Care Home: The Birches

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What the care home does well The manager ensures that there is good liaison between the service and the guest`s usual carers and relatives. This ensures that the home is able to provide care which is tailored to individual needs, and takes account of any recent changes. The staff are working towards enabling guests to further develop their living skills and make small steps of progress during respite care; so it is not just a "stop-gap" facility, but offers guests the chance of increased development during their stays. The home provides guests with the opportunity to try out new experiences and activities, and to visit new places. Good liaison between the home and family members enables staff to support guests with their health care. The manager is getting to know different respite guests as much as possible, so that he can appropriately match support staff to the guests, who have a similar outlooks and prefer the same sorts of activities. The manager demonstrated that he has a clear vision for the development of this respite service. The staff will help guests to feel integrated into the community. What has improved since the last inspection? This was the first key inspection for this service. What the care home could do better: The statement of purpose and the service users` guide need to be separated into two distinct documents. The service users` guide must provide clear and accessible information for guests, in a format which is most suitable for them. Medication storage needs to be reviewed and improved as outlined in the report. Receipt of medication into the care home must be clearly signed on the Medication Administration Records, (MAR charts), with each item signed by two appropriately trained staff. MAR charts must be accompanied by a photograph of the guest. The alteration work must include redecoration of all areas, ensuring that the premises are suitable for their designed purpose. The patio area in the rear garden must be made safe and fit for purpose. The registered person must ensure that the fire panel and thermostatic controls for this part of the building are accessible to staff; and must complete any associated requirements given by the Fire Officer. A maintenance file must be set up and maintained, so that there is a record of ongoing maintenance checks within the home. Key inspection report Care homes for adults (18-65 years) Name: Address: The Birches 16 Salisbury Road Tonbridge Kent TN10 4PB     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: Susan Hall     Date: 1 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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 29 Information about the care home Name of care home: Address: The Birches 16 Salisbury Road Tonbridge Kent TN10 4PB 01732373710 01732373710 info.kent@futurehomecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Future Home Care Ltd Name of registered manager (if applicable) Mrs Celeste Pearson Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category / ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The home is managed by Future Home Care, who are experienced providers for supported living and domiciliary care; and who are able to provide care for adults with learning disabilities and associated physical disabilities. The premises are situated in a quiet residential area on the edge of the town of Tonbridge. The home is easily accessible by car and by public transport. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 7 Brief description of the care home The home consists of half of a large bungalow, with three bedrooms for giving respite care to guests on a previously arranged basis. Guests are able to stay for a maximum of sixteen nights at any one time. This is a new service, and fee levels are currently under discussion with the local authority. Fees are arranged on an individual basis, according to each persons needs. Care Homes for Adults (18-65 years) Page 5 of 29 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 home is assessed as having a rating of Good, 2 stars. This was the first key inspection for this service, since it was registered with the Commission in April 2009. A key inspection includes assessing all the information obtained by the Commission, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We did not receive a completed AQAA, and were informed by the companys service manager that no request for an AQAA had been received. We raised this concern with our business services department. Care Homes for Adults (18-65 years) Page 6 of 29 The visit took place over four hours, commencing at 09:30 until 12.30pm; after which we (i.e. CQC) visited the companys regional office in Maidstone, where we examined staff recruitment files for an hour. A new manager has been appointed, and is currently going through registration processes with CQC. He has previously been a registered manager for other care homes. He was present throughout the visit to the home, and provided helpful information. The care service was previously managed by the NHS, and Future Home Care purchased this and six other services during the last year. These were registered with the Care Quality Commission in April 2009. Future Home Care are based in Birmingham, and are mainly committed to arranging individual care packages for clients, using Supported Living and Domiciliary Home Care. All of the clients who were living in the home when Future Home Care (FHC) took it over, have been fully reassessed by care managers, as well as by FHC, and have been provided with independent advocacy as well as with Social Services care managers. All of them have moved out into supported living arrangements. Since registration with CQC, the building has been altered to provide two separate facilities. A dividing wall has been built between the two wings, and there is separate access to each part. Half of the building is now being used as a supported living home; and the other half is being developed as a respite service. As the Commission do