Care Home: The Hollies

What the care home does well Before people move into the home they receive information to help them decide if it is the right place for them. The manager will meet each person and assess their needs to make sure that the home will be suitable. Residents who are able and wish to can go out of the home to local shops, pubs and restaurants and to meet friends. Residents enjoy the meals in the home. Staff help residents with their personal care needs. Staff make sure that when residents are unwell that they see their doctor. Staff are trained to be able to look after residents properly. Staff listen to residents and act on what they say. What has improved since the last inspection? This is the first inspection of the home since it was purchased by new owners. What the care home could do better: The way information about residents is recorded could be improved so that each person`s care plan tells staff how the person wishes to be cared for. More activities could be provided for residents. Staff must ensure that residents receive the medicines that are prescribed for them. More could be done to help residents complain if they are unhappy. Key inspection report Care homes for adults (18-65 years) Name: Address: The Hollies 70 Canewdon Road Westcliff-On-Sea Essex SS0 7NE     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: Carolyn Delaney     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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 Hollies 70 Canewdon Road Westcliff-On-Sea Essex SS0 7NE 01702354744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Ramkishore Tandon and Dr Nisha Menon Name of registered manager (if applicable) Mrs Saralamma Nanappan Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: The maximum number of service users who can be accommodated is 10 The registered person may provide the following categories of service only Care home only Code PC to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE 4 places Learning disability Code LD 10 places Date of last inspection Brief description of the care home The Hollies is a care home for people who have a learning disability and who need help and support for their health and personal care needs. The home is situated in a quiet residental area of Westcliff on Sea. There are local bus routes into Southend on Sea and trains to London. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 4 10 Brief description of the care home The home provides singe bedroom accommodation for up to ten people. The fees for a place in the home range from £637.00 to £1200.00 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited we sent surveys to residents, staff and health care professionals to tell us about they home. We asked the manager to complete an Annual Quality Assurance Assessment to tell us how they met the needs of residents. When we visited the home we spoke with residents and staff. We looked at how residents were involved about making decisions about how the home was managed. We looked at care plans and how people were helped to do the things they want during the day. We looked at how staff looked after residents when they were unwell. Care Homes for Adults (18-65 years) Page 6 of 31 We looked at how complaints were dealt with and how residents were protected. We looked at how many staff worked at the home and how they were trained. We looked at the home to see if it was safe and comfortable. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into the home can be assured that their assessed needs will be met because they are involved in all stages of the process. Evidence: The manager told us in the Annual Quality Assurance Assessment that new residents were admitted only on the basis of a full assessment being undertaken by the manager or deputy manager. They told us that prospective residents, their next of kin, social workers and independent advocates were involved any decisions made. They told us We draw up an individual care plan based on the assessment made. They told us that any potential restrictions on choice, freedom, services or facilities based on specialist needs and risk and or required by a treatment programme were discussed and agreed with the prospective resident during assessment. Four of the seven residents who completed surveys told us that they had been asked if they wanted to move into the home. Three said that they had not. The majority of people living in the home had done so for a number of years and this may account for their responses about being asked if they wished to move into the home (one person Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: had lived in the home for more that twenty - six years). Each of the seven people told us that they had received enough information about the home to help them decide if it was the right place for them. Three visiting health and social care professionals completed surveys. Two told us that the homes assessment arrangements usually ensured that accurate information was gathered and the right service was planned for individuals. The other person told us that it always was. When we visited the home we looked at how information about the home and the services offered was provided for residents and other people who may be looking for a care home. We looked at the statement of purpose and service users guide. We saw that there was detailed information about the home and the daily routines. Information was presented in a clear way with photographs and pictures to assist people who may have difficulty in understanding the written word. The manager told us that seven of the ten residents currently living in the home would be capable of understanding the information. We advised the manager that consideration should be given to providing information in other formats such as braille, audio or video presentations so as to facilitate people with visual, hearing or other communication difficulties. We looked at the arrangements for assessing the needs of people before they were offered a placement. There had been no new admissions to the home since it was bought by its new owners and registered in August 2009. We looks at the documents used to record information about a person during the assessment process. We saw that the assessment covered each persons physical and mental health, personal, emotional and social care needs. The views and wishes of each individual would be incorporated into the assessment so as to ensure that they were fully involved in the process. The manager told us that some residents social workers had carried out reviews of their placement and care within the previous six months. We looked at the reviews for two people. We saw that the social workers had visited residents in the home to carry out the reviews. Residents families or significant others had been invited to participate in reviews. The views of residents, their families, social workers and staff working in the home were recorded. It was recorded that one of the residents said I am happy here, I love everyone. Their family said (resident) has settled well into the home and has put on weight. We are happy with the care they receive. Another resident said that they liked the staff and that they were free to do what they please such as going out and making friends in the local community. 