Care Home: The Firs

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What the care home does well Staff stated that the new manager is `excellent, can only give her praise`, she `has been achieving a lot in a short space of time` and `she has been brilliant`. Nine of the fourteen staff have completed NVQ (national vocational qualification) at level two or above. Residents are supported to go on holidays and where appropriate to maintain contact with their families. When staffing levels permit staff ensure that residents are given opportunities to make use of their local community. Staff observed in the course of their duties were very courteous and were seen to have a very good rapport with residents. An independent advocate is invited to attend all person centred planning (PCP) meetings that are held on a six monthly basis. What has improved since the last inspection? Arrangements have been made to have the needs of one of the residents reassessed and to look at each resident`s compatibility with each other. Where appropriate arrangements have also been made for staff to attend refresher courses to keep up to date with their mandatory training. The procedure and format for recording staff supervision is in the process of being changed and senior staff have received instruction on how this is to be carried out. Staff will benefit from the new system and this in turn will have a knock on effect on the quality of record keeping generally as staff receive a clearer direction in respect of their individual role and responsibilities. The refurbishment of the property which that had begun following the last inspection of the home has recommenced and the home is looking much more homely as a result. Work carried out to date includes the refurbishment of the bathrooms, a new boiler and a new fire alarm system has been fitted and the home has been repainted internally. Residents and staff will benefit form living and working in a much more homely setting. There are now clearer arrangements in place for the management of residents` disability living allowances (DLA) and as a result of the revised arrangements there are now monies that need to be returned to residents. These have yet to be repaid. A record is now kept of all correspondence either received or entered into on behalf of residents. The trust is now carrying out more detailed monitoring visits on a monthly basis and the reports of the outcome are detailed. What the care home could do better: At the time of the last inspection seven requirements were made. Only one requirement was addressed in full and that related to the need to keep a record of all correspondence entered into and received on behalf of residents. Progress has been made in relation to meeting all other requirements and it was noted that significant progress in particular has been made since the new manager has been appointed. It is acknowledged that additional time is needed to meet these areas fully. The majority of these requirements will not therefore be repeated on this occasion but they must be completed in full. Two requirements will be repeated. As a result of this inspection five requirements have been made. These include the need to review and update the statement of purpose, the need to ensure that care plans are thoroughly reviewed and contain up to date accurate information about the needs of the residents. Risk assessments must be reviewed regularly. Residents must be given greater opportunities to participate in stimulating and interesting activities and staffing levels must be reviewed to ensure that there are always enough staff on duty to enable this to happen. Key inspection report Care homes for adults (18-65 years) Name: Address: The Firs 2 Hiltop Drive Rye East Sussex TN31 7HT     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: Caroline Johnson     Date: 0 8 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 33 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 33 Information about the care home Name of care home: Address: The Firs 2 Hiltop Drive Rye East Sussex TN31 7HT 01797225780 01424751641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hastings and Rother Primary Care Trust Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. 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 Firs is a two-storey home situated in a residential area on the outskirts of Rye. The town centre, with its shops and access to bus and rail routes is approximately one mile away. The home is registered to accommodate six adults with a learning disability. Resident accommodation consists of six single bedrooms. Bathing and toilet facilities are provided by way of three bathrooms, one of which provides an adapted bath facility. Communal areas comprise of a large lounge and separate dining room. A large Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 6 0 3 1 0 2 0 0 8 Brief description of the care home garden is situated to the side and rear of the property. Parking is available at the front of the home. Hastings and Rother Primary Care Trust (PCT) are the registered providers for the home. The Trust manages nine other homes within the Hastings, St Leonards and Rother area. Fees for the service range from 1331 to 1366 pounds per week for a block contract. Care Homes for Adults (18-65 years) Page 5 of 33 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 report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment [AQAA] and last inspection report. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care settings. For the purpose of this report, those living at the Firs are referred to as residents. As part of the inspection process a site visit was carried out on 08 October 2009 and it lasted from 10:20am until 16:15pm. The appointed manager was not available on the day of inspection so the senior support worker facilitated the inspection. During the visit there was an opportunity to observe the residents in their surroundings. Time was also spent talking with two staff in private. Two care plans were examined in detail. Other documentation seen included:- staff rotas, training, menus, health and safety, Care Homes for Adults (18-65 years) Page 6 of 33 quality assurance and leisure activities. Since the last inspection the registered manager resigned from his position as manager and a new manager has been appointed to this position. The new manager only took up position a month prior to this inspection and she is in the process of applying for registration. In advance of the inspection process a range of surveys were sent to the home for them to distribute to residents, staff and any visiting professionals. One professional survey was returned. With the exception of two areas the response was fully positive. In relation to a question about respecting privacy and dignity and a question regarding supporting people to live the life they choose, the response given was usually . Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: At the time of the last inspection seven requirements were made. Only one requirement was addressed in full and that related to the need to keep a record of all correspondence entered into and received on behalf of residents. Progress has been made in relation to meeting all other requirements and it was noted that significant progress in particular has been made since the new manager has been appointed. It is acknowledged that additional time is needed to meet these areas fully. The majority of these requirements will not therefore be repeated on this occasion but they must be completed in full. Two requirements will be repeated. As a result of this inspection five requirements have been made. These include the need to review and update the statement of purpose, the need to ensure that care Care Homes for Adults (18-65 years) Page 8 of 33 plans are thoroughly reviewed and contain up to date accurate information about the needs of the residents. Risk assessments must be reviewed regularly. Residents must be given greater opportunities to participate in stimulating and interesting activities and staffing levels must be reviewed to ensure that there are always enough staff on duty to enable this to happen. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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. Prospective residents must be given up to date and clear information about the arrangements in the home and the services on offer. Evidence: There is a detailed statement of purpose in place but this needs to be updated to include the changes that have occurred since the last inspection. These include changes to the Registered Social Landlord, changes to the management of the home, changes to the provision of day care and changes to the address of the Commission. Within the past few months the Registered Social Landlord gave notice of termination of their contract and they no longer carry out this role. The Trust are currently looking for a new housing association to take on this role and there are interim arrangements in place until this can be arranged. The terms and conditions/licence agreements have not been updated since the new owners took over the home over eighteen months ago. It was reported that there are still a few issues to be resolved and it is hoped they will be out for consultation in the Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: near future. A requirement was made at the last inspection of the home that the registered person ensure that they could meet the needs of the residents both in terms of their individual needs and in terms of their compatibility as a group. During the course of the year some work had been carried out in relation to meeting this requirement however, no changes had been made as a result. Since the new manager was appointed a month prior to the inspection she has looked at compatibility issues and has set up a meeting with Social Services to reassess the needs of one of the residents. Care Homes for Adults (18-65 years) Page 12 of 33 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 provide detailed information about the needs of the residents but guidelines for providing care must be updated as and when needs change to ensure that staff have accurate and current information about how individual needs are to be met. Evidence: Two care plans were examined in detail on this occasion. In both cases the support plans had been updated recently. In each care plan there were a range of guidelines in place to ensure that individual needs are met. Some guidelines were in the care plan and some in another reference folder. In most cases the guidelines had been written several years ago and had been reviewed on an annual basis. At the last review carried out in October 2008 there was a note made that the guidelines need to be updated in a new format. For one of the residents there were notes saying that the guidelines need to be updated as some of the information is no longer relevant. A range of tools are used to identify risks and to consider action that needs to be Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: taken as a result. Some risk assessments had been reviewed recently, some were needing to be reviewed and in one case one tool used was not dated. Person centred planning (PCP)meetings are held every six months. Records showed that staff work hard to involve residents in the planning of the meetings. Attention must be made to ensuring that the views documented are those of the residents and not the staff. An example of this was a record seen stating I would like to know who my new landlord will be. Due to the complex needs of the resident they would not have been able to express this view. As a result of the PCP meetings a range of recommendations are made that must be achieved by the next meeting and in each case a timescale is given. Staff were able to say that some of these actions had been addressed but generally this documentation is mainly updated in advance of the next meeting so it is not possible to see at a glance if it has been achieved. Staff spoken with were clear that with the new format planned for supervision, each staff member would be updating the care plan that they have responsibility for in advance of supervision so this level of detail would need to be documented in the future. Staff were observed to be giving residents choices and encouraging them to make decisions and there is some evidence in documentation that staff are beginning to record where a resident has made a decision. An example of this is where a resident chose to continue gardening rather than to go for a walk. In addition it was noted that one resident sought out a member of staff when they wanted to go into the garden and needed support to put on their wellington boots. Other residents actively take a staff members hand when they want to take a staff member to another room to show them what they want or to attract their attention. As required at the last inspection of the home a record is now kept of all correspondence either received or entered into on behalf of residents. Care Homes for Adults (18-65 years) Page 14 of 33 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. Staffing levels at times mean that not all residents are currently able to make good use of their community for activities. Evidence: Since the last inspection the day care provider used by the Trust that had been contracted to provide each resident with a minimum of three sessions a week has been given notice and no longer