Care Home: The Vine House

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What the care home does well We tried to visit the home the day before this inspection but found that everyone was out. People living at The Vine House are supported to lead busy, meaningful lives and to help out with the running of the home. People living in the home told us in their surveys that the home helps them with going out, cooking and cleaning and said `its nice living here, the staff take me out and look after me`. Staff told us that the home: `is very particular dealing with the needs of the service user. The "HOME" focuses on the personal care, activities and the environment of the service users. The "HOME" always wants to put things into the HIGHEST standards of care. All things must be in right place`. And `we provide excellent services for the service users. We also provide good and enough leisure facilities for our service users`. They also told us that the home could do better by providing more training for staff regarding Learning Disabilities. We passed this onto the manager who said that training such as this could be requested by staff at any time. What has improved since the last inspection? The manager told us that some areas of the home had been redecorated since the last inspection, and we saw that some of the paperwork had been updated. We found that the requirements made in our last report had been completed or were underway. What the care home could do better: This is a small home that focuses on the needs of the people living there and as a result, people receive a person centred service. However there are things that need to be improved in other important areas such as paperwork, staff training, staff recruitment and quality assurance, to make sure the service meets legal requirements. Information intended for people who live at the home also needs to be made easier to understand. Key inspection report Care homes for adults (18-65 years) Name: Address: The Vine House 9 Northdrift Way Farley Hill Luton Beds LU1 5JF     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: Rachel Geary     Date: 1 6 1 2 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 30 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 30 Information about the care home Name of care home: Address: The Vine House 9 Northdrift Way Farley Hill Luton Beds LU1 5JF 01582485744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: P & P Community Services Ltd care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: That the home be registered to provide residential care for 2 adults who have learning difficulties and who may also have sensory impairment. The condition that all persons who are admitted to the home must have learning disabilities as their primary assessed need. Date of last inspection Brief description of the care home The Vine House residential home was registered on the 14th October 2003. It is owned by P & P Community Services Ltd. The house is located on the outer region of Luton and is within walking distance of shops, parks, pubs and places of worship. The ground floor has a sitting room and a kitchen combined with dining area. The upstairs floor has a bathroom and toilet, two bedrooms and a small office which also serves as a sleep in room for staff. The front of the house has a drive way with parking for up to two cars. The garden is located at the rear of the home and has both a lawn and patio area. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 2 2 0 9 0 2 2 0 0 9 Brief description of the care home The fees for this home range from £1,200 to £1,700 per week. Care Homes for Adults (18-65 years) Page 5 of 30 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: A key inspection is a thorough type of inspection when we look at all of the key aspects of a service. For this key inspection, we looked at all the information that we have received or asked for since the last inspection of this service on 9th February 2009. This included surveys which we sent to the home to give out to people who live there and the staff. We received 4 surveys back - 2 from people living at the home and 2 from staff. We looked at information that we received from the home. This is information about the service that the home has to tell us about by law. We also looked at information that we asked the home to send us following our visit. We carried out an unannounced visit to the home on 16th December 2009 which lasted nearly 4 hours. During the visit to the home we met one of the people who lives there and we observed the way that staff supported them. We also looked at some of the paperwork that the home has to keep such as care Care Homes for Adults (18-65 years) Page 6 of 30 plans, risk assessments, medication charts, staff records, menus and health and safety records. Care Homes for Adults (18-65 years) Page 7 of 30 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 30 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 30 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. Some useful information has been produced to help prospective users of the service to make an informed choice about where they live. However this needs to be developed to ensure it is available in a format suitable for the people for whom the home is intended. Evidence: The service has developed a statement of purpose (SoP), which sets out the aims and objectives of the home, and includes a service users guide. The guide is currently only available in a standard format and does not include all the required information. The statement of purpose contained more detailed information but findings from this inspection do not support all of the claims made such as the home provides luxurious accommodation, a range of ancillary rooms and we have a quality audit system every six months to assure quality in all aspects of the service (see environment and management sections of this report). We met one of the two people living in the home during the inspection. They told us Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: that they were happy living in the home and liked the other person they lived with. The manager confirmed that compatibility was taken into account as part of the homes assessment and pre-admission process. Contracts for people living in the home were in place setting out what people can expect to receive for their fees such as accommodation, food, light, heat, room cleaning, personal laundry and personal care. They did not include information about travel costs which people may be liable to contribute towards (see protection section of this report). The homes statement of purpose did include the following statement: some transport will be provided as part of the service, but individuals who receive mobility allowance will be expected to contribute towards leisure activities outings. This needs to be much clearer to ensure people know exactly how much they will be expected to pay and how often. The contract had also not been produced in an easy read format and the manager confirmed that neither of the people living in the home at the time of this inspection could read. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not used as a working document and do not consistently reflect the care being delivered. Evidence: Care plans had been developed and there was evidence of them being reviewed on a regular basis. They had not been produced in an easy to understand format however, and they tended to focus on the current needs of the people living in the home, with limited information to show how people are supported to meet their changing needs, aspirations and achieve goals. For example we read that one person was able to make a cup of tea independently and the manager said that this was something that they had not previously been able to do. However it was not clear what else they were working towards to help them to achieve some further independence in their life. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Records such as daily diaries, risk assessments and review notes indicated that the home was supporting people to achieve further independence, but that care plans had not been updated to reflect this. Person Centred Plans (PCP) were in place but were being held by staff in the office. Some attempts to make these easier to understand had been made through the use a few pictures. We noted that some records that should link together such as risk assessments, review notes and PCPs, contained different information to the care plan. For example one care plan stated that the person enjoyed music, discos, magazines, swimming, walks, wildlife, cinema, bowling, snow, DVDs and the library. However the PCP only recorded interests as music, curry and discos. Some dreams and aspirations had been identified such as to own a computer, leisure and recreation and to fulfil my education, but it was unclear how these might be achieved. We saw one risk assessment which referred to horse riding but this had not been included in the persons care plan or PCP. And another for road sense, stated that guidelines would be compiled to support the person in the community. However these guidelines could not be located during the inspection. Other risk assessments that we looked at covered areas of risk as identified in the care plan and also areas such as cleaning, ironing and cookery, which were not included in the care plan in any detail. We then saw a written list of tasks in 1 file for staff to help 1 person living in the home with which included vacuuming, washing up, setting the table and shopping independently. This showed us that staff understand the need to support people in developing their independent living skills. But it was not clear if these tasks were actually being worked on and if any progress was being made in these areas. We noted one record which stated: It was about 9pm. I asked (the users of the service) to go to bed. We spoke to the manager about this. She told us that people did not have a set bedtime and this was a recording issue which needed to be addressed. Records also sometimes referred to the people living in the home as boys rather than men. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead meaningful lives and to participate in the domestic routines of the home. Evidence: This is a small service and people living in the home benefit from individual support and attention. There was evidence that people are supported to access community facilities and to participate in the running of the home. They are also encouraged to maintain links with friends and family. Records show that people are supported to go out frequently to local leisure and community facilities, daycare placements and college. On the day of the inspection both users of the service were meeting up to attend a Christmas party. A daily diary for one person for the day prior to the inspection, recorded that they had Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: been food shopping, listened to music, helped to prepare lunch and tidy the dishes, been shopping in town, watched TV and helped to prepare dinner. Activities for the 3 weeks prior to the inspection included 2 discos and 2 bowling sessions and several takeaways. A Christmas party for staff and people living in the home was planned for the following day. Both users of the service had been on holiday to Bognor Regis earlier in the year. During the inspection one person was at a day care placement - a gardening project and the other person was at home. We were told that they attend college once a week - reduced from 3 days because of funding cuts. The manager said that she was looking into alternative individualised options for them. Menus were being maintained, but again they were not easy to understand for people who are not able to read. There was evidence that people living in the home contribute to menu planning. One the day of the inspection, lunch consisted of a chicken sandwich and yogurt, with mince meat curry, cabbage, rice and ice cream for dinner. Care Homes for Adults (18-65 years) Page 15 of 30 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. A possible lack of staff training regarding the safe administration of medication, may be placing people who use the service at risk. Evidence: The manager told us that no actual personal care was being provided to the users of the service at the current time. However guidance and support is provided as required. Guidelines about peoples health and medical conditions were in place to help staff with meeting their specific health care needs. We noted that one person was written up for medication in the event of a seizure, which the manager said had not happened for around 3 years. A risk assessment about this told us that there was a need to ensure that a sleep in member of staff was on duty at night to provide adequate support in the event of a seizure. The manager was asked how the member of staff would know about a seizure happening if they were asleep. She said that the persons GP had advised that due to the infrequency of the seizures that this arrangement was sufficient at the current time. This had not Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: been recorded on the risk assessment. The manager also told us that all the staff had been trained to administer medication in the event of a seizure, but was not able to locate