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. People living in the Hollies are not always supported to make decisions and choices about their daily lives. Evidence: The manager told us in the Annual Quality Assurance Assessment that each service user had an individual care plan. They told us that the care plan was made and reviewed after thorough discussion and agreement with the service user and any appropriate health professionals involved. They told us that the plan described any restrictions on choice and freedom (agreed with the service user) imposed by a specialist programme (e.g. a treatment programme). They manager said that there were procedures in place for supporting people who were likely to be aggressive, cause harm or self-harm, which focused on positive behaviour, ability and willingness. Three of the six residents who completed surveys told us that they could always make decisions about what they do each day, two said that they usually could and one said that they sometimes could. Four people told us that staff always listened and acted on Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: what they say and two people said that staff usually did. Two of the three social and health care professionals who completed surveys told us that they felt residents social and health care needs were properly monitored, reviewed and met by the home. One person told us that they usually were. One professional commented that more could be done to support residents to make decisions. When we visited the home we looked at the care plans for three residents. We saw that each person had information recorded around the things they liked to do and the activities they wished to participate in. However some of this information had not been reviewed since September 2009 and information recorded was in contrast to that recorded elsewhere in some care plans. For example it was recorded in one persons activity plan that they spent time each day watching television and participating in leisure activities within the home. It was recorded elsewhere in their care plan that they disliked watching television and that they did not participate in activities and would become disruptive and interrupt others. It was recorded that this person enjoyed working in the garden, however this was not reflected in their daily activities plan. Due to the level of communication difficulties experienced by this resident we were unable to ask them about the activities they wished to participate in or any particular likes and dislikes they had. Each persons care plan included details of around daily routines and the times that residents wished to get up and go to bed etc. We saw evidence that more able residents were supported in making decisions about how they spent their time and to access activities and amenities outside of the home. A number of residents went out shopping locally, went for walks, met with friends etc. One resident we spoke with told us I go to the pub for a pint and meet my friends. Another resident said I go to Summer nights club and that is good. There was less information recorded as to how people living in the home who have more complex needs were supported to make decisions about their lives. We saw that risks to individuals health and welfare were identified and that there was detailed information recorded including how staff were to support residents to participate in activities, while minimising risks to their health and safety. A number of residents exhibit unpredictable and challenging behaviours as part of their condition and risks to members of the public were identified as part of each persons plan for going out in the community. Care Homes for Adults (18-65 years) Page 13 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 living in the home are not always supported to experience a lifestyle which suits their needs and wishes. Evidence: The manager told us in the Annual Quality Assurance Assessment that residents were given the opportunity to take part in activities, for example going to college, day centres, clubs, helping with housekeeping, meal preparations and other day to day running of the home. They said that in this way they try to promote independence and socialisation of individuals within the community. The manager said that involvement with family was encouraged with the agreement of the service user. They also said that residents were provided with a balanced nutritious diet, they were given a choice of meals and meal time to suit them. They said that meals were given three times a day and more if requested by any resident. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: Six residents completed and returned surveys. Five of the six told us that they could do what they wanted to do during the day, in the evenings and at weekends. When we visited the home we looked at the arrangements in place for enabling and supporting residents to experience a lifestyle, which suited their needs, wishes and capabilities. The manager told us that there were planned activities each week including aromatherapy, music therapy and exercises. They told us that residents had access to a mini bus for outings. We saw that each person living in the home had an activities plan for each day. However there was limited information recorded about the activities residents enjoyed. We saw that some residents spent most afternoons and evenings watching television. One resident we spoke to told us that they were Tired of doing nothing. During the inspection an aromatherapist visited in the morning. Residents told us that they enjoyed this. In the afternoon entertainment was provided by a visiting entertainer who played the saxophone. We observed that five residents were enjoying the music and some were dancing with staff and singing. However one resident was clearly distressed by the noise and made non verbal indications