Care Home: Winnett Cottage

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What the care home does well The service focuses on a very individualised approach to people living at Winnett cottage and this helps create an atmosphere that is both inclusive and consultative. People who use the service confirmed that staff consult them on issues relating to their support needs. Winnett cottage works hard to encourage and support people in developing and improving their self-help and social skills in order to prepare them for moving on to more independent living. The staff team appear both open and honest in their approach to their work and recognise that people who are using their service require a consistent and positive approach. This was reflected by some of the people using the service who stated " I can always go to the office if I need some help". "The staff are fair but firm, which is what I need". The standard of training within the home is good, with all staff having received the mandatory training necessary to do their job effectively. There was a very warm and welcoming atmosphere. What has improved since the last inspection? There are some aspects of the environment that have improved since the last inspection which include, repairs to the roof of the outbuilding that houses a range of gym equipment and pool table, several areas have also been redecorated and refurbished and the issue with inconsistent water temperatures has now been resolved with the purchase of a new boiler and water tank. What the care home could do better: There needs to be a general improvement in the standard of monitoring and recording on both individual care plans and with the auditing and monitoring of the standards within the home. Several risk assessments seen had not been reviewed or updated, which could place people at risk. It is important that as part of the person centered approach each person confirms that they have been part of the care planning process by signing their own care plans. There must be a system where any individual risk is identified at the earliest possible point to ensure that risk are reduced and control measures put in place to protect people. Medication procedures must be monitored more closely as part of the overall quality assurance system to ensure that any errors are identified at the earliest possible stage in order to reduce any risk to people using this service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Winnett Cottage 111 Hertford Road Bragbury End Stevenage Hertfordshire SG2 8SH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julia Bradshaw     Date: 0 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 31 Information about the care home Name of care home: Address: Winnett Cottage 111 Hertford Road Bragbury End Stevenage Hertfordshire SG2 8SH 01442878504 01438816713 winnett@psycare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Psycare Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 10 Winnett Cottage is a psychiatric aftercare hostel accommodating a maximum of ten adults in individual rooms. There are various communal areas including a large day room, a TV room and a communal dining room. The garage has been converted to provide an on-site leisure facility with a gymnasium and a recreation area. Visiting professionals may use a quiet interview room. The hostel is located in a quiet residential area on the outskirts of Stevenage and close to a local parade of shops. Stevenage Town Centre with its range of commercial outlets, amenities and public service links to other towns is easily accessible. Service users are allocated an individual care pathway facilitator who will encourage and support the service user in formulating and implementing their own daily living programme and lifestyle plan. Information regarding the service is available within the Statement of Purpose and Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home Service User Guide. These and the most recent Inspection report are held within the main office. The range of fees are between £1150 and £1300 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality Commission is based upon outcomes for the people using the service. We looked at three care plans and tracked the individual care for those people. As part of the planning we look at information we received including the Annual Quality Assurance Assessment (AQQA). This is a self assessment document required by law in which the provider tells us how well they think they are meeting outcomes for individuals. We also looked at any concerns and also feedback from relatives, staff and the people using this service. The last key inspection was carried out on the 17th June 2008. Care Homes for Adults (18-65 years) Page 6 of 31 We observed staff at work and how they interacted with the people living at within the home. There was also a tour of the building in which the inspector had the chance to talk to the people using this service, the staff, the shift leader and the newly appointed manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is kept up to date and provided for all prospective users of this service and everyone wishing to enter the home has a full assessment of need completed. This ensures that all parties can be sure the home can meet all individual needs. The terms and conditions of the home are agreed in writing so that people are clear about the roles and responsibilities. Evidence: The newly appointed manager confirmed that the service had updated both the Statement of Purpose, which sets out the aims and objectives of the service and provides information about the specialist care the service offers. The Service User Guide includes details what the prospective and current individuals can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. The manager stated that All new service users are given a copy of the guide and the services makes one available for all to view as they wish. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment was detailed and appropriate to the policy and procedure in place. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race, gender, age and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. One person who uses the service commented, The staff are good here and are helping me to move on.. The assessment process is conducted annually to ensure that any changes in need are identified and associated support plans are then reviewed and or implemented. There are no privately funded placements. Each person had a statement of their individual terms and conditions and these are reviewed and adjustments made annually or as required. The AQQA states that We work very closely with the potential new resident during the assessment period. Day and night stays are arranged during this period. Advice is given from the referral team with regard to the individual persons assessment. During this period full consideration is given to the individual and their views. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect a detailed record of peoples needs, which ensures that people using the service receive a service that meets their needs but inadequate risk assessing and reviewing currently places people at risk and could fail to protect them. Evidence: A total of three care plans were case tracked fully. It was established that people who use the service receive appropriate health care support, which is suitable to meet their needs. Personal health care needs including specialist health and dietary requirements are recorded in each persons care plan. The service stated that they receive external support services from the clinical care teams. Psychology, psychiatric and community psychiatric nurse support is provided by the local Community Mental Health Teams. The service also has the full use of an occupational therapist. The care plan provides information and a guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: guidelines, risk assessments for the management and control of a range of issues, including, where appropriate behavioural support guidelines. It was observed that the service reviews the needs assessment on an annual basis and this is linked with the care plans in place providing the required information in order for the staff to know how to best meet the needs of the individual. It was observed that personal support is responsive and created to meet the individual choices, needs and preferences. Generally staff were observed to respect the privacy and dignity of everyone living within Winnett Cottage. People are supported to maintain their independence and generally can take responsibility for their personal care needs. Risk assessment are in place for a number of issues where control measures may be required to be identified and implemented in order for the individual to take risks as required. However on the day of this inspection three individual risk assessments had not been reviewed since the last inspection was carried out. The risk assessment seen for people smoking within their bedrooms was dated 2007. This risk assessment should be reviewed and updated annually in order to ensure peoples health and safety is protected. There is also no mention within the recently completed AQAA completed regarding risk assessment and how this is managed as part of the holistic approach within peoples support plans. There was also an issue raised with the new manager regarding one person living at Winnett Cottage who is hearing impaired. There was inadequate provision in place to ensure this person is not placed at risk when the fire alarm is activated. Currently the only control measure in place to alert this person is by another service user or staff member. Any identifiable risk should be assessed and appropriate control measures in place to ensure the individual is not placed at any unnecessary risk. During the inspection it was directly observed that confidential records were being stored appropriately. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can feel assured that they will be offered and receive appropriate opportunities for social/leisure and community involvement. Evidence: People using the service at Winnett Cottage have the opportunity for personal development. Examples included development of independent living skills, socialising, working, voluntary placements, college and further education and training. People have the opportunity to access services within the community and were able to confirm that they were received effectively and through professional channels. The opportunity for people to receive paid employment through the completion of tasks such as gardening, cleaning and painting and decorating is provided. People are Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: encouraged to become part of the local community and some individuals access the local community independently on a regular basis. Everyone using the service is supported in gathering relevant information regarding employment, further education, employment skills and benefit advice if required. The service supports people in accessing a range of activities outside of the home, which include, a day trip to Southend and holidays are planned for later this summer to Blackpool. The service has a rota for daily living tasks and routines in which each person takes responsibility. These include cooking, washing up and vacuuming as well as participating in a daily milk and bread rota. Meals are offered on a flexible basis and everyone is encouraged to participate in the cooking with appropriate support as required. Individuals determine the menu and choose a weekly menu specific to the meals that they are encouraged to cook on a rota basis. This is supported through discussions with people on a day to day basis. People then have the option to change their original choice to something more preferable, on the day. Staff then order the shopping for the home. These daily routines promote independence for everyone using the service, using a person centred approach at all times. Staff were observed to interact with all service users well and it was clear that mutual respect was held within the home for both staff and service users. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be assured that peoples holistic health care needs are being met as there are incomplete and insufficient records maintained in the home. Evidence: Generally the health care records were maintained to a satisfactory standard although one file checked on the day of this inspection contained several gaps in the recording of health care visits in February March and May 2009. These checks should include, general health care check ups, mental health out patient appointments. Various appointments had been documented within the daily diary but again follow up notes were incomplete with regard to the outcome of these visits or if they had been attended or cancelled. The medication cupboard is situated within the main office of the home. The current arrangements for the storage and administration of medication are adequate. All staff have been trained and inducted in the administering medication. There is currently no controlled medication held in the medication cupboards, however there is a robust procedure in place for the administration of Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: these medications, if required. There was a reconciliation on one persons prn (only when required) medication and this proved inaccurate. There were 20 paracetamol recorded as being present on the 11/5/09 and only 12 recorded as being present on the 14/5/09 with 8 paracetamol unaccounted for. This was reported to the manager immediately and asked to be investigated as a matter of urgency. The Quality Assurance system with regard to medication must therefore be improved in order to ensure this type of error is identified at the earliest point, in order to ensure the people using this service remain protected. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be assured that they will be protected from abuse and that they will be listened to if they raise any concerns or make a complaint about any aspect of their care. Evidence: The service has a detailed complaints procedure in place. A record is maintained in the home of any complaints made detailing actions and outcomes as necessary. People using the service have been informed about the complaints procedure. This is on display in the home. Three people spoken to stated that they knew who to talk to if they had reason to complain. We go to the office if we have a problem and sort it out. The staff know that we will complain if we are not happy with something. The recent AQQA states that no complaints have been received within the past year. A detailed procedure is in place to ensure that people using the service are protected from abuse and harm. Staff receive suitable and adequate safeguarding training (Protection of Vulnerable Adults). Two staff spoken to on the day of this inspection confirmed that they had been inducted and were fully informed about the whistle blowing policy and how to implement it, if necessary. Staff employed within the home are all subject to enhanced Criminal Records Bureau disclosure. Care Homes for Adults (18-65 years) Page 19 of 31 Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides a comfortable and homely environment in which people can live safely. Evidence: A tour of the building was undertaken as part of this inspection site visit. There has been a variety of improvements carried out and the AQAA states that The redecoration and replacement flooring has been fitted to 5 bedrooms, an investigation and repair to the blocked drains, a replacement boiler has been fitted, a replaced shower has been fitted and also the water tank has been replaced. An old shed has been demolished and the downstairs bathrooms have been refurbished. New patio doors have been fitted and two toilets have been redecorated. A new oven has been purchased and a new garage roof has been refitted. The main lounge has also been redecorated. Some bathrooms have been refurbished and decorated. New sheds and storage areas have been provided in the garden. New gym equipment has been provided. New vanity units are going to be replaced within the bedrooms. Two people spoken to stated that they were happy with their room and enjoyed using the gym facilities based in the outhouse. There is a risk assessment in place in relation to people smoking in their bedrooms. However this requires reviewing as the current assessment seen was dated 2007. The Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: general standard of cleanliness was good with all areas seen tidy and no mal odours found. The AQAA states that We have a superb cleaner, who is very conscientious and thorough in their work. There is domestic rota in place and two people spoken to stated they were involved with and that generally it works well in agreeing who is responsible for specific areas within the home. Bedrooms were not inspected on this occasion as people chose to keep these areas private. There were a couple of areas within the home that will soon require attention as they are looking worn and tired. These are the carpet in the front lounge and the walls in the laundry room which are damp and require re-rendering. However these issues do not present as an immediate problem but the expectation is that before the next inspection takes place these two issues will be addressed and rectified. All fire records were up to date and health and safety records inspected maintained to a satisfactory standard. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are suitably well trained and supported to carry out their role effectively, in order to meet the needs of the people using this service. Evidence: The senior staff work alongside the care pathway facilitators to ensure there is both consistency of approach and to support and supervise newly appointed staff. This was seen on the day with a new member of staff was working alongside a permanent member of staff, as part of their induction programme. The new member of staff confirmed that they had been inducted using the homes own induction programme which is linked to skills for care. They also confirmed that they had received training in fire safety, food hygiene, health and safety and infection control. There has also been a range of training provided as part of the mandatory requirement as well as additional training in the Mental Capacity Act, dual diagnosis training, personality disorder training, safeguarding training and medication training. Staff spoken to confirmed that they had received the necessary training in order to carry out their role effectively. The AQAA states There is a training programme for staff