evidence of this training for some staff during the inspection. This is a concern because staff work alone in this home. See also staffing section of this report. Health Action Plans were in place and there was evidence of regular health care checks taking place. The home was using a MDS (monitored dosage system) for medication. Photos of the people living in the home were being kept with the medication administration records (MARs) to help to prevent errors in administration. We checked the MDS and MARs and found that medication had been administered and signed for correctly. Appropriate medication storage was in place and original prescriptions were being kept for reference and again to help to prevent errors with dosage and administration. Care Homes for Adults (18-65 years) Page 17 of 30 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. A possible lack of staff training regarding the safeguarding of vulnerable adults, may be placing people who use the service at risk. Evidence: The homes complaints procedure can be found in the statement of purpose and service user guide. Attempts to make the procedure easier to understand had been made through the use of picture symbols. However when asked, the manager confirmed that the current users of the service would not be able to understand these. We noted that this version also did include the contact details for the Commission. The manager told us that she works at the home approximately 5 times a week so is available to speak with people if they have any concerns. She also said that people do have regular contact with family and other professionals through day care/college, so there are opportunities for people to raise any concerns they may have with people outside of the home. The funding authority for one person living at the home was acting as their financial appointee for their benefits. A regular allowance was being paid to the person in question but there was insufficient information available to know overall what the person was entitled to and how much money they had in total. The manager said that Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: she had requested this information but had not been successful in getting it. There was evidence that where the home did support people with managing their finances that this was done appropriately. Individual bank accounts had been set up and records were being maintained. Records and monies checked on the day of the inspection tallied. We were told that people are occasionally asked to contribute towards the cost of transport for leisure activities. Whilst this would seem reasonable, there was nothing in the service user contract to say that this arrangement been agreed to by the people living in the home. However, there was also evidence to show that the home supports people to make the most of their money and to use it in their best interests. Transactions that we saw were all for personal purchases and we noted that people had been supported to get cinema and bus passes and to use these when possible. The manager said that the homes budget paid for staff costs for outings and holidays and we found no evidence to dispute this. Records indicated that abuse awareness issues are discussed with people living in the home and that some staff had received training regarding the safeguarding of vulnerable adults (SOVA). The manager told us that all the staff had received SOVA training, but was not able to locate evidence of this training for some staff during the inspection. This is a concern because staff work alone in this home. See also staffing section of this report. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The living environment is homely, clean and comfortable and appears to meet the needs of the people who use the service. Evidence: Overall we found the home to be clean and comfortable. On the ground floor there is a kitchen/diner and lounge, and on the first floor there are 2 single bedrooms, a small bathroom and a small office. An enclosed garden is situated to the rear of the property, and there is parking for 2 vehicles directly to the front of the home. The manager said that since the last inspection some areas of the home had undergone redecoration. We noted the home to be in a fair state of repair although some was a bit tired or dated. For example we noted that the carpet in one of the bedrooms had come away from its backing and the carpet on the stairs was looking a bit worn in places. The manager told us that the tile transfers in the kitchen had been renewed and we saw some small holes in one of the kitchen cupboard doors indicating that a lock that had been there previously, had been removed. The manager confirmed this was the Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: case. We noted that the only shower available was attached to the bath taps and not fixed to the wall. The manager said that this suited the current users of the service who were happy to use the bath. One of the people who lives at the home also told us they were happy with this arrangement. En suite facilities are not provided but each bedroom has a hand basin fitted. Care Homes for Adults (18-65 years) Page 21 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment and training practices may be placing people who use the service at risk. Evidence: In our last report for this service we made a requirement about staff application forms to ensure that they are completed properly and appropriate references sought prior to people working in the home. On this occasion, the manager confirmed that these matters had been addressed and that references were now only accepted from ex employers or professionals. During this inspection, we looked at the recruitment and vetting checks for the homes newest member of staff and found a reference on file from a dentist that was not on headed paper. There was no mention of this dentist on the persons application form and there was no information in the reference itself to say how the dentist knew the member of staff, or for how long. There was also no evidence that the reference had been verified for authenticity. The manager explained that she had needed to take up a 3rd reference because one of the referees given on the application form had failed to provide a reference at the time. There was no statement by the person as to their mental health as required. And the Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: application form had not been completed in full so it was not clear if the person had provided a full employment history, together with a satisfactory written explanation of any gaps in employment. A criminal records bureau (CRB) disclosure had