not inspect supported living homes, it was not applicable for us to view that part of the building. The inspection therefore concentrated on the respite service, which is for up to three people at a time. The company call respite service users guests and they are referred to as guests for the rest of this report. The company are in the process of reregistering the service for three people. There were no guests in the home when we visited, but we viewed the care planning for one guest who had stayed for the previous weekend. We also inspected medication arrangements, viewed the premises, read some of the policies and procedures, and talked with the manager about the ongoing development of the service. The manager is only admitting one guest at a time, during weekends only, while major redecoration and alterations are being carried out. This work is done from Monday to Fridays, and so it is possible to use the home at weekends. This also provides staff with the opportunity to get to know the guests well, prior to longer respite stays in the future. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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. The homes statement of purpose and services users guide need to be amended to contain the relevant information for each document; and to be produced in appropriate formats. There are good assessment procedures in place. Evidence: The home has a statement of purpose and a service users guide set up as one document. This includes some relevant information, but needs to be amended into two separate documents. The current document includes details of the facilities available, the providers, the staff team and the goals and aims of the home. However, it does not clearly indicate that this is a respite service; and does not explain how the system will work. This must be clearly stated so that enquirers understand the purpose and outworking of this service. The information is provided in large print, and there are some colour photographs. However, in its current format, the service users guide does not provide most guests with an understanding of the service, and the company need to decide how to put the guide into a format which will be applicable to as many guests as possible. e.g. a Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: series of photographs, pictures or symbols etc. New guests have a full assessment of their individual needs carried out by the manager or senior staff in the home; and the manager also accesses the care management assessment, and as much information as possible from current carers or family members. Guests who are currently receiving the service have previously had initial assessments from when the home was owned by the NHS. The manager has checked this information, and has provided a detailed overview for staff, which shows how to meet all the persons care needs, such as communication needs, mobility, eating and drinking, personal care, behavioural issues and social preferences. The staff ensure that prospective guests have as long as they need, to decide if they wish to try out the respite service. They can visit for afternoons or evenings, and for meals or to join in with activities; and can have an initial overnight stay before deciding if they wish to attend the home for respite on a more regular basis. All guests have contracts set up by the local authority. These currently include agreements for specific time frames e.g. twenty-eight nights per year. The manager stated that he wishes to discuss these contracts with social workers and family members, to try and ensure that guests have the right amount of respite care; recognising that some guests may need more respite care than others. This would provide respite care on a more individualised basis according to need, rather than the same number of nights for each person. The company does not currently provide their own details for the terms and conditions of residency. The manager stated that these would be added into the homes service users guide in the future. Care Homes for Adults (18-65 years) Page 12 of 29 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 home provides an individual plan of care for each guest, which reflects their specific care needs. Evidence: Each guest has a detailed plan of care, and the plans are drawn up with the involvement of the guest and their usual carers. These often include family members. The emphasis of the home is to use the respite time to help guests to further develop their day to day living skills; to support them in their ability to communicate; and to provide them with the opportunity to carry out normal activities and try out different activities. This entails spending time with the persons usual carers, to establish how to work with the development plans which they already have in place. The home liaises with the care management team and the community learning disability team as a part of this process. We viewed one care plan for a guest who had stayed for respite care over the previous weekend. The care plan sets out the persons usual care package e.g. any college or Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: work experience; their day to day routine; their interests and hobbies; physical health needs and medication; any behavioural difficulties and the appropriate management; and support needed with personal hygiene and toileting. The care plan files include these details in a separate format which is easier for guests to understand, called things you need to know about me. This section is written in a simple format, which includes some pictures or symbols. The manager is going to develop these further in due course, so that care plans are written as much as possible in a style which the individual guest understands, and in which they can be involved. This includes daily reports. These are currently written by the support staff for each morning, afternoon and night shift, and do not contain much content. The manager stated that he is going to implement a system whereby the guest is supported in completing