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Inspection on 12/05/10 for 23 Barncroft Street

Also see our care home review for 23 Barncroft Street for more information

This is the latest available inspection report for this service, carried out on 12th May 2010.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information about the service is produced in easy to read formats. Staff receive regular supervision which supports them in meeting the needs of people living at the home. People are supported to maintain contact wiht family and friends so that they maintain relationships that are important to them. People who live at the home are able to personalise their bedrooms to reflect their taste and preferences.

What has improved since the last inspection?

There has been little or no improvement in the service over the past twelve months. The key inspection report of May 2009 had 13 recommendations of which only 2 have been actioned. Some of these outstanding recommendations have been changed to requirements due to the increased severity of risk to people living at the home.

What the care home could do better:

People should be better supported to access the local community and participate in a wider range of activities. Suitable arrangements should be made to ensure the team of staff on duty is available in sufficient numbers of support people when required. The medicine management must improve to safeguard those people that live at the home. All systems must be improved to ensure that all medicines are administered safety to people living at the home. Quality assurance systems should be further developed so that the home can demonstrate views are actively sought and that isses have been identified and are actively addressed. There needs to be a review of training so that it incorporates protected time so that staff learn in an effective manner. Work is required to improve the care planning and risk assessment process further, so that the home can demonstrate all needs have been assessed and are being met appropriately. People living in the home and or their representatives should be involved in this process if they would like to be. The staffing levels and deployment of staff needs to be reviewed across the home to ensure people`s needs are met appropriately at all times by people who know them well. The home has recently appointed a new Care manager but the home has been with out strong permanent leadership for some time and this has led to slippage. A permanent day to day manager is needed in the home to ensure the home is run in a way that meets the needs and expectations of people living there. Staff communication training is need to be reviewed to ensure that people living in the home are empowered to make choices. Recruitment procedures need further work to ensure theyare robust and protect people living at the home. People must not wait excessive amounts of time for their breakfast when they have requested it. This will ensure people receive food and drink that meets their nutritional needs in a timely manner.