been carried out in respect of the member of staff but it did not include confirmation that checks had been made against the adult (protection of vulnerable adults) list. The Vine House is registered to provide a service to vulnerable adults. Records indicated that the staff member had been working at the home since July 2009. To this end we left an Immediate Requirement Notice to ensure that proper recruitment and verification checks are made prior to someone starting to work at the home. The manager responded to our requirement on 6.1.10 and indicated that the concerns raised by us had all been remedied. This will be assessed by us at the next inspection of this service. We looked at training records for 3 members of staff to find evidence of training to meet the assessed needs of the people using the service. We looked for training around the management of epilepsy and the administration of rectal diazepam as well as mandatory training such as infection control, moving and handling, safeguarding of vulnerable adults and first aid. We did find evidence of training for some staff but not all (see also the health care and protection sections of this report). Records showed that meetings were taking place for staff and people living in the home. Care Homes for Adults (18-65 years) Page 23 of 30 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. This is a small home that focuses on the needs of the people living in the home and as a result, people receive a person centred service. However there are inconsistencies in other areas such as paperwork, training, recruitment and quality assurance which must now be improved in order to meet regulatory requirements. Evidence: The homes service user guide (SUG) states that the registered manager who is also a director of P & P Community Services Ltd - the registered provider for the home - has a BA Health (Care Management) Degree, Diploma in Health & Social Welfare and a Masters in Health and Social Care. The SUG also states that she has many years experience working in the care field. We asked the manager about the homes quality assurance system. She told us that an external person who has a background in care, carries out an audit annually. This was last done in August 2008 and has not been done this year due to the person being unwell. Therefore the home did not have an annual development plan for the home for 2009. The manager said this would be done before Christmas. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: As stated earlier in this report the home is also not yet fully able to demonstrate year on year development for users of the service, linked to their care plans (see individual needs and choices section of this report). Satisfaction surveys are given to people who use the service and their families but not currently to staff. The home does not use an advocacy service, so staff help people in the home to complete their questionnaires. The questionnaires that we saw had not been designed in a easy to understand format. Prior to this inspection we also sent surveys to people living in the home and to staff. We received 4 back in total - 2 from staff and 2 from people in the home (see the summary section of this report). We asked the manager to complete an Annual Quality Assurance Assessment (AQAA) before this inspection, which she did. It contained some clear and relevant information about the service. The AQAA told us about changes that have been made and where some improvements are still needed. Further improvements have been identified throughout this report. The manager confirmed that no one living in the home was subject to a Mental Capacity Act 2005 deprivation of liberty authorisation at the time of this inspection. We did not see any evidence of peoples liberty being deprived. For example a lock had been removed from the biscuit cupboard in the kitchen and the key to the front door was now accessible to staff and people in the home. These areas had been included in the report following our last inspection of this service. The health, safety and welfare of staff and people living in the home was being promoted in a number of ways. For example regular maintenance and safety checks such as electrical appliances, the heating system and fire fighting equipment. No concerns regarding this area were noted during this inspection. Care Homes for Adults (18-65 years) Page 25 of 30 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 26 of 30 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 1 34 19 You must ensure that all 21/12/2009 matters listed within Schedule 2 of the Care Home Regulations 2001 (amended) must be secured prior to commencement of employment for all staff working at the home. This is to verify the suitability of people employed to work with the people who use your service. 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 5 The homes service user 09/02/2010 guide should include all the required information as set out in this regulation including the cost of facilities or services not covered by fees. So that people living in the home can be clear about the service provided and the terms and conditions between them and the home. 2 6 15 Care plans must fully describe the services and 10/02/2010 Care Homes for Adults (18-65 years) Page 27 of 30 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 facilities to be provided by the home to help people to meet their current and changing needs and aspirations and achieve goals. So that people can know their needs and personal goals are reflected in their individual plans. 3 20 13 Please provide written confirmation of the current arrangements for the safe administration of rectal diazepam, if required. To ensure that people living in the home are protected by the homes policies and procedures for dealing with medicines. 4 23 13 Please provide written confirmation of the current arrangements by training staff or by other measures, to prevent people who use the service from being harmed or suffering abuse or being placed at risk of harm or abuse. To ensure that people living in the home are protected from abuse. 27/01/2010 27/01/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 1 The service users guide and other information about the home should be available in a format suitable for the people for whom the home is intended. Care plans should be made available in a language and format that users of the service can understand. The homes complaints procedure should be developed in an appropriate language/format, suitable for the people for whom the home is intended. 2 3 6 22 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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