Care Home: Warwick Road, 4

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What the care home does well The provider and the staff team engaged with the inspection process in a very positive manner. Staff have developed warm and affectionate relationships with the people they care for. They are positive and show a genuine interest in people`s needs. The home has a warm and friendly atmosphere. Staff are polite, courteous and respectful. The home is domestic in appearance, fits in well with the local community and is nicely furnished. A full medicines audit trail is maintained and medication is stored securely and generally well managed. What has improved since the last inspection? Following requirements and recommendations made in the last inspection, the home has: improved its arrangements for handling people`s money; provided evidence that robust pre-employment checks are carried out; made sure that staff have completed mandatory training or made arrangements for them to undertake this training; made sure that staff files contain documentary evidence of the training they have completed; have arranged for staff to work with speech and language therapy staff to devise a communication passport for each person; increased staffing levels to make sure people using the service are safe; completed a Health Action Plan for each person; given people`s relatives information about how to make a complaint; improved the arrangements for monitoring the quality of care provided at No 4 Warwick Road. What the care home could do better: Regular audits of the medication system should be carried out to help confirm that staff are following the provider`s medication policy and good practice guidance. A copy of the provider`s medicines policy and current editions of professional guidance on medication practice in social care should be kept in the treatment room. Individual medication profiles should be updated whenever medication is changed. Ensure that people`s support plans contain statements of desired outcomes, are available in an easy to read version and are reviewed every six months. This will help to make sure that staff are clear about the action they must take to meet people`s needs. Ensure that where people`s support plans identify that staff need training to carry out specified tasks, this training is provided. This will help to make sure that staff have the necessary skills and competencies to meet people`s needs. Carry out an assessment of each person`s capacity to make key decisions regarding their day to day lives using a recognised tool. This will help to make sure that people are supported to make the decisions that affect their lives. Submit an application to register a manager for the home. This will help to make sure that the home is managed by a suitable person who has appropriate skills and competencies. Ensure that at least 50 percent of the team has obtained a National Vocational Qualification at Level 2 or equivalent. This will help make sure that people are cared for by appropriately trained staff. Ensure that the MUST nutritional risk assessment recommended by the Care Quality Commission is completed for each service user. This will help to promote people`s health and well-being. Key inspection report Care homes for adults (18-65 years) Name: Address: Warwick Road, 4 4 Warwick Road Wallsend Tyne And Wear NE28 6RT     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: Elizabeth Gaffney     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 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 26 Information about the care home Name of care home: Address: Warwick Road, 4 4 Warwick Road Wallsend Tyne And Wear NE28 6RT 01912344655 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northern Life Care Limited T/A U.B.U. Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home No 4 Warwick Road is a purpose built, semi-detached bungalow. The home is registered to provide care for four adults with learning disabilities who may also have physical disabilities. The home does not provide nursing care. It is situated in the centre of Wallsend and is close to all local amenities. There is a pleasant garden to the rear and a car park to the side of the building. The current range of charges for a place at the home are 994 to 1174 pounds. There are extra charges for hairdressing and private chiropody. A copy of the most recent inspection report is available in the main reception area. 0 1 1 2 2 0 0 9 2 Over 65 2 Care Homes for Adults (18-65 years) Page 4 of 26 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: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out. Before the visit, we looked at: * Information we have received since the last visit on 01 December 2009; * How the service dealt with any complaints and concerns since the last visit; * Any changes to how the home is run; Care Homes for Adults (18-65 years) Page 5 of 26 * The providers view of how well they care for people; * The views of staff and other professionals. An unannounced visit was made on the 13 April 2010. During the visit we: * Talked with some of the staff and the provider; * Looked at information about the people who use the service and how well their needs are met; * Looked at other records which must be kept; * Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; * Looked around the building to make sure it was clean, safe and comfortable; * Checked what improvements have been made since the last visit. No surveys were returned by staff or people using the service. We told the provider what we found. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Regular audits of the medication system should be carried out to help confirm that staff are following the providers medication policy and good practice guidance. A copy of the providers medicines policy and current editions of professional guidance on medication practice in social care should be kept in the treatment room. Individual medication profiles should be updated whenever medication is changed. Ensure that peoples support plans contain statements of desired outcomes, are available in an easy to read version and are reviewed every six months. This will help to make sure that staff are clear about the action they must take to meet peoples needs. Ensure that where peoples support plans identify that staff need training to carry out specified tasks, this training is provided. This will help to make sure that staff have the necessary skills and competencies to meet peoples needs. Carry out an assessment of each persons capacity to make key decisions regarding their day to day lives using a recognised tool. This will help to make sure that people are supported to make the decisions that affect their lives. Submit an application to register a manager for the home. This will help to make sure that the home is managed by a suitable person who has appropriate skills and competencies. Ensure that at least 50 percent of the team has obtained a National Vocational Qualification at Level 2 or equivalent. This will help make sure that people are cared for by appropriately trained staff. Ensure that the MUST nutritional risk assessment recommended by the Care Quality Commission is completed for each service user. This will help to promote peoples Care Homes for Adults (18-65 years) Page 7 of 26 health and well-being. 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 26 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 26 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 are suitable arrangements for making sure that peoples needs are assessed before they move into the home. These help make sure that staff know how to meet peoples needs when they move into No 4 Warwick Road. Evidence: There has only been one admission into the home during the previous 12 months. This persons care records show that the home obtained detailed information about their needs from their family and social services. The persons family completed the providers Getting to Know Me information booklet. This provided staff with valuable information about the persons life experiences before their admission into No 4 Warwick Road. The booklet also includes information about the risks the person faces in their day-to-day life. The home also obtained a copy of the persons social services assessment, which provided details of their support needs and how they should be met. Care Homes for Adults (18-65 years) Page 10 of 26 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. Improvements have been made to the information held about peoples needs. But, further development of peoples care plans and risk assessments is required to make sure that staff are clear about how their needs should be met. Evidence: Improvements have been made to the quality of information held in peoples care records. For example, peoples assessments have been reviewed and updated. Care records now have a better structure making them easier for staff to use. Support plans have been devised for each person setting out what support they require. They cover such areas as help needed with medication, managing personal finances, continence management, and morning and evening routines. However, peoples support plans do not contain statements of desired outcomes and are not available in an easy to read version. Six monthly reviews of peoples support plans have not taken place. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Staff said that there had been some uncertainty within the team about how they should respond to the more challenging aspects of some peoples behaviour. Similar issues had also been raised by professionals who have regular contact with the service. The provider and acting manager have held team meetings to clarify how people should be supported and what behavioural strategies are to be used. Staff said that this has helped to provide people with more consistent care. Staff have developed support plans for people who have identified communication needs. They have also devised Communication Passports for each person in consultation with the local speech and language team. Staff support and encourage people to make simple everyday choices. However, the home has not carried out a formal assessment of peoples capacity to make the key decisions that affect their daily lives. Staff have completed a range of risk assessments for each individual covering areas such as money management, susceptibility to choking and use of the kitchen. These assessments provide staff with clear guidance about how to promote independence whilst also keeping people safe. However, some risk assessments have not been reviewed, and where appropriate updated, on a regular basis. This may place people using the service at risk if staff do not have up to date information about how to keep people safe. Action is being taken to address this matter. Care Homes for Adults (18-65 years) Page 12 of 26 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 are provided with opportunities to participate in their local community and the provider is seeking extra funding to improve staffing levels so that better support can be offered. But, current staffing levels are insufficient to enable staff to support people to pursue all of the opportunities that are available to them and this limits their lifestyle choices. Evidence: The local councils care management team has expressed concerns that people using the service do not have sufficient opportunities to engage in culturally and age appropriate activities, or make use of community based facilities. The provider and council are working together to address this matter. However, during the inspection, staff supported each person to access the community. For example, people were supported to visit the local health care centre, their bank, a cafe and nearby shops. Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: Staff have obtained and recorded in peoples care records information about their social interests and preferences, and the places they enjoy visiting. The provider acknowledges that further work needs to be done to improve peoples social needs care plans so that staff are clear about how to meet their needs. Although improvements have been made to peoples weekly planners they still contain limited information about the activities they will take part in, who will organsie them and over what time period the activities are expected to take place. Staff reported that people are supported to engage in activities outside of the home. However, staff said that they are often anxious about there being insufficient support within Warwick Road whilst they are out. Staff also said that they feel vulnerable supporting people in the community as some challenging behaviours can be difficult to manage when lone working. People are supported to maintain contact with family members. Peoples records contain important information about their previous life experiences as well as details about the relationships that are important to them. However, support plans setting out the support people need to maintain important relationships have not been completed for each person. Peoples care records contain limited information about how staff support them to maintain and develop independent living skills. However, people were observed helping out in the kitchen with staff support. Also, staff support service users to participate in shopping trips to purchase food for the home. It is evident that people enjoy these outings. The kitchen is clean, hygienic, tidy and well equipped. Food stock levels were good. The meal time observed was a pleasant social occasion. Person centred menu planning has recently been introduced by the acting manager. Staff are now expected to consult people about what they would like to eat for the week ahead. However, the current records of food served in the home are inadequate. They do not provide satisfactory details of what people have eaten. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting peoples personal and healthcare support needs and managing medication are generally good. This means that people can be confident that staff will know how to protect and promote their health and well being. Evidence: Service users care records show that they receive healthcare as and when needed. For example, people have seen an optician, dentist and GP during the last 12 months. Support plans have been devised for each person to promote their health and well being. These cover such areas as support required when attending medical and healthcare appointments and taking medication. Checks of peoples weight are carried out monthly. Peoples records do not contain a Health Action Plan or a completed MUST nutritional risk assessment. Support plans setting out how staff should meet peoples personal care needs have been devised. For example, in one persons care records, there is guidance describing the support they need with personal care, oral hygiene and bathing. Support plans covering assistance required with continence care and shaving have been put in place for another service user. People looked well cared for and staff were attentive and responsive to their needs. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Staff said that people receive a good level of physical care which meets their needs. Administration of medicines was observed and generally followed good practice guidance. However, both carers involved in the process signed each Medicines Administration Record (MAR), although only one carer actually witnessed the medication being given. All medication was stored securely within a small locked treatment room and room temperatures are regularly recorded. Prescriptions are sent to the home first for checking before being dispensed and this good practice helps ensure that all the medication a person needs is received in time. A medication file within the treatment room is used to store copies of professional guidance on handling medicines in social care settings, photocopies of dispensed prescriptions, guidance for staff on administration procedures and some medicines information. This guidance is not up to date and the providers handwritten medication protocol does not cover all aspects of handling medication in the home. This means that staff do not have easy access to up to date guidance to help them understand how to handle and administer medicines safely. Comprehensive records are maintained for all medication received and returned to the pharmacy. An individual medication profile is kept for each service user and is used to record current medication. These profiles were not always up to date and do not sometimes reflect a persons current medication. Also, they are not dated to assist in identifying the current profile sheet in use. The current MARs were looked at and a sample of medication was counted and checked against the administration records. There were no discrepancies between the quantity of medication received, the number of doses recorded, and the quantity of medication remaining. In addition, there were no significant gaps on the administration record although a few applications of creams and ointments had not been fully recorded. These observations indicate that people living in the home can expect to get their prescribed medication correctly as prescribed. The stock control of some prescribed infrequently used liquid medication could be improved. A regular audit of the medication system is carried out monthly by the homes acting manager and, once every three months by the providers community manager. However, there was no evidence that monthly medication audit is actually taking place and the last quarterly audit we were shown had been undertaken in August 2009. One persons care plan contained clear and comprehensive guidance on the way that prescribed buccal Midazolam should be used to treat occasional epileptic fits. Medication training is provided to staff handling medicines and each person is assessed as competent before undertaking this task. Additional medication training updates were scheduled over the next two months. Care Homes for Adults (18-65 years) Page 16 of 26 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. The