internally i.e infection control, drugs and alcohol, diabetes, clozapine, heart attacks, meaningful day, epilepsy, hepatitis, care planning, full risk assessments and safe medication administration. External training includes; all mandatory, NVQs 2, 3, and 4, mental Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: health training i.e personality disorder, dual diagnosis etc. The lead care pathway facilitator has attained their NVQ level 3 and 4. There has been a new manager appointed within the past month from within the organisation. The home had previously been covered by a manager from another service in the interim period, whilst recruitment took place. Staff supervisions and staff meetings are inconsistent but it hoped that these will now improve with the appointment of a permanent manager. The staffing levels are a minimum of two care pathway facilitators and these ratios are increased when individual needs require it. The current staffing structure is one manager, one lead care pathway facilitator and care pathway facilitators. The manager and senior cover the on-call rota and there is also waking night care support each night. People spoken to during this inspection felt that the current staffing levels during both the daytime and nigh time were sufficient and that there was always someone available to talk to, when necessary. The are a core team of staff that have been at the home for several years, which is positive for people living at this service and provides consistency and reliability. Three staff files were inspected and contained all the relevant and required information to meet the standard. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate recording and monitoring currently compromises the heath and welfare of the people using this service. Evidence: The new manager has only been in post for a period of weeks before this inspection was carried out. However they are familiar with the service and have been an employee with Pysecare for several years. The home had been managed in the interim by someone from another service, since the permanent manager left in September 2008. The new manager has a broad range of experiences within the caring profession. The staff team have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff and the people who use the service determines that the management are professional and approachable. The Manager leads and supports a stable staff team who have been trained to satisfactory levels. The AQAA determines that there has been an increase use of audit tools and regular supervising and staff meetings. However on the day of Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: this inspection these statements could not be fully evidenced, with the last staff meeting minutes held on the 9/04/09 and staff supervisions records were inconsistent, with several months lapsing between supervisions. This therefore does not currently meet the minimum required standard of six supervisions per month. However these standards are expected to improve now the home has a permanent manager in post. There were also some standards within the recording of information within individual care plans that was inconsistent including, the service users signature on one care plan and several risk assessments had not been dated or signed. There should be an individual risk assessment in place where there is a risk identified and control measures devised in order to protect the persons health and welfare. The manager promotes equal opportunities, has good people skills and understands the importance of person centered care and effective outcomes for people who use the service. The service has detailed policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles and safeguarding issues. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The service provides suitable training regarding safeguarding and staff showed a sound working knowledge of action to take in such an event. A training matrix has been developed. Whilst the AQAA determines that staff have completed their mandatory training. It was confirmed that manual handling, fire awareness, risk assessment, medication, food hygiene, infection control and safeguarding training have all been completed by a number of staff to date. As part of the inspection process, we reviewed a random selection of staff files. Three staff files were audited to ensure suitable checks had been conducted. All files contained the required information to comply with the National Minimum. Regulation 26 visits are carried out by one of the directors of the Company. However the records seen on the day were not up to date with the following reports missing for this year, January, February, April and May 2009. The service has a range of internal Quality Audits that should take place on a daily, weekly and monthly basis. However the current system of auditing the key standards needs improving to ensure all areas are monitored closely and effectively, in order to ensure errors are identified at the earliest possible time. This has been highlighted with the issues identified within this report relating to medication, care plans and risk assessments. Care Homes for Adults (18-65 years) Page 26 of 31 Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Any identifiable risk must be 31/07/2009 assessed and control measures put in pace to ensure people are protected from harm. To keep people safe and protected. 2 20 13 All medication procedures must be strictly adhered to in order to ensure that people receive the correct medication prescribed. To ensure that peoples health care needs are protected. 31/07/2009 3 36 18 Staff must be provided with the appropriate support and guidance in order to ensure they can carry out their role effectively. To ensure staff are supervised appropriately to carry out their role effectively. 31/08/2009 Care Homes for Adults (18-65 years) Page 29 of 31 4 43 24 The service must improve the regularity and monitoring of standards, through an effective quality assurance system, in order to ensure that peoples health and welfare is protected. To ensure people are safe and standards are monitored and maintained. 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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