a daily diary with the support staff, providing a clear picture of their day, their moods, their experiences and any unusual occurrences. Guests are encouraged to make their own decisions as much as possible about what they want to do, and where they want to go, in a risk assessed framework. They are also supported in making small everyday decisions about items such as their preferred time for getting up and going to bed; their choice of clothes; choice of bath or shower; and the food they eat. This is all dependent on the discussions which have taken place with their usual care staff, so that the support staff in the home are working together with their usual carers to provide consistent support. The home has a system in place to ask for feedback from the guests and their usual carers after each respite visit, so that any concerns or developments can be discussed. This provides a context for the next respite visit as well, so that the guests and their usual carers can build up confidence levels in the care and support provided by the home. Discussions take place prior to each respite visit to agree any changes, and to discuss how each guest is progressing. Risk assessments are set up according to individual needs. These follow the different aspects of care, such as risks associated with giving personal care e.g. risk of slipping in the bath or shower; risk of epileptic seizure while bathing; risks associated with eating and drinking, such as choking; use of mobility aids; and risks associated with going out of the home, such as inappropriate behaviour, or exploitation of finances when shopping. Each risk assessment includes management guidelines, and these are reviewed each month so that any necessary alterations can be made. Care Homes for Adults (18-65 years) Page 14 of 29 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. Guests are able to choose their preferred lifestyles, and are supported in their individual development in all areas of life. Evidence: Care plans demonstrate that guests are encouraged in maintaining and developing their individual living skills. This includes activities such as taking part in household chores like dusting and vacuuming; and support with managing their own personal hygiene, such as brushing teeth, choosing clothes, and dressing and undressing. The care plan we looked at included sufficient evidence to show that small steps and goals are agreed with the guest, so as to encourage their development, and to support them in new experiences as well. There are detailed guidelines for support staff so that they know, for example, exactly how to support a guest with bathing, or with mobilising. The manager is developing further guidelines for each guest, so as to have even more detailed steps, showing the small goals which can be achieved. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The service ensures that guests are supported in continuing with agreed education courses, such as college courses and day services. They also access the community as much as possible, providing guests with the opportunity to try out new experiences, as well as accessing a range of leisure pursuits according to individual preferences. These might include bowling, horse-riding, swimming, shopping, train rides, meals out etc. A care plan showed that one guest had been taken out on a steam boat. Guests are also able to enjoy their own choice of DVDs and television programmes, and spend time in the communal lounge, the sensory room, or the garden. The manager tries to match staff as much as possible to each guest so that they can enter into their choice of activities. Guests are enabled to meet up with their own friends or family members, and the care plans include details of people who are important to them, so that they can contact them if they wish to do so. Guests are also encouraged to interact with each other, and to develop new friendships. The staff ensure that they are aware of any special dietary needs, and the home provides a good range of nutritious food. Guests are encouraged to choose their own meal choices, and to take part in meal preparation and clearing away after meals, according to their individual abilities. Staff will support guests with eating and drinking according to the guidelines in individual care plans. Care Homes for Adults (18-65 years) Page 16 of 29 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. Guests are supported with personal and health care in a sensitive manner which retains their dignity. Medication procedures need to be checked for full compliance with regulations. Evidence: Care plans include very clear guidelines for how to support guests with their personal care and support. These are drawn up to show the amount and type of support needed, for example with bathing or showering, dressing and undressing, washing, brushing teeth and shaving. For example, a guest may be able to wash themself, but need prompting at each stage of the process; or may be able undress but need assistance with aspects of dressing. Personal care is given with attention to maintaining the privacy and the dignity of the individual; and same gender care is given in accordance with discussions for each person. Additional support is provided by the community learning disability team, and this includes access to physiotherapy, speech and language therapy, and occupational therapy. Care plans contain details of the guests GP; and guests are supported with appointments to see their doctor, consultants, dentist or optician, if needed during Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: respite stay. The home works with the guests usual carers to ensure that ongoing health needs are met, and that staff are informed of any health changes. The care plans contain specific information about how to promote the guests health care, for example, managing epilepsy. Seizures are charted with the time and duration and type of seizure; and show the action taken to protect the individual. There are clear management guidelines in place showing the action to be taken, and