provider and staff team take steps to address safeguarding concerns and poor practice. But, recurring safeguarding concerns show that the homes systems and processes for keeping people safe need further development. Evidence: The home has a complaints procedure which is included in the service user guide. Each person has a support plan that sets out how staff will support them to make a complaint. The Care Quality Commission has been notified of one complaint. The concerns raised are being dealt with under the local authoritys safeguarding procedures. The provider has carried out a robust investigation and produced an action plan which sets out how they will address the improvement recommendations that have been made. The local authority intends to monitor the delivery of the providers improvement recommendations to make sure that any progress made is sustained. Following a previous safeguarding concern, the provider has improved the arrangements for handling peoples money. Staff were able to clearly describe the arrangements for handling peoples money and said that things were now much better. This was confirmed by an audit of peoples financial records. Minimum staffing levels are now in place and this helps to make sure that people are safe within the home. The homes safeguarding policy is currently being revised and updated to take account of recent changes in legislation. Care Homes for Adults (18-65 years) Page 17 of 26 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 standard of accommodation is generally good. This means that people are able to benefit from living in a home which is well-maintained. Evidence: The home is clean, tidy, hygienic and there are no unpleasant odours. Lighting levels are good and the home is warm throughout. The layout and design of No 4 Warwick Road enables people to live together in a homely domestic environment. Each person has their own bedroom, which reflects their needs and personal preferences. People share a lounge/dining room and kitchen. The home has been re-decorated throughout and this has greatly improved the overall appearance. The home has been adapted to meet the needs of the people living there. A range of specialist aids and equipment has been provided, such as hoisting equipment and pressure relieving mattresses. Staff said that they have access to all of the equipment that they need to provide people with safe care. The home has an infection control action plan and the majority of staff have completed relevant training. Care Homes for Adults (18-65 years) Page 18 of 26 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. Records demonstrating that staff have been subject to robust pre-employment checks have improved and the arrangements for supervising staff are satisfactory. But, although the arrangements for providng induction training are good, not enough staff have completed an appropriate social care qualification. Having a relevant qualification demonstrates that staff have the skills and competencies to satisfactorily meet peoples needs. Evidence: A range of pre-employment checks are carried out before staff can start work at the home. Criminal Disclosure Certificates and PoVA First checks have been obtained for all staff. Each member of staff has completed an application form and undergone a recruitment and selection interview. Staff have been supplied with a contract of employment and the provider has obtained a health declaration from all staff. Staff have supplied a full employment history and provided two references. Only 27 percent of the staff team have obtained a National Vocational Qualification (NVQ) at Level 2 or above. This means that the home has not complied with the National Minimum Standard which states that 50 percent of care staff must obtain this qualification. However, staff without this qualification are in the process of working towards it. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: The majority of staff have completed a specialist induction programme for people who work with individuals who have a learning disability. Some staff have also completed more specialised training covering such areas as epilepsy and managing peoples eating, drinking and swallowing needs. Some staff have completed equality and diversity training since the last inspection. However, not all staff have completed training in person centred planning, working with people who have challenging behaviours, carrying out risk assessments and the use of physical intervention. Personnel records contain documentary evidence that staff have completed mandatory training in health and safety, moving and handling, first aid, food hygiene, infection control and fire safety. The local authoritys contract and care management teams have previously expressed concerns about staff sickness levels, the frequent use of agency staff and staff turnover. However, there have been improvements. For example, most of the care team have worked at the home for over a year. There has been a reduction in staff sickness levels and there is limited use of agency staff. Following agreement reached with the local authority, a minimum of three staff are now rostered on duty between 8am and 10pm to care for three people. The provider is hoping to obtain additional funding from the local authority to enable extra staff to be provided on each day time shift. This will help the team to make sure that people receive the right level of support they need when accessing the community. The night time period is covered by a member of staff who sleeps-in and a waking night worker. All domestic tasks are carried out by care staff, with service user involvement wherever possible. Arrangements are now in place to make sure that staff receive appropriate work based supervision. The recently appointed acting manager has had at least one or two supervisory sessions with each member of staff. Plans are in place to provide each member of staff with an annual appraisal. Staff records are kept secure and treated confidentially. Care Homes for Adults (18-65 years) Page 