including covering their ears with their hands and shaking their head. Staff in the room did not appear to notice this behaviour. We spoke to the manager about this and following our discussion they told us that staff had taken the resident to their bedroom where it was quieter. The manager told us that some residents attended day centre and that one person usually attended courses at the local college but that they were awaiting a place on their chosen course. We saw that the more able residents were enabled to to go out and about in the local community. However while there was a mini bus available there was little evidence that the more dependent residents were provided with opportunities to go out. We looked at daily records where staff recorded activities that residents participated in. These records were poorly maintained and there were days where no records were made. We saw that on a number of occasions staff recorded that residents did not go out due to poor weather and that they participated in home based activities. From records these activities usually meant that residents watched television or participated in karaoke. There was no information about other activities provided for people who did not wish to participate in these activities. Due to communication difficulties it was not possible to ask some of the more dependent residents about their preferences for how they spent their free time. The manager told us that they had invited residents relatives to attend social events such as the Christmas party so as to support residents in maintaining family contact. They told us that the the response had been poor and that only one family had attended. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We looked at the arrangements for providing meals for residents. We saw that there was a planned menu and that this was reviewed and amended where residents made comments or suggestions. Three residents we spoke with told us that they enjoyed the meals at the home. On the day of the inspection we observed how staff supported residents for their lunchtime meal. Residents were served faggots in gravy with vegetables. There was no choice of meal and the member of staff who was cooking told us All residents like faggots so they are having this today. Residents told us that they enjoyed their meal. We saw that the more able residents chose where they sat and were given ample time to eat their meal in a leisurely way. Residents who needed supervision or support were assisted as needed. 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. People living in the home are supported for their health and personal care needs in the way which suits their capabilities and wishes. Evidence: The manager told us in the Annual Quality Assurance Assessment that residents were given choice and support with activities of daily living including personal care. They told us that staff supported people to do as much as possible to promote independence. They said that care was taken to ensure that personal care was delivered in private to promote each persons dignity. The manager said that residents choose their own clothes and lifestyle. They told us that technical aids and equipments were provided for maximising independence and that key workers were employed to help ensure that residents physical, emotional and health needs were met. The manager told us that residents health was monitored so that problems were identified and dealt with at an early stage. They told us that they did not have any residents who managed their own medication. Staff who completed surveys told us that they were given up to date information about the needs of the people they supported and cared for. One visiting health care Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: professional commented Staff always treat residents with care and dignity and their wellbeing always seems to be at the fore. Each of the three health care professionals who completed surveys told us that they felt that residents social and health care needs were properly monitored, reviewed and met by the home. They also said that staff usually sought and acted on advice to meet residents health care needs and to improve their wellbeing. When we visited the home we looked at the care plans for two residents. We saw that staff had recorded for both the level of support they required for maintaining acceptable levels of personal hygiene. We saw that residents were supported according to their capabilities and were encouraged to be as independent as possible. Residents preferences for when they took baths and showers was recorded and staff supported people accordingly. We looked at how residents health care needs were assessed and how they were supported for these. Each person had a care plan, which described their general health care needs. However these plans had not been reviewed or updated for some months in some cases. The manager showed us the work that was being done to develop more individualised care plans with the involvement of each individual resident. The new plans, which had been completed were person centred and reflected the wishes and needs of people around their personal and health care needs. Staff recorded when a person felt unwell and took prompt action to ensure that they were seen by their doctor. Staff also encouraged and supported residents to have regular health care checks ups such as eye tests, blood tests etc. We looked at the arrangements in the home for ensuring that residents received the medicines, which were prescribed for them. We saw that staff had undertaken training around the safe handling and administration of medicines in 2008. We looked at the medication administration records for each of the residents living in the home. We saw that some records were poorly maintained and staff could not demonstrate for three people that they had received some of the medicines, which had been prescribed for them. We also notes some discrepancies when we checked the number of tablets against the number received and those signed as having been administered. We discussed these issues with the homes manager who assured us that more stringent checking and monitoring around the administration of medicines would be implemented. 