provides a service. There was evidence that staff have been advised to go ahead and arrange more person centred activities for individuals. A staff member spoken with stated that draft plans have been drawn up which include a range of activities based on the individual wishes and needs of the residents. These plans were not available at the time of inspection. Each of the residents has a weekly planner which identifies the activities that they should be involved in. In relation to the two planners seen it was noted that planned Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: activities were regularly crossed out and an alternative was carried out. However, the reason the activity had changed was not always stated and often the alternative was an inhouse activity. Records showed a heavy reliance on television and music as activities and in one week two activities related to tidying a bedroom. It is not always possible to identify if an activity has happened as it is not always ticked as having happened. A support record is then completed and this is where staff record not just any personal care provided but there is also reference to activities carried out and the outcome. Within this record there was reference to some activities that were not on the activity plan. Comments regarding the activities are limited and often just state that residents were relaxed or vocal. On the day of inspection two residents were out for the morning and the remaining residents were in the house mainly watching television or listening to music. In the afternoon there were only two staff on duty one of which was involved for part of the afternoon with the inspection process. Residents therefore spent most of the day watching television. From examination of the actual activities provided it is evident that although staff do their best to make the most of opportunities to go out, for large parts of the day residents are not participating in stimulating activities. Staff stated that they have welcomed the opportunity to go ahead to organise more activities. However the current arrangements regarding mean that this can be difficult to achieve when there are only two staff in the afternoons. This should improve once new staff commence in post. A staff member stated that they have booked a trip to the Sealife centre for next month. Plans are also to be made to see the lights in London. Residents enjoy regular trips to cafes and restaurants. It was reported that three of the residents had a boat trip for a day in June and thoroughly enjoyed this outing. With the exception of one resident everyone had a holiday this year. It was assessed as more appropriate for one of the residents to have day trips instead. Four of the residents have relatives that they are supported to maintain contact with. An advocate also visits the home monthly and is invited to attend all the PCP meetings. Residents are encouraged to participate in activities of daily living around their home and this is evidenced regularly in their weekly planners. There is a four week menu in place. In addition there is an alternative menu list. Staff stated that some of the residents can make limited choices. For example they can Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: choose from two boxes of cereal or choose between tea or coffee. If a particular resident doesnt want their meal they will just push the food away. Staff leave it a while and then offer a different meal or sometimes it is possible to take this resident into the kitchen where they will choose what they want. Care Homes for Adults (18-65 years) Page 17 of 33 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. The home is good at ensuring that the healthcare needs of the residents continue to be met. Evidence: The arrangements in place for the storage and handling of medication were examined and were in order. A range of measures are in place to monitor the medication in use on a daily, weekly and monthly basis. A record is made in the handover system to show that this work has been carried out. Information is also available to show how each resident likes to receive their medication. Each staff member has to complete formal training on the medication in use in the home and following this they are then assessed in the home to ensure that they are competent at this task. Records seen showed that some staff need to complete refresher courses and a small number of competency assessments need to be undertaken. It was noted that three of the staff team have been booked to attend a refresher course and three staff have been placed on a waiting list to attend the next available course. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Staff observed in the course of their duties were very courteous and were seen to have a very good rapport with residents. Records showed that staff support residents to attend a range of healthcare appointments and staff monitor residents weights on a monthly basis. A requirement was made at the last inspection of the home that an assessment of the needs/wishes of residents be assessed in relation to dying and death and that if necessary/appropriate the relatives of the residents should be consulted as part of this process. This requirement had not been met but it was noted that the new manager had drawn up a format for carrying out the assessment. Each of the keyworkers had been asked to undertake this work with the residents and their relatives and they had been given a timescale for achieving this task. A staff member spoken with was clear about the action to be taken to achieve this. Care Homes for Adults (18-65 years) Page 19 of 33 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. There are systems in place to ensure that anyone wanting to make a complaint can do so. The home needs to build upon the recent attempts to clarify procedures in relation to the protection of residents and ensure that all staff are aware of their individual responsibilities. Evidence: There is a detailed procedure in place to ensure that anyone wishing to make a complaint can do so. A simplified version of the complaint procedure is also on display in the home. There have been no complaints since the last inspection of the home. There is also a detailed procedure in place on adult protection and prevention of abuse. Prior to the inspection the appointed manager contacted the Commission and advised that since taking up her position she had become aware that staff were not fully clear on the types of issues that needed to be referred to the adult protection team. Since then she has held a staff team meeting where she gave advice and guidance to staff on the subject. Minutes of the meeting were seen and were very detailed. It was however noted