Care Home: Vine, The

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What the care home does well There have been no new admissions but the resettlement procedures in place ensure that the individual needs and aspirations of prospective residents are properly assessed before admission. Residents are part of their local community and they take part in activities of their choosing. Residents are supported to maintain their friendships and relationships with relatives and they are able to take part in the chores around the home. Personal care arrangements are informed by good written information and staff induction. Health care planning is good. The manager listens to concerns and to formal complaints and she takes appropriate action to investigate and resolve any issues. The Complaints procedure is suitable for the needs of the residents and there are regular opportunities for them to raise issues they are concerned about. Staff understand safeguarding procedures The home premises are reasonably well maintained and homely. The new home manager has settled in well and has plans for how the service can be improved. Health and safety procedures are in place. What has improved since the last inspection? Recruitment procedures have improved and the manager understands the need to supervise staff without full checks in place. Recruitment procedures are not ideal as most staff cannot be fully checked until they arrive in the UK. What the care home could do better: There is some good written information about how people should be cared for and supported but there is inconsistent quality in planning and a lack of evidence that residents have been consulted about these plans. Staff could achieve a more consistent result if they had a standard template to work to when planning and reviewing care records. Health care planning is good but records do not provide evidence that plans have been acted upon in some cases and this means that staff may not have an accurate and up to date information on which to act. This means that health care is only adequate. The systems in place to ensure safety with medicines are adequate but more must be done to ensure that residents receive medications as they are prescribed, that medications in use are within their expiry date for safe use. Storage must also be reviewed as it is not suitable for the storage of controlled drugs. Staff should have a better understanding of the new deprivation of liberty safeguards. More could be done to make the communal kitchen accessible to wheelchair users and infection control and odour control present a challenge in some areas of the home. High staff turnover reduces the effectiveness of team training and development and provides poor continuity for the residents themselves who share their home with a constantly changing staff team. More must be done to assess the quality of the service being provided and to maintain essential records. Key inspection report Care homes for adults (18-65 years) Name: Address: Vine, The 58-60 Rosendale Road London SE21 8DP     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: Sonia McKay     Date: 0 7 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 32 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 32 Information about the care home Name of care home: Address: Vine, The 58-60 Rosendale Road London SE21 8DP 02086709248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): vine_60@yahoo.co.uk www.larche.org.uk L`Arche Lambeth Name of registered manager (if applicable) Mrs Marcela Friedlova Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (CRH - 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 - Code LD Date of last inspection Brief description of the care home The Vine is located in a residential road in West Norwood close to the organisations workshops, high street shopping and transport networks. Two houses are joined together to create one large home and back garden. The Vine is registered to accommodate seven adults with a learning disability some of whom may also have a physical disability. All of the residents require varying degrees of support and assistance in their daily lives. The home is one of five residential care homes in Lambeth and Southwark, which are part of the local LArche community. The aim of the community is to create an environment that welcomes people with learning disabilities. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 7 1 3 0 2 2 0 0 9 Brief description of the care home Fundamental principles of the community are that each person has a right to friendship, a spiritual life and to live in an environment that fosters personal growth. Prospective residents receive an information pack that contains the Statement of Purpose and Service Users Guide and a copy of the most recent Commission inspection report is available on request at the home. Current fees range between £435.22 and £519.20 per week and depend on the support needs of individuals placed. Care Homes for Adults (18-65 years) Page 5 of 32 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 inspection was carried out in one day by one inspector at the home. The inspection was facilitated by the home manager and area manager. The home manager completed a survey for us. This gave us some information about the home and the service provided by the staff. I looked at things the home has notified us about since the last inspection. I looked at records about care and medicines. I looked at records about the staff and how they are recruited and trained. I looked at records about the running of the home. Care Homes for Adults (18-65 years) Page 6 of 32 I contacted a local authority social worker for views about the care of one of the residents. I looked at the communal areas of the home and two of the bedrooms. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There is some good written information about how people should be cared for and supported but there is inconsistent quality in planning and a lack of evidence that residents have been consulted about these plans. Staff could achieve a more consistent result if they had a standard template to work to when planning and reviewing care records. Health care planning is good but records do not provide evidence that plans have been acted upon in some cases and this means that staff may not have an accurate and up to date information on which to act. This means that health care is only adequate. The systems in place to ensure safety with medicines are adequate but more must be done to ensure that residents receive medications as they are prescribed, that medications in use are within their expiry date for safe use. Storage must also be Care Homes for Adults (18-65 years) Page 8 of 32 reviewed as it is not suitable for the storage of controlled drugs. Staff should have a better understanding of the new deprivation of liberty safeguards. More could be done to make the communal kitchen accessible to wheelchair users and infection control and odour control present a challenge in some areas of the home. High staff turnover reduces the effectiveness of team training and development and provides poor continuity for the residents themselves who share their home with a constantly changing staff team. More must be done to assess the quality of the service being provided and to maintain essential records. 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 32 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 32 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. There have been no new admissions but the resettlement procedures in place ensure that the individual needs and aspirations of prospective residents are properly assessed before admission. Evidence: There are no new residents and there are no vacancies at this time. Resettlement procedures have been judged as good at previous inspections which have shown that peoples needs are properly assessed before they are offerer ed placement in the home. Care Homes for Adults (18-65 years) Page 11 of 32 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. There is some good written information but failure to organise the planning, review and goals setting systems properly means that the outcome for the resident is only adequate. There is also a need to keep better evidence of how these plans have been agreed with each resident or their representatives. Evidence: I looked at planning and assessment records for two people living in the home. The home manager has organised a top sheet for each set of records to help staff locate information more easily. The files are reasonably well organised but there is no set format to care planning records. The first person has epilepsy, a learning disability and uses a wheelchair. There is useful information about his likes and dislikes. There is useful information about current care needs and details are good in regard to personal care preferences. There are health care plans and risk assessments to cover Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: areas of home and community life. All have been reviewed in the last year. There was an internal placement review in February 2009 but no goals were set and there is little evidence of how these plans have been agreed with the resident. Records for a second resident were of a similar standard. There is some detailed information about personal care and communication but some areas of support, such as cultural needs and financial planning are not covered. Some plans, for example, support required to attend Church, have not been reviewed for many years. The manager said the support guideline is still the same. This should be confirmed by evidence that the guideline has been reviewed along with other the support plans. Care Homes for Adults (18-65 years) Page 13 of 32 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. Residents are part of their local community and they take part in activities of their choosing, but most spend time within the community workshops and groups. Residents are supported to maintain their friendships and relationships with relatives and they are able to take part in the chores around the home if they are able. Evidence: The quality assurance audit completed by the home manager for the Commission before the inspection has good information about how individual lifestyles are supported at the Vine. Larche is a faith based community that offers active support to each resident to enable them to develop their faith and spiritual lives. Residents who choose not to attend religious activities of any particular denomination are offered opportunities to engage in art, music and nature. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Most of the current residents attend Larche workshops and groups for daytime activities. The close proximity of the other Larche homes provides a close community. Residents regularly have supper invitations to see friends living in other homes in the area. Larche Lambeth has been operating for more than 25 years and has developed good relationships with local individuals and organisations. Staff live in at the Vine with the intention of building a shared community with consistent engagement between the staff and residents. All residents are offered a minimum of two weeks of holiday away from the home in each year, either alone with staff support or as part of a group with shared interest. There is a range of in-house activities available, including television, DVDs, music and musical instruments. Evening and weekend activities in the community and at home are also provided. Personal information held in individual care files contains detailed information about family and friends, their birthdays and family history. This enables staff to support residents to maintain and develop family relationships. One resident has started voluntary work at the local library. One resident has started drama therapy. Residents are supported to maintain relationships with their family and friends. Records of the meals prepared show that a range of meals is served. Food stocks are plentiful and include plenty of fresh fruit and vegetables. Each resident chooses and