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. People living in the home can be assured that they will be safeguarded from harm because staff are recruited robustly, and trained to recognise and report any concerns or allegations. Evidence: The manager told us in the Annual Quality Assurance Assessment that they had a complaints policy and procedure in place. They said that any complaint received would be recorded and responded to within twenty - eight days. The manager said that residents, if they wished, could make a complaint one-to-one with a staff member of their choice and that they were assured that they would not be victimised for making a complaint. The manager told us that all staff has received training in the safeguarding of vulnerable adults and that there were policies and procedures to help ensure that residents were protected from abuse, neglect and self harm. Each of the seven residents who completed surveys told us that they knew who to speak to if they were unhappy. Four of the seven residents said that they knew how to make a complaint. Each of the nine members of staff who completed surveys told us that they knew how to act if they received any complaints about the home. Each of the three health care professionals who completed surveys told us that the home always acted appropriately if they raised any complaints or concerns. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: When we visited the home we looked at how residents were supported to express their views and to make complaints. The manager showed us a copy of the complaints policy and procedure. This set out how a person could complain or raise concerns and how these would be received, investigated and responded to. However the documents were not written or presented in a way, which some residents would be able to understand or use. The manager told us that there had been no complaints made since the home was purchased from the previous owners. We looked at the arrangements for safeguarding people who may be vulnerable from harm or abuse. We saw that all but one member of staff had completed training around safeguarding issues, including recognising signs of abuse and poor practice, and their responsibilities in reporting any concerns or allegations. Training was planned and a date arranged for the remaining member of staff who had not undertaken recent training. We spoke with three members of staff and the manager about how they help safeguard people living in the home from abuse. Staff told us that they would observe residents who may be at risk and report any concerns to the manager. Staff told us that some residents posed risks to others as they could be aggressive or unpredictable. They told us that they supported these residents through monitoring and one to one support. We looked at the arrangements for recruiting staff to work at the home. Only one person (the manager) had been employed to work in the home since it was registered. We looked at their staff file and we saw that all of the appropriate checks including references from previous employers, Criminal Records Bureau disclosures and Independent Safeguarding Authority checks had been obtained before they commenced work. This helps to safeguard residents by ensuring that only suitable people are employed in 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 live in a clean, safe and comfortable home. Evidence: The manager told us in the Annual Quality Assurance Assessment that all residents were provided with single rooms and that all communal areas were easily accessible. They said that the garden was well maintained and residents took part in gardening and growing seasonal fruits and vegetables. They told us that they ensured that all equipment was regularly serviced to ensure a safe environment for the residents and staff. They told us that the premises were safe, comfortable, bright, cheerful, airy, clean and free from offensive odours, and provided sufficient and suitable light, heat and ventilation. The manager said that they home offered access to local amenities and support services, to suit the personal and lifestyle needs of residents. They told us that there were policies and procedures for the disposal of clinical waste, dealing with spillage, provision of protective clothing and hand washing. All of the residents who completed surveys told us that the home was always fresh and clean. We spoke with two residents during the inspection and they told us that they liked their home and that they could arrange their bedrooms as they chose. One visiting health care professional commented The environment leaves a lot to be Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: desired and needs updating. They also said that residents could be better supported to make decisions about their environment. During the inspection we carried out a brief tours of the premises. We saw that residents bedrooms were clean and personalised according to the wishes and preferences of the occupants. The home is an old style property and the general decor is in need of updating. The manager told us about some of the work already completed as part of improving the environment for residents including re plastering of some walls. They told us that they planned to carry out more refurbishment and decoration work in the coming year. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are cared for by staff who are recruited thoroughly and trained to meet their assessed needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that all staff had received training around the needs of residents. They told us that staff were aware of the disabilities and specific needs of residents. They said that sixty percent of care staff held the National Vocational Qualification level 2 or higher in Health and Social Care. The manager said that staff recruitment was done through a thorough recruitment procedure based on equal opportunity and ensuring the protection of service users. They said that two written references were obtained and any gaps in employment record were explored. They told us that staff were only employed after satisfactory Criminal Records Bureau disclosures and Independent Safeguarding Authority checks had been obtained. Each of the seven residents who completed surveys told us that care staff and the manager always treat them well. Five said that staff always listened and act on what they say and two said that they sometimes do. The manager told us what the staffing levels were to support the needs of residents. They told us that four staff covered the day shifts and that the night duty was covered by one member of staff and a sleep in Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: (who would be called upon to assist if needed during the night). The manager said that extra staff would be used if residents required extra support. Nine members of staff completed surveys and they told us that all of the checks, including