Key inspection report Care homes for adults (18-65 years) Name: Address: 23 Barncroft Street 23 Barncroft Street Hill Top West Bromwich West Midlands B70 0QJ     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: Karen Thompson     Date: 1 4 0 5 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 34 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 34 Information about the care home Name of care home: Address: 23 Barncroft Street 23 Barncroft Street Hill Top West Bromwich West Midlands B70 0QJ 01215568809 01215568807 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.voyagecare.com Milbury Care Services Ltd Name of registered manager (if applicable) Mrs Hayley Whitehouse 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: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 4 Date of last inspection Brief description of the care home 23 Barncroft Street is an adapted bungalow property, which is owned and managed by the Milbury Organisation. The home is situated in the Hilltop area of West Bromwich, which is easily accessible and is close to nearby public transport routes. Local shops and amenities are also available. The accommodation consists of four single occupancy bedrooms, kitchen, lounge/dining area, and bathroom and toilet facilities. There is a small enclosed rear garden/patio and off road parking to the front of the property. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 4 2 7 0 5 2 0 0 9 Brief description of the care home People who use the service are offered 24-hour personal care and support. The service should be contacted for information about the current fees. Care Homes for Adults (18-65 years) Page 5 of 34 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: One inspector carried out the inspection over a two day period, the home did not know we were coming on the first day of our visit. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The majority of people living at the home have complex health and nursing needs. We case tracked two peoples care which involves establishing individuals experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication Care Homes for Adults (18-65 years) Page 6 of 34 needs. Time was spent observing care practice, interaction and support from staff. Members of the management team were present for the duration of the inspection. We looked at a sample of care, staff and health and safety records. Prior to the inspection visit the home completed an Annual Quality Assurance Assessment (AQAA). This was completed by the Operations Manager for the service. We used the information provided to us about the service and the information gathered during the visit to assess the homes performance. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: People should be better supported to access the local community and participate in a wider range of activities. Suitable arrangements should be made to ensure the team of staff on duty is available in sufficient numbers of support people when required. The medicine management must improve to safeguard those people that live at the home. All systems must be improved to ensure that all medicines are administered safety to people living at the home. Quality assurance systems should be further developed so that the home can demonstrate views are actively sought and that isses have been identified and are actively addressed. There needs to be a review of training so that it incorporates protected time so that staff learn in an effective manner. Work is required to improve the care planning and risk assessment process further, so that the home can demonstrate all needs have been assessed and are being met appropriately. People living in the home and or their representatives should be involved in this process if they would like to be. The staffing levels and deployment of staff needs to be reviewed across the home to ensure peoples needs are met appropriately at all times by people who know them well. The home has recently appointed a new Care manager but the home has been with out strong permanent leadership for some time and this has led to slippage. A permanent day to day manager is needed in the home to ensure the home is run in a way that meets the needs and expectations of people living there. Staff communication training is need to be reviewed to ensure that people living in the Care Homes for Adults (18-65 years) Page 8 of 34 home are empowered to make choices. Recruitment procedures need further work to ensure theyare robust and protect people living at the home. People must not wait excessive amounts of time for their breakfast when they have requested it. This will ensure people receive food and drink that meets their nutritional needs in a timely manner. 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 34 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 34 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 is provided in an easy to read formats the ranges of fees needs to be included to ensure people living at the home have all the information they need. There have been no new admissions to the home since the last key inspection so the pre-admission assessment process was not assessed. Evidence: We were given a copy of the Service User Guide during the inspection, this was in pictorial format. This makes the information accessible to people who do not read. The Service User Guide contained the name of the person it was being given to. The guide however did not contain the fees payable by the person living in the home. Four people were living at the home at the time of our visit. There have been no new admissions to the home since our previous key inspection in May 2009. Care Homes for Adults (18-65 years) Page 11 of 34 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 and risk assessments do not contain the information that staff need to meet the assessed needs of people living in the home. Evidence: People living at Barncroft have complex care and nursing needs. We looked at two care plans in detail and others were sampled. They contained information about their personal, social and healthcare needs in the form of individual support plans and risk assessments. However on closer examination by observing staff practice and talking to people living in the home we found that these records did not reflect the current needs of people living in the home or reflect the care that was being given. For example, we observed one person asking to be got out of bed from 9:20am, their care plan reflected this as their preferred wish however they were not assisted out of bed till 10:30am. This person also informed staff on being hoisted back onto their bed that they were not comfortable but staff told them they were okay. This person called the care manager who adjusted their position to one they felt comfortable with. This demonstrated that peoples wishes and preferences are not consistently being met by Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: staff working at the home. We also found in this person care plan a risk assessment for the use of bedrails however there was only one bedrail on this persons bed. It is normal practice to have two bedrails on a bed if they are considered necessary. Records and discussions with staff and people living and visiting the home confirmed that up until recently the lack of specialist bedding had meant people where not able to go back to bed during the day until this had been launded. Whilst the issue has now been resolved it should never have occured as it placed restrictions on people living at the home. Care records do not demonstrate that regular meetings are being held to review the persons care needs. Relatives told us they had had no input into the drawing up of the care plan. Staff told us they had not yet attended or received training on the Mental Capacity Act and Deprivation of Liberty Safeguards. This was observed at the previous key inspection of May 2009. If staff do not understand their