helps to prepare an evening meal to the best of their ability and staff and residents eat main meals together at a large dining table, often with friends. Residents also make snacks and drinks without support if they are able. The kitchen facilities are not accessible to residents who use wheelchairs and more could be done to enable wheelchair users to cook and prepare meals themselves. There is an old range style cooker and residents are not able to use it. Care Homes for Adults (18-65 years) Page 15 of 32 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. Personal care arrangements are informed by good written information and staff induction. Health care planning is good but records do not provide evidence that plans have been acted upon in some cases and this means that staff may not have an accurate and up to date information on which to act. This means that health care is only adequate. The systems in place to ensure safety with medicines are adequate but more must be done to ensure that residents receive medications as they are prescribed, that medications in use are within their expiry date for safe use. Storage must also be reviewed as it is not suitable for the storage of controlled drugs. Evidence: Personal care guidelines are detailed. The manager said that emphasis is placed on inducting new staff on the specific daily routines of each resident. A key working system is in place but it lacks consistency and continuity because of frequent changes in staff. All of the residents need some form of assistance with personal care and some also Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: need assistance with toileting and continence care. Personal care is provided by same gender staff in the privacy of bedrooms and bathrooms and there are detailed guidelines about the support required. The home has improved the personal care service for one resident by ensuring that he has the necessary equipment in place in the bathroom that he uses. The manager says that seeking advice from specialist teams, such as occupational therapy and a physiotherapist has also improved care. I note that a health care plan says one of the residents should see his neurologist this year but no record is kept of the appointment attended. However there is a guideline made by the neurologist as a result of a recent consultation so an appointment must have taken place. Records could be better organised so that health care could be more easily tracked. One resident was also supported to obtain and start using a hearing aid. The home manager has also attended training about sexuality issues. Residents go shopping with staff to choose and buy their own clothes and to do things like go to hair dressing appointments. At the last inspection we noted that one resident was prescribed an emergency medication for epileptic seizures that staff were not trained to administer. This placed the resident at risk and we made a requirement. The home has addressed this by arranging the appropriate training for staff. I looked at dental care residents for another resident. Her plan says she should see a dentist regularly. There are no records of an appointment on file but the manager found an entry for an appointment in the communal house diary that suggests one was made. A mouthwash prescription is in place for bleeding gums so the appointment was likely to have been attended. Again records should be better so that key staff, who change frequently, can deliver care in accordance with assessed needs and plans. We have made a requirement about record keeping under standard 41, record keeping. I looked at the arrangements in place for giving residents there medicines. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Medication is stored in metal lockers in a small room, used only for storage. The lockers and the room are kept locked. Hoverer, this would not be suitable for the storage of any controlled drugs should they be prescribed. As from January 2008, controlled drugs have to be kept in a cupboard which meets the requirements of the misuse of drugs safe custody regulations. A requirement is made about this. Medication administration records are in kept in a file. They do not contain photographs of the residents or information about the side effects that staff should look out for. Photographs should be available as an extra reminder to staff who are administering as reminder of who the medication is for. Staff should be aware of the side effects so that they can provide proper support with health care. Both actions are recommended. Medication administration is recorded properly and I did not see any gaps in recording on the sheets I looked at. There is a sample signature list for staff trained to administer medication and this training forms part of the induction of new staff. Polices and procedures are in place. Weekly spot checks take place and the results of these checks are recorded. This stops medications running out and helps the home to monitor whether the medicines are being administered properly. I note that directions for the use of one cream are that it is to be used three times each day but staff are only applying the cream at night. It is not clear why the cream is prescribed and where it is to be applied. This means that the medication is not being administered as prescribed and the directions for use are not adequate. There is a requirement about this. I note that one person is prescribed eye drops, which have a finite expiry date based on when the bottle is first opened. There is no record of when the bottle of eye drops was first opened so there is no record for when the bottle is to be replaced. There is a requirement about this. A local authority care manager said that the service meets the health needs of the resident she is reviewing. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager listens to concerns and to formal complaints and she takes appropriate action to investigate and resolve any issues. The Complaints procedure is suitable for the needs of the residents and there are regular opportunities for them to raise issues they are concerned about. Staff understand safeguarding procedures but they should also have a better understanding of the new deprivation of liberty safeguards. Evidence: There is a good complaints policy. There is text version and a more accessible version for residents who may not be able to understand a text only document. Regular house meetings provide residents with an opportunity to raise concerns. A local authority care manager completed a survey for us and said that the home responds well to any concerns that she raises during review meetings. The home manager has arranged the complaints book so that the timescales of any complaints investigation are recorded. Records show that the manager has taken appropriate action to address the complaints made and to resolve them. Abuse awareness training is part of the Larche induction and formation training undertaken by all new staff. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: All residents require assistance with financial matters. Receipts are retained for all transactions and stored with the individual expenditure records. These records are periodically audited by the Larche financial controller and are also part of the Regulation 26 monitoring inspections conducted on behalf of the registered provider. This provides residents with safety from financial abuse. A spot check of cash held in the safe keeping indicated that cash balances tallied with records. Foreign currency and valuable documents, such as bank books, that are held in safe keeping are also recorded. This is evidence that a requirement made in the previous inspection report has been addressed. Individual financial support needs should be developed into specific support plans. A record of visitors is available and is being used appropriately. The manager and staff have not been trained in the new Deprivation of Liberty Safeguards, and they need a good understanding of their roles in ensuring people are not deprived of their liberty. This training is recommended for all. There has been one safeguarding investigation since the last inspection and discussion with the manager indicates that appropriate actions are taken to investigate concerns and to safeguard residents. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home premises are reasonably well maintained and homely. More could be done to make the communal kitchen accessible to wheelchair users and infection control and odour control present a challenge in some areas of the home. Evidence: The large home is generally suitable for its stated purpose, although the kitchen facilities are not accessible to people who use wheelchairs. The building is in keeping with other homes in the residential area. There is ramped access to a small rear garden and a small front garden with off road parking. There is a cyclical programme for re-decoration in place. Two of the ground floor bathrooms are adapted to meet the needs of the residents using them. The kitchen is not fully accessible and improvements in this area would be of benefit. A clinical waste removal contract in place and clinical waste is stored appropriately before collection. The home is clean and tidy and there are adequate hand washing Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: facilities. One bathroom is only be used by one person. This resident has challenging behavioural needs that mean that there are constant hygiene issues. I raised this with staff who said that behaviour support specialists have said to ignore the behaviour. However, this raises significant infection control concerns that should be reviewed regularly with specialist input if necessary. Bedroom number nine has a bad odour. The resident has continence care needs. We have made a requirement about this. Care Homes for Adults (18-65 years) Page 22 of 32 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. High staff turnover reduces the effectiveness of team training and development and provides poor continuity for the residents themselves who share their home with a constantly changing staff team. Evidence: Staff are called assistants and they are provided with board and lodgings. Some staff live on premises. Larche is a Christian community of people with and without a learning disability. Assistants are required to be part of all aspects of Larche community life. Staff take turns to be on duty and records are kept of who has worked on each day as required. Staff turnover is high, with assistants often staying for only a year. This does not provide good continuity of care. High turnover has also reduced the impact of a training and development programme. The manager is looking at the specific training needed by the current staff team for Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: the coming year. All new staff undertake induction training and during their first year they complete foundation training. This is a programme of mandatory and service specific training. Staff are taught how to use equipment such as hoists during their first few weeks of induction. Records relating to the recruitment of two of the new staff were looked at. A human resources officer co-ordinates telephone interviews and the recruitment of new staff. As staff live on premises and are often recruited from overseas the POVA first check, a check against the list of people who are not allowed to work with vulnerable adults because of previous concerns or convictions, and enhanced British criminal records check cannot be done until the prospective member of staff arrives in the UK. The provider has increased the number of checks undertaken in their own country before the person arrives because of this. Overseas criminal records checks are obtained along with three references. When the member of staff arrives the British checks are taken up straight away. New staff do not work alone with residents until these checks are done and the results are satisfactory. There are ten assistants employed. Eight have been employed in the last twelve months. The manager said that as of September 2009 all staff will receive training in towards a specific care qualification for working with people with a learning disability. A health needs specific training session was underway in a communal room on the day of this inspection. Staff also need training in the Deprivation of Liberty Safeguards. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new home manager has settled in well and has plans for how the service can be improved. More must be done to assess the quality of the service being provided and to maintain essential records. Health and safety procedures are in place. Evidence: The new manager is experienced and qualified and is registered with the Commission. The manager has been working and living in the Larche community for a number of years, so she knows the residents well. She facilitated this inspection well. Information that the manager completed in the quality assurance audit that we requested before the inspection shows us that she has already identified areas of home and service development for the coming year. She has also made effort to address issues raised in the last report. A representative for the registered care provider visits the home each month to do a small inspection of the quality of service being provided. A report of the outcome of these visits is sent to the manager. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: There is no quality assurance system in place in the service. There is a new requirement about this. There is no record of the furnitures owned by each resident. This is required. There is no inventory of the personal possessions belonging to each resident. This is a recommended. Elsewhere in this report there is other evidence of failing to keep proper records. In regards to medication and health care records. The manager and staff need a better understanding of the records that are a legal requirement. We have made a requirement about improved record keeping and recommend a better understanding of records legally required. There are health and safety policies and procedures in place. There is a file full of health and safety information and different checklists relating to periodic checks of equipment by professionals and by staff. As required in the previous inspection report, action has been taken to address problems identified by the fire authorities. Fire doors now have the necessary fittings. The AQAA, annual quality assurance document says equipment in use at the home has had appropriate safety checks carried out recently. Wheelchairs are checked and maintained at a local facility. I note that recent services have resulted in repairs. It is not clear as to how long the faults were there before the repair. There are no records of visual checks made by staff between planned service inspections. This is recommended. Care Homes for Adults (18-65 years) Page 26 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 There must be a record of the opening date of medications with a finite expiry date based on the date of opening. So that residents are not administered medications that are out of date for safe and effective use. 09/01/2010 2 20 13 There must be suitable storage in place for safe storage of any controlled drugs. Regulations about the storage of controlled drugs changed in 2008 and care homes must all now have suitable storage available. 31/03/2010 3 20 13 Medications must be administered in accordance with prescriber directions. So that residents receive the medical treatment they require. 09/01/2010 Care Homes for Adults (18-65 years) Page 28 of 32 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 4 24 16 All parts of the care home must be free of offencive odours. One bedroom has a smell of urine. 28/02/2010 5 39 24 The registered person must 31/03/2010 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. The system must also provide for consultation with their service users and their representatives. So that residents are confident that their views underpin all self monitoring, review and development by the home. 6 41 17 The registered provider shall 31/03/2010 maintain in respect of other records to be a kept in a care home a record of information specified in Schedule 4. There is no record of items of personal furniture purchased by the residents. So ownership is not clear. 7 41 17 The registered provider shall 31/03/2010 ensure that all records are kept up to date and are available for inspection. Care Homes for Adults (18-65 years) Page 29 of 32 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 So that they record the current situation for each resident. 8 41 17 The registered provider shall 31/03/2010 maintain in respect of each service user a record of information specified in Schedule 3. Medication records are incomplete and Records relating to health care are also incomplete. 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 3 4 5 6 7 6 17 20 20 23 23 30 Care planning should be developed around a set format of areas for each person. The kitchen and kitchen facilities should be accessible to wheelchair users. There should be information about side effects of prescribed medicines. There should be a photograph of each resident with their medication administration records. All staff should be trained in the Deprivation of Liberty Safeguards. Individual financial support needs should be developed into specific support plans. The manager should seek further specialist advise about maintaining good hygiene in a first floor bathroom because current practise involves a risk of infections spreading. The manager and staff should have a better understanding Page 30 of 32 8 39 Care Homes for Adults (18-65 years) 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 of the records that are legally required. 9 10 39 42 There should be an inventory of each persons personal possessions. Staff should maintain a record of their own visual inspections of wheelchairs and other aids and equipment. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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