Care Home: The Copse

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What the care home does well One person agreed to give feedback about the way staff care for the people at the home. This person agreed that they like to have familiar staff provide personal care, physical choices are the way staff empower people to make decisions and staff know when they are unhappy because they may refuse to participate in the activity. This person also indicated that they felt safe at the home. Support workers giving feedback about the way they meet the needs of people at the home, conveyed a clear understanding about each individual living in the unit. Specific knowledge about the person likes were expressed indicating that there is a personlised approach to meeting people. What has improved since the last inspection? Support staff told us that since the last inspection, staffing levels have improved and staff are more dedicated because there is less reliance on bank and agency staff. Support staff also spoke about having more input into the care planning process, which they said would ensure people benefit from consistency. What the care home could do better: There are eight requirements arising from this key inspection and one partly met requirement from previous inspections. The previous partly met requirement relates to keeping the premises under good state of repair. While it is acknowledged that the future of The Copse in this location is undecided, the premises have a neglected and institutional appearance. Care planning and associated risk assessments must be improved to ensure there is a consistent and personalised approach to meeting the changing needs of the people accommodate. A new format is to be introduced to structure information and to include risk assessments that run alongside the care plans. Care plans must include the person`s ability to meet their needs, their likes and dislikes and preferred routines. The way that people make decisions must form part of the care plan and if the person lacks capacity, the agencies involved must be included into the action plans. The purpose of assessing risks is to provide an action plan that allows the person to take risk safely. Medications systems must be made safer, qualified nurses must ensure that the records are signed immediately after medicines are administered. The manager must conduct an investigation into an allegation of abuse and if necessary reports to the Safeguarding Adults lead to ensure that people are protected from abuse. Support workers must be given the opportunity to undertake vocational qualifications; this will mean that people at the home benefit from having staff that are qualified to meet their needs. The recruitment process must be made safer by ensuring that the referees validate the references and by ensuring that when references are from a line managers` they represent the view of the organisation. Key inspection report Care homes for adults (18-65 years) Name: Address: The Copse Beechmount Close Old Mixon Weston Super Mare North Somerset BS24 9EX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Jones     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Copse Beechmount Close Old Mixon Weston Super Mare North Somerset BS24 9EX 01934811448 01934811352 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw healthcare (Homes) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: 24 Adults, aged 18 and over, with Learning Difficulties which can include 14 Physically Disabled Persons Manager must be a RN on Parts 3, 5, 13 or 14 of the NMC register Staffing levels as detailed in the Notice of Registration dated 1st September 2004 apply Date of last inspection Brief description of the care home The Copse is care home with nursing for adults with learning disabilities and physical disabilities. It is situated on the outskirts of Weston super Mare. The home is arranged into four small units each with their own communal areas. The residents at the home can also access a minibus. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 24 14 24 14 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted unannounced over three days in April 2010 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. This information was used to plan the inspection visit. There are seventeen individuals living at the home and six were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also Care Homes for Adults (18-65 years) Page 5 of 31 used to confirm the findings. The views of the people living at the home and staff were gathered through face-toface discussions. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There are eight requirements arising from this key inspection and one partly met requirement from previous inspections. The previous partly met requirement relates to keeping the premises under good state of repair. While it is acknowledged that the future of The Copse in this location is undecided, the premises have a neglected and institutional appearance. Care planning and associated risk assessments must be improved to ensure there is a consistent and personalised approach to meeting the changing needs of the people accommodate. A new format is to be introduced to structure information and to include risk assessments that run alongside the care plans. Care plans must include the persons ability to meet their needs, their likes and dislikes and preferred routines. The way that people make decisions must form part of the care plan and if the person lacks capacity, the agencies involved must be included into the action plans. The purpose of assessing risks is to provide an action plan that allows the person to take risk safely. Medications systems must be made safer, qualified nurses must ensure that the records are signed immediately after medicines are administered. The manager must conduct an investigation into an allegation of abuse and if necessary reports to the Safeguarding Adults lead to ensure that people are protected from abuse. Support workers must be given the opportunity to undertake vocational qualifications; this will mean that people at the home benefit from having staff that are qualified to meet their needs. The recruitment process must be made safer by ensuring that the referees validate the references and by ensuring that when references are from a line managers they Care Homes for Adults (18-65 years) Page 7 of 31 represent the view of the organisation. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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. People at the home have accessible and up to date information about the home to enable people to make decisions about moving into the home. Evidence: There is a 2009/10 Statement of Purpose that says the aims and objectives of the home are to provide specialist support, development of a person centred care approach to enhancing the Principles of Valuing People. It also states that the purpose of the home is to provide personalised care to people with learning disabilities with associated physical and sensory needs. However, the Statement of Purpose would benefit from reviewing to ensure that the information included meets the requirements of legislation. The Statement of Purpose and Service User Guide are also in an easy read format that includes pictures and words. This means that the people for whom its intended can understand the information. We were told that there are 17 people currently accommodated and there are no new Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: admissions. The deputy manager said that the people currently accommodated are being re-assessed so that alternative accommodation can be found for these individuals Care Homes for Adults (18-65 years) Page 11 of 31 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. Care plans are not essential to the delivery of care and people have little say about the way their care is to be provided. There is little evidence that they are empowered to make decisions and risk assessments must be developed to show that people are able to take risks safely. Evidence: The care planning process was discussed with the deputy manager, who told us that formats have changed and care plans are being re-written. At present the deputy and team leader devise care plans, once the social workers reviews and discussions with support staff have taken place. It was also confirmed that care plans are monitored monthly, however, because the staff team is not stable, care plans are not up to date. Person centred training was provided and attended by the deputy and one support worker. Consequently only one person has had a person centred review, with a care plan that says the way care is to be delivered and describes their ability to meet the need. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: There are gaps in the information about the way care is to be delivered so that the assessed needs can be met. It is therefore difficult to establish that there is a consistent approach to meet the needs. Few of the care plans seen were signed and dated. The deputy said that where people needs change and need more structure in their routine, care plans are up dated as a priority. Monthly monitoring sheets and daily reports say little about the progress made with the care plan. It is evident that that external agencies are involved in the care of the people at the home, however, their advice is not part of the care plan and there is little evidence that their advice is put into practice. People at the home have communication needs and for one person that needs a structured routine, the care plan was updated. While the care plan specifies the way the staff are to communicate with the person, the way the person uses body language and sounds to make decisions is not included. The individuals abilities to make decisions are not part of the care plan and where people lack capacity its not stated within the care plan. The deputy said that advocates will be appointed to support people to find alternative accommodation. One person at the home with the support of the staff agreed to give feedback about the care at the home. Staff said that this individuals prefers staff that are familiar, physical choices are used to empower people to make decisions. Support workers were asked about the care planning process. We were told that qualified nurses prepare care plans and since the appointment of the current manager, support staff are more involved with the care planning. Support workers act as keyworkers which involves taking specific interest with a number of individuals at the home. For example, arranging appointments and buying toiletries. In terms of empowering people to make choices, we were told that giving people informed choices, building relationships and interpreting body language are the ways that people are supported to make decisions. Other staff included facial expressions as a means that people at the home use to communicate. People at the home can at times use aggression and violence to communicate with staff. For one person the updated Management Behaviour Plan (MBP) has reduced the number of episode. For other people that present this behaviour, MBPs are not specific and there is little evidence of monitoring other that to say they have taken Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: place. Staff consulted about people that exhibit aggressive and violent behaviours said that they know how to manage behaviours exhibited. Other support workers said that people at the home are individuals and there are varying levels of aggression exhibitied which can be deffused by 1:1, team work and open communication between staff. Risk assessments are in place for activities that may involve an element of risk. The quality of the information included is poor as it is not clear the level of risk and the actions taken to lower the risk. The current manager told us that new care plan formats include risk assessments to make it easier for staff to identify the risk to then take steps to lower the risk. Care Homes for Adults (18-65 years) Page 14 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home would benefit from being better connected with their local community and have more meaningful activities. Visitors are welcome and people benefit from healthy eating. Evidence: An activity worker was appointed in-house activities and The Brandon Trust are used to provide external 1:1 day services. The deputy explained that the activity workers role is to support people with skills development, sensory skills and community activities. The day services rota in place shows that people have snoozelum sessions, go swimming and independent skills training. Lifestyles form part of the care plan and suggests ideas, for some individuals there is an activity timetable, although staff record to say that an activity took place, the information is brief and the type of activity undertaken is not recorded. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: While staff were observed engaging with people and some were participating in activities. For example, dancing and listening to music. Activities provided could be more meaningful. There is a Visitors policy and says that family and friends are welcome at the home. There is an easy ready policy that defines the rights of the people living at the home. It says that people have the same rights including to be treated with respect, make choices and have privacy. People can expect to be asked about the way their care is to be delivered; care plans will then be designed to promote personalised care. Respectful of space, opportunities to go out and have their personal space reflect their tastes. We were told that support, catering and ancillary staff are employed so there is no expectation that people participate in household chores. The manager said that some people undertake life skills training and this would be a part of their care needs. Discussions with the catering staff took place and we were told that it is the cook that prepares the menus. Menus in place show that breakfast is generally prepared in the units by the support staff, at lunchtime there is a cooked meal and at tea-time a lighter meal. While the menus are varied, there are no choices of meals and when we spoke to the cook, we were told that overall the people in the home eat the meals listed in the menus. On the occasions that people do not eat the meals served an alternative is provided. There is a minimum use of frozen vegetables; the focus is on fresh vegetables and fruit. Meat is ordered 3 days in advance because of the short expiry dates. The cook and handyman are making use of a small area at the back of the kitchen to grown vegetables and its anticipated that potatoes, cabbages, lettuce and tomatoes will be grown. At the most recent Food Agency visit the home was awarded 5 Star for Food Hygiene. . Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals health and physical need are met by the staff. Medication systems must improve for medication systems to be made safer. Evidence: People living at the home need assistance with personal care which forms part of their care plan. However, personal care plans are generic and do not bring information about the person together to form a detailed plan about the way care is to be provided. Members of staff receive annual Manual Handling training to support those individuals need assistance with mobility. Two staff at the home are Manual Handling trainers which ensure that correct techniques are used. Individuals that are at high risk of developing pressure areas are accommodated at the home. For this reason qualified nurses and support staff at the home have received training in recognising pressure areas from the district nurse team. Other preventative measures include monthly visits from the district nurses. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: The manager told us that there is a new Shaw Trust support plans with risk assessments that run alongside. While it is acknowledged that these risk assessments were recently introduced, they require more information. Existing risk assessments are difficult to follow, where the needs have changed, there is little information about the actions that need to be taken as a result of the individuals changing needs. There is documented evidence that confirms people have access to a GP, district nurse, physiotherapist and access NHS facilities. When a health care professional visit is requested by members of staff a consultation sheet is used to record the outcome of the request. Health care was discussed with support workers and we were told that individuals health care is discussed with the team in the unit. Decisions about contacting health professionals are taken together and during handovers, advice given is passed onto staff. Medication systems and less stock medications have improved the medication systems. There are identification sheets with the persons photograph, GPs contact details, and known allergies along with information about the way the person will take the medication. Medication forms are in place and summarise the individuals prescribed medication, their purpose and side effects. As required (prn) medications protocols lists the purpose of the medication, the reasons for taking the medications and signs and symptoms that must be noted. The records of administration were checked and gaps in the recording indicate that members of staff do not always sign the records after administering medications. Codes are used to explain the reasons why medications were not administered. Homely Remedies are administered from stock supply when required by the person and include pain killers, cough medicines and other stomach remedies. Administration of these homely remedies is recorded separately and states the name of the person, the reason for administration and the balance. A check of the remedies held was undertaken which correspond with the records. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints formats will ensure that people know how to make complaints which are appropriately investigated. Staff know how to manage situations where people use aggression and violence to communicate. People at the home must be protected from abuse. Evidence: There is an easy read Complaints procedure that includes pictures and words which is on display in the entrance of the home. This will ensure that people can understand the steps they must take when they want to complain. The staff have received five letters of compliment between 2008-2009 and three complaints in 2009. Complainants received acknowledgement letters from the manager about the way the complaint will be managed and resolved. Where appropriate meetings are convened to look more in-depth into the concerns raised. This ensures that complaints are resolved appropriately. Members of staff were consulted about their responsibility to enable people to raise concerns. Support staff told us that their knowledge of the person would alert them that they were not happy which would be passed onto the manager. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: One person involved with giving feedback about the home indicated that they felt safe at the home. The Shaw Trust have developed a Safeguarding Adults policy that defines the purpose of the policy which is to protect people from abuse. The principles of abuse and the actions to be taken by the staff when abuse is suspected are also described. It is detailed and makes clear to staff their duty to report allegations of abuse. The Whistle blowing policy says that its aim is to create an environment where staff can come forward and report poor practice. Staff are reassured through the procedure that they will be protected from reprisals and specifies the implications for not reporting poor practice. Training records confirm that staff have attended Safeguarding Adults training during induction and as refresher training. There were two Safeguarding Adults referrals made by the previous manager and were based on medication errors and neglect (pressure areas). Since these referrals preventative measures have been introduced to ensure people at the home are safeguarded. However, not all incidents of alleged abuse are referred to the Safeguarding Adults lead. The current manager was asked to investigate the actions taken about the incident and it transpired that the incident was not reported. We have received reassurances that appropriate action will be taken to ensure the safety of vulnerable adults. Support workers giving feedback said that Safeguarding Adults and Whistlblowing was covered during staturory training. They said that poor practice would not be tolerated at the home. Care Homes for Adults (18-65 years) Page 20 of 31 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. People at the home benefit from having personal space that reflects their lifestyle choices and personalities. The home has an intitutional appearance. Evidence: The Copse is situated on the outskirts of Weston super Mare. The home is arranged into four small units each with their own communal areas. We were told by the current manager that there will be no more referrals until the future of The Copse is decided. It is evident that great care has been taken to ensure that private space reflects the personalities of the person and that communal areas are comfortable and homely. However, other parts of the property have an intuitional appearance. It is also evident that for sometime there has been little maintenance work undertaken making the home appear neglected and institutional. As a result of work needed in an upstairs bathroom, a unit was closed and people moved to other units within the home. We were told that there is no risk as long as the bathroom is not in constant use. However, this unit was for people with sensory needs and the equipment needs to be moved so that people who benefit from tactile objects can continue to do so. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff employed at the home attend training that ensures they can meet the specific needs of the people accommodated. The recruitment process must be more robust to ensure the staff employed are suitable to work with vulnerable adults. Staff must have opportunites for vocational qualifications. Evidence: The current manager explained that there is a current recruitment drive for three nurses on fixed term basis. At present the staffing levels are seven in the morning and six in the afternoon, organised into two staff per unit with one person doing 1:1. It was further stated that because of the number of vacancies staffing levels are high; realistically staffing levels will be reduced by not replacing support workers when they leave. We were reassured that the staffing levels will not go below seven in the morning and six in the afternoon. We spoke to the deputy manager who said that the staffing levels currently in place only cover basic care. This following example was given to reinforce the comments, we were told that there is a homes vehicle but the people at the home cannot be left with one member of staff. This means that people are having less contact with the community. We were also told that staff have to do personal shopping without the person because there is insufficient staff. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: At night there is one member of staff awake on each unit and a team leader who is a qualified nurse in overall control of the home. At present although the night staff are regular staff, they are from an agency. The recruitment process followed for the two most recently employed staff at the home was checked to determine the robustness of the process. Trust application forms request full employment history and the names of three referees, one of which must be the most recent employer. Inconsistencies in the information declared through the application form were found. The current manager must ensure that full employment history is sought for the staff that have not appropriately completed the application form. Candidates sign a declaration of criminal background which must correspond with the Criminal Records Bureau (CRB) obtained; this is to establish that the person is of good character. Standard reference forms are used to seek information about candidates; referees are not currently asked to validate the reference or asked about any disciplinary procedures that the person may have been subject of. Since the key inspection the Trust has taken action and will be requesting referees to give information about disciplinary procedures and to validate references. While written references are sought, references were accepted from the line manager and not from the organisation. The manager must ensure that the reference from the line manager represents the organisation. New employees must attend a four day induction within six weeks of their employment which involves background information about the Trust and Statutory training about what staff need to know to be safe at work on Health & Safety, Food Hygiene, Infection Control and Safeguarding Adults. Staff must also attend Fire, COSHH, mental health, dementia and Deprivation of Liberty Safeguards (DOLS) training. An in-house familiarisation day follows with coaching and mentoring about the role. LDQ must be undertaken by support workers within six months of employment and specific training is provided to staff that work with people that challenge, mental health needs including dementia. Eight staff working at the home have vocational qualifications of NVQ level 2 and upwards. This means that less than 50 of the staff are qualified. The manager must ensure that staff are qualified. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Supervision is six weekly with the team leaders and the sessions focus on performance and personal development with an action plan developed in each session. A supervision matrix is in place and while there are gaps, overall staff have regular supervision. It is of some concern that the manager who is working across two homes had not had supervision since Sept 2009. We were told that supervision with the area manager is to take place on the day after the key inspection. We soke to staff about training and supervison. One member of staff told us that after working at the home for three years they are finally doing LDQ and another felt that supervision is a paper excersise that only lasts five minutes. Other staff felt that supervision was more meaningfull and they are eager to undertake vocational training. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are supported by a temporary manager and the views of the people at the home are used to develop the homes systems. Individuals live in a safe environment. Evidence: The current manager told us that the post is for twelve weeks and is acting in a gate keeping capacity. Supporting and leading the team to ensure that standards of care at the home are maintained and comply with legislation. For example, food, environment, systems. Supervising team leaders, convening meeting and identifying those individuals at risk are a priority. We were also told that consistency is maintained through handovers, supervision and team meetings. We asked one person about the staff and this person indicated ok. Staff were also asked about the management of the home and some staff said that staffing levels have improved as there is less reliance on bank and agency staff because there is more dedication. Other staff said there were inconsistencies with the way the home is managed. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The Trust operates its own Quality Assurance system that comprise of internal and external audits. External audits are generally undertaken by a quality audit team. Internal audits are at present through questionnaires to people living at the home and their relatives. Catering, medication, care planning and the environment form part of the questionnaires. House meetings are also part of the system and take place in each unit. Action plans are then devised from the audits. Facilities for the safekeeping of cash and valuables are in place and a sample check of cash held in safekeeping was conducted. Records of cash held examined corresponded with the cash held and receipts in place evidenced the purchases made on behalf of people at the home. Fire risk assessments that assess the potential of fire in the premises are in place and the action plan in place ensures that preventative measures to reduce the risk are taken. Annual portable appliance checks and gas boiler checks are conducted to ensure people live and work in a safe environment. The manager said that the fees at the home range from £590.00 - £ 640.00 per week. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 24 23 (2) (b) The management keep the 04/06/2008 environment under review such that the premises are of sound construction and kept in a good state of repair. This should include the bathrooms. (Partially met previously set for 04/06/07) Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 12 The registered person must enable the people at the home to make decisions about their health and welfare. Care plans must therefore include the likes, dislikes and preferred routines to provide a more personalised approach to meeting needs. 12/08/2010 2 7 17 The way people communicate must be recorded. Care plans must include the communication needs of the person with methods of communication used to make decisions. 12/08/2010 3 8 13 Activities that people participate are so far as reasonable are free from avoidable riks Risk assessments must be completed to assess the 12/08/2010 Care Homes for Adults (18-65 years) Page 28 of 31 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 level of risk and where possible put measures in place to lower the level of risk. 4 12 16 The registered person must consult with individuals to provide a programme of activities. A programme of activities that meet the needs of the individual that is meanigfull must be developed. 5 20 13 The registered person must make arrangements for the recording, handling and safekeeping for the safe administraion of medications. THe manager must ensure that staff sign the records after administering medications 6 23 13 The registered person must make arragements by training or other measures to ensrue people at the home are safeguarded from abuse The manager must take appropriate action to ensure that vulnerable adults are protected from abuse. 14/06/2010 14/06/2010 12/06/2010 Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 32 18 The registered person must ensure that suitably, qualified, competent and expereiced staff are working in the home. Vocational training must be provided to ensure qualified staff are working at the home. 14/01/2011 8 34 19 The registered person must ensure that the staff employed are suitable to work with vulnerable adults. The manager must establish the authenticity of references sought and must ensure where line manager references are accepted they represent the view of the organisation. 14/06/2010 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 30 of 31 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). 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