20 of 26 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 home has a strong manager who has clear ideas about how the service needs to improve. Improvements have, and are, being made to the systems for monitoring the performance of the home and steps are being taken to make sure that people have a safe home in which to live. But, improved teamwork, clearer roles and responsibilities, better quality care plans and comprehensive protocols for managing peoples challenging behaviours will help the staff team to sustain and maintain the improvements the provider is introducing. Evidence: The homes acting manager has worked at the home since October 2009. She is experienced in working with adults who have learning disabilities and has obtained relevant qualifications, including the Registered Managers Award. However, an application to register the acting manager has not yet been submitted to the Care Quality Commission. The provider has a clear view of the improvements that they would like to see take place at No 4 Warwick Road and is actively working towards this. Staff report that people receive a good quality of care within the home but that Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: they are less confident about their capacity to safely support people in the community. Although discussions with staff indicates that morale is low, it is evident that they are committed to the people they support and want to see the service improve. The provider is taking steps to improve teamwork within the home to make sure that staff are clear about how to provide people with a good care experience. Arrangements are in place to monitor the quality of care and services provided at the home. For example, the provider carries out monthly monitoring visits to check that peoples needs are being met and that the home is being run in a satisfactory manner. More robust quality monitoring processes are currently being introduced. Quality monitoring surveys are issued to peoples relatives and an analysis of the outcomes is produced. This helps the provider to find out what peoples families think about the quality of service received by their relative. The arrangements for improving peoples financial rights have improved. The arrangements for controlling who has access to the homes safe are now robust and known by staff. Good financial records are kept and there is evidence that regular audits take place. The provider requires staff to undertake twice daily checks of all money held on behalf of service users and to keep a record of this. Two staff signatures are obtained for all financial transactions involving service users money. Receipts are obtained for all purchases. The premises are generally safe and free from hazards. A sample of health and safety records was checked. This showed that the home has a current gas safety certificate and hoisting equipment has been serviced during the last six months. There are current certificates confirming that the homes emergency lighting and fire alarm systems have been recently serviced. Staff have received fire instruction, and participated in fire drills, at the frequency stipulated by the local fire and rescue service. Personal Emergency Evacuation Plans (PEEP)are in place for each person. The provider reported that one persons PEEP is currently under review to make sure that it reflects their changing needs. However, although a range of workplace risk assessments have been completed, they have not been recently updated. The provider acknowledged that these assessments are in need of updating. Care Homes for Adults (18-65 years) Page 22 of 26 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 23 of 26 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 A regular audit of the whole 21/05/2010 of the homes medication system should be carried out and an action plan prepared to deal with any issues identified. This will help to ensure that staff follow the homes medicines policy closely and protect the health and welfare of people living in the home. 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 6 Ensure that peoples support plans: contain statements of desired outcomes; are available in an easy to read version and are reviewed every six months. Ensure that peoples risk assessments are reviewed regularly and a written record kept. Make sure that each persons weekly planner includes: details of the activities they are to be involved in; which Page 24 of 26 2 3 9 12 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 members of staff will support the activity and for how long. Consider providing pictorial activity planners. 4 12 Continue to work with the local authority to secure the funding necessary to provide suitable staffing levels for when people access the community. Ensure that there are appropriate menus and detailed records of food provided to people using the service. Update individual medication profiles whenever there are any changes to medication. Ensure containers of liquid medicines are marked with the date of first opening and replaced after three months of use. Ensure carers who sign the Medication Administration Records witness the administration of all medication they sign against. Ensure a copy of the services medicines policy and up to date copies of professional guidance on medicines in care homes are kept in the medication file in the homes treatment room. Ensure that the homes safeguarding policy and procedures are updated to reflect current developments within the field of adult safeguarding. Ensure that at least 50 percent of the staff team have obtained a National Vocational Qualification at Level 2 or equivalent. Make sure that all staff receive an annual appraisal. Submit an application to register a manager for the home. Make sure that the homes workplace risk assessments are updated at least every 12 months. 5 6 17 20 7 20 8 20 9 20 10 23 11 35 12 13 14 36 37 42 Care Homes for Adults (18-65 years) Page 25 of 26 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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