is a two-storey building. It was previously part of the local hospital for people with learning difficulties. There are 11 single rooms all without en-suite facilities, although one room has a shower. There are 4 toilets and 3 bathrooms available. The home has large gardens and is surrounded by open countryside. Car parking is available to the front and rear of the property. Information on the service can be found in the homes statement of purpose and service user guide. Copies of these are available from the manager on Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 11 1 7 1 1 2 0 0 8 Brief description of the care home request. Information on fee levels for the service were not available on the day of this inspection, however these can be obtained from the manager on request. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star . This means that the people who use the service experience good outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection on 17 November 2008, including information gathering during a site visit to the home. The unannounced visit was undertaken over one day by one inspector. It began at 9.30 am and finished at 3.00 pm. On the day of the visit the inspector spoke with the people who live in the home, staff and the manager of the home. Inspection of the premises and close examination of a range of documents, including three care plans, were also undertaken. The owner submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment, (AQAA). The AQAA is a self assessment tool that focuses on how well the outcomes are being met for people who use the service. Care Homes for Adults (18-65 years) Page 6 of 32 The owner told us that the current fee for residential care is £365.61 to £988.80 per week. At the end of this visit, feedback was given to the manager on our findings, including requirements or recommendations that may be in the key inspection report. 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 the service are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement actions 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: People must be assessed before they move into the home. This helps to identify their current needs and wishes and how these are to be met. this gives the staff the necessary information to follow to meet these needs. People must have a plan of care that details their needs and how they are to be met, providing staff with detailed information and the opportunity for review to make sure that the support provided is as up to date as possible. The complaints procedure must include the details of the CQC and how to contact them so that people may access this additional support if they wish to do so. The complaints procedure should also be available in different formats for the people who live in the home so that anyone, regardless of ability, may use this procedure to raise concerns. The fire risk assessment must be kept up to date to make sure that it accurately reflects the latest information on how to protect people from the risk of harm from a fire in the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standard 2. On the whole people are assessed prior to moving into the home, however on occasions this does not occur and the staff cannot be sure that they know the needs of the individual and how to meet these. Evidence: Information recorded in the AQAA included, Community care assessments and care plans are obtained before an admission takes place. Also an assessment of the service user in their current home prior to visiting the Beeches is essential, this is done so that we as a home can ensure we can provide a service that will meet the needs of the individual. We examined the care files of three people who live in the home. None of these included a Community Care Assessment, with two of the three containing an assessment and care plan developed in the home. The one person who did not have an assessment had been admitted to the service in an emergency, with the manager Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: informing us that they are not always able to obtain information from the Care Management team about people. A full assessment of need must be undertaken on all people who move into the home and as soon as possible once admitted. This will help to make sure that the care staff are aware of the latest needs and wishes of the individual and how these are to be met. The two assessments that were in place covered a variety of areas including peoples social and personal care needs. Additionally there were assessments from other health professionals that could be used when planning the level of support. Risk taking has been identified in the care planning process with people telling us they are aware of the content of their care plan and are involved in its review. From the six surveys received from people who live in the the home half of the people felt that they received enough information before they moved in. As the last inspection a requirement was made that a care plan is developed with each person, based on either a Care Management assessment of the homes own assessment, this requirement remains. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 6, 7 & 9. On the whole people are supported through the care planning process. However this does not always occur and in particular in an emergency admission. This means that when people may be at their most vulnerable they get a lower level of support. Evidence: We spoke to some of the people who live in the home. They told us that they had care plans and knew what were in them. They also told us that they are involved in the review of these. Information recorded in the AQAA included, People have a care plan that has been developed with them, along with the needs that are identified within their care plans provided by the local authority and community care assessments. This then provides the staff members with a holisitic care plan that highlights all area of both needs and wishes of the service user. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: When we spoke to staff they told us that they referred to peoples care plans and spoke to people to find out their latest needs and how these would be met. In the staff surveys returned, the information recorded included that all staff felt that they were given up to date information on the needs of the people they support. We examined the care files of three of the people who live in the home. Two of these files included plans of care that assist the staff to know the individual needs and wishes and how peoples needs are to be met. One person had no assessment or care plan in place.The manager told us that this person had been admitted into the home in an emergency and that this person had accessed the service approximately two years ago. However, without up to date assessment and care plans the staff would not know the up to date needs and wishes of the individual and how these would be met. A requirement was made at the last inspection of the service that a care plan is developed and agreed with each person. This requirement remains. People who live in the home told us that they are able to chose what they want to do. In addition all of the people who returned a survey to us recorded that they could do as they wanted each day and at weekends, with all but one person recording the same for evenings.We observed during the day that people were able to chose whether to be in their own rooms or with others. Staff told us that people make decisions about different things and that this includes; what time to get up , what to wear, what to eat and what to do. Staff also told us about the risks and decisions that people make in their daily lives and that these included snowboarding and football. In addition to general risk assessments held in peoples care plans we saw individual risk assessments, for example, going to work or using a bicycle. Information recorded in the AQAA included, Risk assessments are in place for each individual, service users are encouraged to take risks but due to the complexities of some individuals needs some things are too high risk for them to undertake independently. People who live in the home told us that staff assist them with their daily lives and that they can live their lives as they wish. One staff member commented in a survey that promoting independence was something that the home does well. At the last inspection it was noted that there were some gaps in the records kept in individual files- no gaps were seen at this visit. Care Homes for Adults (18-65 years) Page 14 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. We looked at standards 12, 13, 15, 16 & 17. People are supported to live their lives as they choose, have a range of activities and receive a good diet. Evidence: During the visit several people were out at education and work placements. One person told us how they had changed jobs, but still work in their local community and receive support from the home to do this. When we spoke to the staff they told us about the different activities that people undertake. These included peoples going out into the local community. For example, going for a walk to the village shops or a local pub for a meal. People are also Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: supported to access public transport to go further afield. One staff member recorded in a survey that discussion at service user meetings includes courses and activities that people may wish to attend. Also that service users can, if they wish to, go on a rota to go grocery shopping with a member of staff each week. Staff also told us about the activities that take place in the home and that these include: flower arranging and games nights. One person told us when asked, that they live their life as they want to and that they get support from the staff to do this. People who live in the home told us that they have enjoyed holidays this year, with one person going to France for a holiday.They also told us that they can choose what to do each day and that staff help them with their daily lives, for example escorting them to work or to the shops. They told us that they can chose what to watch on the TV or to watch a DVD. Information recorded in the AQAA included, Service users are supported to access activities both within the home and community. Also that, Service users are very much part of the local community. They access that local amenities some on a daily basis. One person told us how they visit their family and continue to have support from the home with this. Peoples daily notes included details of people maintaining these relationships, for example, when relatives telephoned or visited the home. Information in the AQAA recorded that, Service users make choices around friendships and relationships, the staff support them. We saw that people decided what to do with their time, either spending it alone or with others. Conversations between people who live in the home and staff were positive and appropriate. One person told us how they feel they can talk to the staff if they need to . Some people hold a key to their room and we saw that staff were respectful and knocked before entering someones bedroom. When we spoke to people who live in the home they told us that they like the food in the home, that it was getting better and that there was more fruit and vegetables available now. Information recorded in the AQAA included, Menus and shopping for food are done on a weekly basis. Service users will openly express what meals they would like to have on the menus and snacks are provided with a meal alternative if they do not want what is put on. We observed lunchtime and people were relaxed and told us that they enjoyed the food. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Peoples files included nutritional risk assessments and daily diary notes recording as necessary peoples dietary intake as necessary. Weight records are also kept to help monitor that people are maintaining a stable weight. The manager told us that the menu is completed with the people who live in the home. People who live in the home support the staff with the grocery shopping as and when they want to. One staff member recorded in their survey that regular service user meetings give people the opportunity for choice with their menu. Another member of staff recorded in a survey that one of the things the homes does well is personal choices with menus for people who live in the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 18, 19 & 20. People are supported with their personal, health and medication needs. Evidence: When we spoke to one of the people who live in the home they told us that there are both male and female care staff, so if they request it there is someone of the same gender to support them. Information recorded in the AQAA included, Personal support is received by service users in the way which they require and Service users physical and emotional needs are met in a number of ways. Peoples appearances reflected their individuality and peoples care plans include the details of any personal support people need. Care files also included letters and reports from other professionals offering people additional support as necessary. Peoples care files included records of visits to health professionals, for example, to their GP, dentist or chiropodist,and details of any specific health conditions. They also include information about support needed with this, for example a risk assessment to help maintain mental health. People who