references and Criminal Records Bureau disclosures had been obtained before the started work at the home. They told us that the induction covered everything they needed to know about the job when they started and that they received training, which was relevant to their roles. helped them met the needs of residents and kept them up to date with new ways of working. We looked at a sample of staff rotas for a four week period. We saw that a number of staff worked long hours without appropriate time off. One person worked fourteen days without a day off. During this time they worked eight twelve hour shifts. This may impact upon the care and support given to people living in the home. We discussed this with the manager who said that they would monitor staff working hours and ensure that all staff had appropriate time off duty. When we visited the home we looked at how staff were recruited, trained, supervised and deployed in numbers to meet the assessed needs of residents. The manager told us that they were the only person to have been employed since the home was purchased in August 2009. We looked at the information available in their staff file. We saw that a full ten year employment history and appropriate references were sought and obtained from this persons previous employers. Satisfactory Criminal Records Bureau disclosures and Independent Safeguarding Authority checks were obtained and the manager was interviewed as part of the recruitment process. We were provided with details of staff training. We saw that staff undertook training around the needs of people living in the home including caring for people who have disabilities and sensory impairment, diabetes awareness, nutrition for the elderly, caring for people with mental health issues and the safe handling and administration of medicines. We saw records for when staff met with the manager (supervision) to discuss work and training needs. 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 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 well managed and run in the best interests of the people who live there. Evidence: The manager told us in the Annual Quality Assurance Assessment that the Registered Manager is a Nurse with twenty - four years experience and more than three years experience in the role of a deputy manager in a nursing home. The Manager had completed her National Vocational Qualification level four in Leadership and Management. They told us that they took up regular courses to update her skills for the efficient running of the home. The manager told us that they ensured that all equipments used in the premises were duly checked and certified by qualified professionals and the certificates were up to date. As part of the inspection process we asked residents, staff and health or social care professionals to tell us what they felt the home did well and where they felt that improvements could be made. Residents told us that the food was good. One person Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: said I like the food and the music. Another person said that The meals are good here. None of the residents identified any areas for improvement. When we visited the home we looked at the arrangements for managing the home and how residents were involved in making decisions and suggestions. The manager told us that they had held two residents meetings and we saw the minutes from these. We saw that items discussed included the new management within the home, menus and activities. Residents had been encouraged to make comments and suggestions and some residents had made suggestions about holidays and activities they would like. The manager told us that they were looking at other ways to obtain the views of residents such as surveys and questionnaires. During the inspection we spoke with the manager about the plans to improve the service provided, including making improvements to the homes environment, planning activities and obtaining information about the things that residents wished to do. We looked at how the home was maintained so that it was safe and appropriate for the needs of people who live there. We saw that regular checks were carried out to ensure that equipment such as hoists, gas and electrical installations were in good working order. We saw certificates to evidence that equipment was serviced by appropriately qualified professionals and that essential repairs were carried out promptly. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 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 15 Individuals care plans must be reviewed and amended where there are changes to the needs and wishes of residents. This must be done so that information reflects residents current needs and choices so that staff can support people appropriately. 27/05/2010 2 12 16 A programme of activities 21/06/2010 and opportunities for social and occupational activities must be developed after consultation with residents about the ways in which they wish to spend their free time. This must be done so as to improve experiences of people living in the home and to ensure that residents are supported to remain active and occupied 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 according to their needs and wishes. 3 20 13 Staff must ensure that they handle and administer medicines in line with residents prescriptions and the homes policy and procedures. This must be done so as to ensure that people living in the home receive the medicines that are prescribed for them as part of their health care treatment. 4 22 22 Information around how complaints are received, investigated and responded to and how a person may raise complaints and concerns must be made available in suitable formats for people living in the home. This must be done so as to ensure that residents know how to make complaints and that they are supported to express their views. 5 32 18 Sufficient numbers of staff must be employed in the home so that staff have appropriate time off duty. 31/03/2010 31/03/2010 28/05/2010 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 This must be done so as to ensure that residents are supported appropriately at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Information about the home should be made available in suitable formats so that people with hearing or visual impairment and those with communication difficulties have information they need. More could be done so as to support residents to make decisions about their daily lives. 2 7 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. 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