when to give additional medication. The manager asks that all medication is brought into the home in its original packaging, and is in date. Each item is hand written on to a Medication Administration Record (MAR chart) with any specific directions. Allergies are highlighted in the care plans. We viewed one MAR chart, and noted that hand written entries are not signed. Each entry must be checked and signed by two suitably trained staff. The manager stated that this would be done in future. Care plans and MAR charts must be accompanied by a photograph of the guest, and photographs were not evident. The manager stated that these are being put in place. However, the MAR chart viewed was neatly written, with good information, and clear signatures for when medication has been given. Additional charts are included for as necessary medicines, with clear guidelines for when to give these. The staff check the number of tablets in stock for each item of medication whenever it is given, and this is an example of good practice. Care plans include a detailed list of the persons medication, with information about any side effects to look out for. Medication storage is provided in one locked cupboard, which the manager stated may not be large enough to take all medication for three respite guests if each one has large amounts of medication. This needs to be reviewed. The home has a small controlled drugs cupboard. This is not fixed according to regulations (fixed securely with rag bolts to a solid wall); and if any controlled drugs are to be stored in the home, the controlled drugs cupboard must meet the requirements. Care Homes for Adults (18-65 years) Page 18 of 29 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. The home has an accessible complaints procedure; and there are good systems in place to enable guests to raise their concerns and be confident they will be listened to. Evidence: The complaints procedure is included in the Service Users Guide, which is given to each guest on arrival in the home. It states that an acknowledgement of complaints will be given within five days; and there will be a full investigation and response within twenty-eight days. Complainants are encouraged to speak to the manager or staff in the first instance, and then the homes service manager, or the care manager if they are not satisfied. It would be helpful to include clear names, addresses and contact phone numbers for the service manager and for the local Social Services department. The details for the Commission are included. The manager said that he is setting up a room file to be kept in each room, so that the information is always to hand for any guests who have not brought their information in with them. It will also be put into a simplified format to aid understanding. A system has been put into place whereby the guest and their usual carers are asked for feedback at the end of each visit. This enables them to highlight any concerns immediately, and action can be taken to prevent re-occurrence before the next respite visit. A complaints log is kept up to date, so that any pattern of complaints can be established. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: All staff are trained in the recognition and prevention of abuse for vulnerable adults, and are aware of the importance of protecting guests from different types of abuse. This may include verbal or physical abuse from other guests, or verbal or financial abuse when out of the homes environment. Staff training commences at the time of induction. There are good recruitment procedures in place, and this is an added protection for guests. Care Homes for Adults (18-65 years) Page 20 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises need refurbishment work in all areas prior to using the facility to its full capacity. Evidence: The premises consist of a large bungalow, which is in two wings. One side has already been converted into supported living for four people, and the other side forms this three bedroomed respite service. Our inspection processes do not include supported living, and so only the respite section has been included in this report. The two sides of the building have had a dividing wall built between them; and a new front door area is to be created to make this part of the building more self-sufficient. The home has a wide corridor with laminate flooring, which is suitable for wheelchair users, and is easy for moving equipment such as mobile hoists. All rooms lead off from this central corridor. Communal areas include a large lounge/diner, a good -sized kitchen, and a sensory room. There are three reasonably sized bedrooms for guests, and one small room which doubles up as a sleeping-in room for staff and as a small office area. The guests bedrooms include one nursing bed, and two new profiling beds; and each bedroom has a wash basin. Wardrobes and other bedroom furniture are in reasonable condition, but additional furniture would enhance these rooms, including a comfortable chair for each bedroom. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Bathroom facilities include a large bathroom with an assisted bath and a shower trolley; and a separate shower room, which is set up as a wet room. All of these rooms need redecorating; and need items to make the premises into a more homely environment and less institutional. The laundry room contains a commercial sized washing machine and a tumble dryer. The manager said that there are plans to move the machines to the other side of this room, to improve the venting facilities to the outside of the property. The laundry room is kept locked when not in use. Chemicals are stored in locked cupboards in the kitchen; and there is a separate locked walk-in cupboard where files and documentation are stored. There is a good-sized garden which includes lawns and a patio at the rear of the building. The patio is currently unsafe with uneven paving slabs with weeds growing between them. This is a slip and trip hazard. We are confident that this is being attended to, and so a requirement