that at the time of the inspection only three care staff had signed as having read the minutes. A staff member spoken with confirmed that they had read the minutes and that the deputy manager had discussed the arrangements in relation to adult protection during a recent supervision. Records showed that arrangements have been made for one staff member to attend formal training on adult protection and a further four staff have been placed on a Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: waiting list. Information provided in advance of the inspection showed that there had been one incident where restraint had been used during the year. A staff member described the situation where restraint was used and the action taken was in order. This had been a planned restraint to enable a medical procedure to be carried out. The Commission had not been informed of the restraint used. Guidelines seen in relation to one of the residents to allow the use of gentle restraint and all staff have had training on the subject. However, it is not clear from the documentation if the use of this intervention has been agreed as part of a multidisciplinary process. It was noted that the guidelines in relation to the use of scip for this resident were written in 2002 and they have been reviewed at regular intervals by the management of the home. Since the last inspection the arrangements in relation to the management of disability living allowance payments have changed and the new procedures are working well. However, it was noted that payments still owed to residents as a result of the changes have yet to be repaid. Care Homes for Adults (18-65 years) Page 21 of 33 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. Good progress has been made in upgrading the home and despite the slippage in timescales work is now beginning to get back on track. Residents will benefit from living in a well decorated and comfortable environment. Evidence: Since the last inspection of the home a programme for the full refurbishment of the property was started. Work included to date includes the refurbishment of the bathrooms, the repainting of the whole of the interior of the property, a new boiler was fitted and a new fire alarm system installed. It was reported that there were plans for the installation of a new kitchen, for new flooring to be fitted in the corridors, lounge, dining room and office and for the woodwork to the exterior of the property to be repainted. Following the inspection the manager confirmed that the front door was painted the day after the inspection and that the date for the refitting of the flooring throughout the downstairs has been confirmed. New seating in the dining room and garden has been purchased and new sofas were also purchased for the lounge. A staff member advised that net curtains had recently been purchased and quotes have been obtained for new curtains. Other outstanding work includes the replacement of locks on bedroom doors and the respraying of the radiator guards. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Areas seen looked homely and comfortable and staff were very pleased with the changes that have been made. They advised that the new manager has been instrumental in pushing forward the refurbishment programme and in achieving results quickly. All areas seen during the inspection were clean. The majority of the staff team have completed training on infection control and those that are not up to date are on a waiting list to attend the next available course. In one care plan it was noted that in relation to one resident the home had borrowed an epilepsy alarm in August 2008 from the head office until a new alarm could be purchased. It was not clear if a new alarm was ever purchased. Care Homes for Adults (18-65 years) Page 23 of 33 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 will benefit from the revised procedures that are to be introduced in relation to staff supervision. A review of staffing levels needs to be undertaken to ensure that residents individual needs can be met. Evidence: On arrival at the home there was one staff member in the home with four of the residents. Two staff members had gone out with two residents. It was reported that there was meant to be a second member of staff on duty but due to sickness they were down to one. Arrangements had not been made to find an agency worker. The team leader advised that it is within their procedures to work for short periods of time with one staff member. Three of the residents spent the majority of their time in their bedrooms and one spent some time in the garden and then in their bedroom. Due to the complex needs of the residents (epilepsy and behavioural)a review should be undertaken to determine if it is safe to have only one member of staff on duty for any length of time. A requirement was made at the last inspection that all staff receive regular supervision. Records seen showed that this requirement had not been met. However, within the past month the manager had introduced a new format for carrying out supervision and she had provided training for senior staff on how to carry out Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: supervision. A senior support worker advised that he has been allocated six staff to supervise and he would be commencing this the following week. One staff member confirmed that she had just received a supervision and another advised that one had been booked for the following Sunday. It was also reported that a senior staff meeting is being organised to look at roles and responsibilities to make sure that everyone is clear about what is required of them. The staff training matrix showed that there are a number of staff needing to attend training in various subjects. However records also showed that the manager has made arrangements for staff to complete training. Some of the staff have been placed on a waiting list to attend the next available course. Nine of the fourteen staff have completed NVQ (National Vocational Qualification) at level two or above. Care Homes for Adults (18-65 years) Page 25 of 33 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. Recent changes to the way in which the home is run are having a positive impact on the home and the outcome for residents. This will need to be sustained to drive up standards in all areas. Evidence: Since the last inspection of the home the registered manager has left his position and a new manager was appointed to this position. They are currently in the process of applying to register as manager. The appointed manager is a qualified nurse in learning disabilities and has also achieved a Managing Health and Social Care Award. Since taking on the managerial position the manager has already held a staff meeting. It was also reported that there are plans to increase the frequency of these meetings and arrangements have been made to hold an away day. Staff spoken with during the inspection made comments like the new manager is excellent, can only give her praise, she has been achieving a lot in a short space of time, she has been brilliant. Each staff member was able to detail the many changes that the new manager has achieved in her short time in post and they all felt very positive about the future. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: A requirement was made at the last inspection that the registered person ensure that more effective monitoring is achieved through Regulation 26 conduct visits of the home. It was noted that the PCT are behind with the monthly visits so they have been looking at records retrospectively. For example in July they looked at records for May, in August records for June. A second visit was carried out at the end of August to look at records for July. It was confirmed that a visit would be carried out in October to catch up and look at records for August and September. In July it was noted that the manager had nine action points to attend to as a result of the visit. Following this visit the PCT reviewed their procedure for carrying out their monthly visits and a more detailed procedure was then introduced. As a result of the two visits carried out in August, one had 63 action points and the other had 72 action points. In each case it was recommended that the home produce an action plan to be returned to the PCT by the end of October. However it should be noted that a further visit would have been carried out by then. The appointed manager took up post a month prior to the inspection and she was not in the home on the day of inspection so it was not clear if an action plan has been started. There was clear evidence in minutes of meetings, from staff comments and from record keeping generally that a number of actions have been taken to address the recommendations of the monthly reports. It is acknowledged that it will take time to improve standards in all areas. Another part of the homes quality assurance system is to seek the views of service users, relatives and any visiting professionals. Last year the PCT introduced a new format for carrying out quality assurance monitoring. Questionnaires were sent to the relatives of the residents and results of these surveys were generally positive. Last year when a relative raised an issue the organisation responded to the individual saying what improvements they would make as a result. On the most recent survey two relatives raised different issues but there was no record on file of any action having been taken to respond. Following the inspection the manager advised that she was confident that a response had been sent from the organisation and she would ensure that a copy of this is kept on the file. There was one visiting professional survey on file and this was a very positive response. As residents have complex needs and are unable to give verbal feedback a system was introduced last year to look for evidence that their individual needs were being met. A member of the senior management team visited the home and along with support from staff assessed the quality of residents lives from a range of aspects. As a result of the exercise, where appropriate, recommendations were made to the home to ensure that there was more detailed recording kept. In addition timescales were set to achieve any recommendations made. The system itself is excellent and it was Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: therefore disappointing to note that there was no evidence recorded that the recommendations made had been addressed. In addition the quality assurance system has not been carried out this year. Following the last inspection the registered manager wrote to the Commission confirming dates for refurbishment works to be carried out in February and March 2009. Further work was identified as needing to be carried out but there were no timescales. A number of these jobs have still to be carried out but as stated in the environment section progress is now being made to ensure that this happens. A requirement was made at the last inspection of the home that the home clarify the arrangements for the management of DLA (disability living allowance) payments. As stated previously this has been clarified but monies owed to residents as a result of the review carried out are still to be repaid. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 26 The registered person must ensure that more effective monitoring is achieved through Regulation 26 conduct visits of the home. The provider must be kept informed of all shortfalls/improvements in order to gain an informed opinion of the conduct of the home. 30/01/2009 2 43 17 The registered provider must 27/02/2009 clarify the arrangements in place for the management of (disability living allowance) payments. Residents must benefit from competent and accountable managemet of the service. Care Homes for Adults (18-65 years) Page 29 of 33 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 1 5A Regulation 6 (a,b) The registered person must ensure that they review the content of the statement of purpose to ensure that it contains all required up to date information. To ensure that residents are kept informed about their home. 15/12/2009 2 6 15 Regulation 15(1,2b) The registered person must ensure that care plans include up to date information about the assessed needs of the residents and how they are to be met. Care plans must be updated as needs change. Care plans must reflect the assessed and changing needs of the residents. 15/12/2009 3 9 13 Regulation 13(4a,c)The registered person must 15/12/2009 Care Homes for Adults (18-65 years) Page 30 of 33 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 ensure that risk assessments be reviewed and where appropriate new risk assessments put in place following a change to the needs of residents. The risk af accidents and harm happening to residents and staff must be minimised. 4 12 15 Regulation 16(2mn) The registered person must ensure that residents are given regular opportunities to participate in meaningful and fulfilling activities. Residents must enabled access to a variety of activities in line with their individual assessed wishes/needs. 5 33 18 Regulation 18 15/12/2009 The registered person must ensure that a review is carried out of the staff levels to ensure that residents individual needs can be met. Residents must be supported by an effective staff team. 15/12/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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