live in the home told us that the staff Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: support them with their health needs and that staff are there for them to talk to, they also told us that staff take them to the doctors. The manager told us that one person manages their own health condition and that they have received training to do this. One staff member told us that they had undertaken training in epilepsy. Following this training they have more knowledge and now support the epilepsy specialist nurse with the work that she does to support people in the home. One person who live in the home told us that staff support them with the taking of their medicines. Information in the AQAA also included, Most service users are supported with prescribed medication, this is given by care workers that have accredited medication training. The manager told us that here are 6 staff in the home who are able to administer medication but that only one of these people had received up to date medication training. We examined the records for the handling of medicines in the home. Records are kept of receipt, administration and disposal of the medicines in the home. Some details of prescribed medicines had been handwritten onto the medication record and it was advised that when there is no option but to do this, then two people complete these entries so that they are double checked and verified. Medication is stored in a locked cupboard and there are no medicines that are described as controlled and no medicines that need to be kept in a refrigerator. At the previous inspection a requirement was made that there must be accurate records of the medicines received, administered and leaving the home or disposed of. This is now met. Care Homes for Adults (18-65 years) Page 19 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. We looked at standards 22 & 23. People receive support to raise concerns and are protected from harm. Evidence: A complaints statement was on display in the home. This referred people to the complaints policy if they had a concern to raise. We examined the complaints policy; this described the process to follow should someone wish to raise a complaint , although the contact details for the CQC were not correct should someone wish to contact them. The manager told us that the complaints policy is not available in different formats, this would possibly make it easier for people who live in the home to understand and access this. Information in the AQAA recorded, Service users will approach staff with concerns they may have. One person who lives in the home told us that they talk to staff when they need to. We have not received any complaints regarding this service. Information in the AQAA recorded, The home has policies for the protection of vulnerable adults in place and is kept on display in the home. We saw that this was available in the office. When we spoke to staff they told us that they had attended training on Safeguarding Vulnerable Adults from harm and in further discussion they were confident in the actions that they would take should an allegation of harm be Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: raised. We looked at the records in the home and found that usual practice is that notifications are forwarded to the CQC and when necessary the safeguarding team. However one notification had not been received by the CQC and the manager must make sure that all notifications are forwarded. We examined the records for peoples finances. Individual records are kept of expenditure and whenever possible the individual signs for their own monies, with a member of staff counter signing these entries. Care Homes for Adults (18-65 years) Page 21 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. We looked at standards 24 & 30. People live in a clean and comfortable home, however the systems to support them from the risk of fire need to be kept up to date to ensure their safety. Evidence: During our visit the manager showed us around the home. On the ground floor there are two lounges, a dining area and a small kitchen area for people to prepare a drink for themselves. Upstairs are service user bedrooms and bathrooms. The laundry room is adjacent to the kitchen and includes the staff toilet.The home was clean and warm throughout with adequate lighting. Peoples bedrooms were personalised to individual tastes and were comfortable. We found that the hot water in one of the bathrooms was running too hot and the manager is aware that this needs correcting. There is a second bathroom were the hot water temperature is not controlled to a temperature close to 43 degrees.However, the manager told us that this bathroom is kept locked and only accessible to people who do not need staff support with personal care. When we spoke to one of the people who live in the home they told us that they clean Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: every day and thats getting better, they are keeping on top of the house. Another person told us that they are happy with the environment that they live in. Information in the AQAA recorded, the home is decorated and furnished to the service users liking, and Each service user has their room furnished to their own personal taste and is supported by the home to keep them clean and hygienic whilst balancing their rights on how to live. The laundry area includes a commercial style washing machine. Policies are available to support staff in infection control and staff have undertaken training in this.Information in the AQAA recorded, Policies and procedures are in place within the home to reduce the possibility of infection and to maintain cleanliness in the home there are daily, weekly and monthly job sheets in place. We looked at the records regarding fire safety and we saw that there had been monthly fire drills up to September of this year. The manager also told us that the staff require fire training. A fire officer had visited the home and required that some environmental work was completed, and that the fire risk assessment was reviewed by 28/02/09. The manager confirmed that the environmental work had been undertaken but that the risk assessment had not been updated. 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. We looked at standards 32, 34 & 35. People are supported by adequate numbers of correctly recruited, and trained staff. Evidence: We looked at the staff records for three of the people who work in the home and the duty rota. When we examined the duty rota, this recorded that there are usually two staff on duty throughout the day. The manager told us that in addition there is an activities coordinator and the manager available to support people. The manager also told us how she has supported people going on holiday and worked as a staff member. Information in the AQAA included that, There are always two members of staff on duty at one time. The manager told us that they recruit people in line with equal opportunities and record decisions made in this process.Also that she writes on peoples recruitment paper the outcomes of any employment decisions. This was a requirement at the last visit to the home and is now met. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We spoke to some of the staff in the home. They told us about the recruitment process they followed to work in the home, including that the necessary checks were undertaken before they commenced in their role. This included a Criminal Records Bureau check (CRB) and references being obtained. Responses in staff surveys confirmed that all staff were only employed following CRB and references being taken up on people. Information recorded in the AQAA included that, Before starting a new member of staff Protection of vulnerable Adults (POVA) and CRB checks are obtained along with two written references. When we examined the staff files we found that they all contained an application form, two written references and a CRB check a POVA first check. The references that had been undertaken were sometimes character references and the manager must be sure that this is only completed on exceptional cases with clear details about why employer references have not been undertaken. The manager does not currently undertake validation of references to confirm the details of both the person writing the reference and the details they are giving and it is recommended that they commence this. Staff also told us about their induction into their role and how this included shadowing a more experienced member of staff. They also confirmed this is their responses in the staff surveys. Details in their personnel files included that they had all undertaken in house induction, with one person having a certificate of confirmation that they had completed a Skills for care Induction. When asked staff told us what training they had undertaken and this included: Infection Control, Medication, Fire Safety and Health and Safety. The manager also told us that all of the staff require training in fire safety. 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. We looked at standards 37, 39 & 42. People live in a home that is well managed and where they are able to raise any concerns and to be protected from harm. Evidence: The manager has worked with and known the people who live in the home for some time. She has applied to be registered with the CQC and has recently undertaken her interview for this post.She confirmed in the AQAA that she has achieved an NVQ level 4 in management. There is now a quality assurance system in the home. This includes a development plan and questionnaires for both service users and their relatives. This was a requirement at the last visit to the home and is now met. Information in the AQAA included, Health and safety and fire equipment checks are Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: completed. We examined some of the maintenance records in the home. There is an electrical wiring certificate in place, however this ran out on 19 August this year and must be renewed. There is a health and safety checklist for the home, which is undertaken monthly to identify any maintenance work or hazards in the home. As detailed earlier some work is required to update the fire risk assessment and it was found that the checks of the emergency lighting were out of date and the manager was also advised to address this. Records were seen of accidents in the home and incidents are recored and forwarded to the Commission as necessary. Care Homes for Adults (18-65 years) Page 27 of 32 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 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 2 14 Prior to someone being admitted to the home in an emergency, and with the involvement of the individual, an assessment of their needs and the support required must be undertaken. This will help to make sure that the staff are fully aware of and confident that they are able to meet the persons needs, wishes and choices. 29/01/2010 2 6 15 People admitted to the home 29/01/2010 in an emergency must be involved in the development of and have a plan of care, that details their needs, hopes and wishes. This will help to support them and the staff in making sure that the correct support is offered and that peoples needs, wishes and choices are met. 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 3 22 22 The complaints procedure must include the up to date contact details of the CQC. This will help people to be able to contact the CQC is they so require this additional support. 04/01/2010 4 24 13 Where hot water outlets are 04/01/2010 not regulated with temperatures close to 43 degrees, risk assessments must be completed to identify how people are kept safe. This is to help to protect people from the risk of scalding. 5 24 13 The fire risk assessment 04/01/2010 must be kept up to date and under review. This helps to support and protect people from the risk of fire. 6 35 18 Staff should be up to date 04/02/2010 with their training, including, for example, fire training. This will help them to keep up to date with their knowledge and continue to meet peoples needs. 7 42 13 The electrical wiring safety checks should be kept up to date. 04/01/2010 Care Homes for Adults (18-65 years) Page 30 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 This will help to ensure that the wiring in the home is safe and does not pose a risk to the people who live in the home. 8 42 13 The emergency lighting checks must be kept up to date. This will help to ensure that the lighting is fully operational should an incident occur that it may be needed to help guide people to safety. 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 04/01/2010 1 2 20 20 Handwritten entries on MAR records should be undertaken by two people, reducing the risk of error. Staff should have up to date or refresher training in the handling of medicines, that is accredited, to make sure that they continue to be qualified and competent in this. The complaints policy should be available in different formats so that all service users can access this. Fire evacuation drills should be kept up to date to help to make sure that if an actual fire occurs people are confident and competent in evacuating their home. References undertaken on staff should whenever possible be from previous employers, with character reference only being undertaken in exceptional cases. References should be validated to ensure their authenticity. 3 4 22 24 5 34 6 34 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. 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