has not been given. The manager is promoting safety by ensuring that guests do not go out into the garden unless they are accompanied by a staff member, until this is rectified. The manager stated that permission has been obtained to have a large tree and some smaller trees in the garden, removed. This will provide more light inside the home, which is quite dark. The front of the property is presently untidy and unattractive, with peeling paintwork on the outside, uncut grass, and some rubbish. Some of this is due to ongoing alteration and building work. The home has had a recent assessment and work carried out in regards to fire safety. However, there is only one fire panel, and this is in the other section of the bungalow. This is unsatisfactory, as staff would be unable to access this in the adjacent part of the building, and it would also be encroaching on the home of people with supported living to be going into their premises uninvited. The company must ensure that the home has its own fire panel and arrangements, in line with any requirements given by the Fire Officer. The company have made arrangements to only admit one guest at a time at present, and only for weekends. This is to ensure the safety of guests while refurbishment and building work is carried out. Care Homes for Adults (18-65 years) Page 22 of 29 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. The guests benefit from having competent and experienced staff, who are chosen for their suitability for different guests. Evidence: The manager is in the process of recruiting staff for a full staff team, ready for the time when the home is fully operational. There are currently two full time support staff and one part-time staff. These are being deployed in other associated areas (such as day centres and supported living) during the week while there are no guests on site. The staffing numbers will be arranged in accordance with the individual dependency needs of the guests who are staying. This will take into account if guests need two to one support when going out of the home; or for hoisting needs when inside the home. There is a second put-up bed available to go in the sleeping in room if a second staff member is needed at night, or for new staff who are shadowing on night duty. Staff will be encouraged to carry out NVQ training and LDQ training if they have not already completed this; and mandatory training is carried out by the company. We viewed one staff file which confirmed that mandatory training is taking place. We were unable to establish the percentage of staff with NVQ training (level 2 and above), as the staff team is not yet complete. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Staff files are stored at the companys regional office in Maidstone, as support staff will need access to all locked areas, and it would not provide confidentiality if staff files were locked in these cupboards. We discussed this with the service manager, who said that the company are also concerned to keep as homely an environment as possible, which is why there is not a specific managers office. However, certain details will be kept on the premises, including staff emergency contact details and their training files. We viewed one staff file which confirmed that mandatory training is carried out; but we were unable to confirm that all staff training is kept up to date as staffing levels are not complete yet. Staff recruitment files contain all required checks, such as proof of identity, two written references, a POVA first check, and a Criminal Record Bureau (CRB) check. Application forms request a full employment history, and training certificates are kept on file. Staff photographs are currently being added to their files. Care Homes for Adults (18-65 years) Page 24 of 29 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. The manager is taking good day to day control of the home, and is aware of current shortfalls and how to rectify these. Evidence: The manager has over twenty years of experience in caring for people with learning disability. He is in the process of registering with the Commission, and has previously been a registered manager in other services. He showed that he has vision for the development of this service; and is very motivated about ensuring that guests who come for respite care gain positively from the experience, and develop further as a result. He is supported by the regional service manager, and by a quality control manager, who is carrying out monthly visits to the home. All guests and their next of kin or usual carers will have the opportunity of feeding back information to the home after each respite visit; and the staff will send a compliments/complaints slip back home with each guest so as to facilitate the guest or their carers in voicing their feelings about the service. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The manager has only been in post a few weeks, but has already ensured that policies and procedures are in place. He said that some of these will need to be altered to make them more specific to this home, and he is in the process of carrying this out. Records were generally seen to be well mantained and up to date. However, the manager has not yet set up a maintenance file, and this is needed to verify that there are safe working practices in the home. As well as ensuring that there is a separate fire panel (as itemised in the section on Environment), the manager was also unsure about access to thermostatic controls for heating and hot water; and these must also be accessible from this side of the premises. There are auditing processes in place, for recording and checking accidents and incidents in the home. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 20 13 The registered person must ensure that all medication storage meets the requirements of the Medicines Act 1968, and the Misuse of Drugs Act 1971, and guidance issued by the Royal Pharmaceutical Society. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 30/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!