roles and responsiblities under this legislation people using the service may be at risk of having their liberty unlawfully deprived. House meetings are not arranged for people who use the service. Staff said individual meeting were more productive because of the diverse needs within this group. Care Homes for Adults (18-65 years) Page 13 of 34 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. Peopel living at the home would benefit from the opportunity to take part in a wider range of activities so that they are enabled to lead a more stimulating and fulfilling life. The arrangements for meeting peoples dietary needs are not always consistent or appropriate. Evidence: We looked at care plans and daily records to establish that people were taking part in activities that they enjoyed. Care plans gave very limited information about what people like to do. We were informed that one person living at the home attended a day centre twice a week. We also observed on the second day of our visit that two people living at the Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: home had gone out shopping with staff. We were also told on the second day that a person living at the home was due to go out to a concert that night. We were told by the new care manager that they had been looking at a number of activities in the location to ascertain their suitability for people living in the home. We identified in our last key inspection of 2009 that the home needed to be more proactive in identifying suitable venues .... to ensure people are fully supported to participate in a range of activities. It is concerning that this still remains an issue and is only being looked at now with any committment. We observed relatives visiting the home. We did discuss a diary entry which indicated that visiting was restricted after 21:00hrs with the management team. The management team felt this was not an unreasonable request due to the impact this would have on other people living at the home. The Service User Guide does state you can have visitors to the home at any reasonable time if you want to. The home might like to consider defining what they consider reasonable along with a discussion with people living in the home so no misconceptions occur. Staff interaction with people living at the home was not always appropriate. The language used by care staff could be seen as controlling e.g you cant have your breakfast in the bath. This was in response to a persons request to have their breakfast prior to having a bath. We were told this was because staff wanted to ensure that persons personal hygiene had been dealt with prior to breakfast. This person had been asking to get up for well over an hour. The delay in their breakfast meant they did not receive their first meal of the day till 11:20am, this was quickly followed by lunch. They had been identified has having concerns in this person care plan with weight management. The practice of having two meals closely together does not help with weight management as it confuses the physical mechanism in the body. We were told that the home was in the process of arranging holidays for people living in the home. A number of people living in the home had chosen their preferred location. Care Homes for Adults (18-65 years) Page 15 of 34 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. Peoples health and personal care needs are not being met appropriately. The care planning recording system needs to be a reflection of the care needed. Medication systems need to improve so that people can be sure that they will recieve theri medication safety and as precribed by their doctor. Evidence: There is a mixed group of people living in the home in respect of age, gender and ability. Observations made during the inspection indicate that staff may not be aware of the impact their interactions have enabling and empowering people in their care. This was discussed in the lifestyle section of this report. Care plans whilst detailed did not reflect the current health and care needs of people living in the home. Each care plan contains a list for staff to sign to say they have read the care plan. In the one file we looked at only one member of staff had signed this list. Indicating that staff were not aware of the care planning instructions. This may account for the observation that care planning instructions were not mirroring practice. The key work allocated to this persons care plan we were told had left the home several months previously. This may account for the care plan not being Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: reviewed regularly. We found that people living at the home had had short term medical conditions but there was no care planning process in place to assess, monitor and evaluate these conditions. Everyone living in the home is registered with a local General Practitioner (G.P). There was evidence of visits to/from health and social care professionals such as opticians, dentist and specialist nurses. We looked at the arrangements in place for medication management. Medication is stored in a locked trolley in a locked room. The medication consisted of a boxed and blistered system. We found one person at the home to have been prescribed pain relief four times a day but the handwritten Medication Administration Record (MAR) stated to give as and when required. Staff at the home were not following the original clinicians instructions. We looked at this persons care plan in relation to pain management and the various types of medication to control pain were not listed in their care plan. The pain relief care plan also did not look at the type or site of pain and was not being assessed regulary to ascertain whether pain management was effective. We also found another person living at the home to have a protocol in place for the use of paracetmol but this was not prescribed on their MAR chart. We found the home was using a coding system for when medication is not administered, but then staff initials were alongside this. It is standard medication practice that staff initials indicate the medication has been given so this should not be running along a coding system. The back of the MAR chart allows for staff to offer explainations for omission of medication, it would be better practice if staff adopted the practice of writing on the back of the MAR chart. We found that handwritten MAR charts did not contain two signatures of staff checking the medication into the home which is deemed good practice. Medication is being administered by Percutaneous Endoscopic Gastrotomy (PEG) lines when it has not been licenced to be administered by this route. PEG routes are made by a surgerical procedure which are put into the abdomen a line so that someone who is having difficulty swallowing can receive nutrition via this route. We did found that the person who had their medication adminstered via the PEG route their medication care plan did not reflect this. Staff however did demonstrate they knew the correct technical procedure for administering medication via this route. We discussed with the management team how to reduce the risk of complications and risk to people who have medication administered by this route. The Care Manager has been working in the home several months but is not administering medication as they have not been deemed competent to do so by the organisation. Whilst this is good practice to ensure all staff are competent in medication administration. The organisation should have assessed this competency much earlier as it is clear that lack of management oversight is affecting the adminstration of Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: medication and placing people at risk. Care Homes for Adults (18-65 years) Page 18 of 34 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. There are systems and arrangements in place at the home to ensure complaints and safeguarding concerns are processed but the culture within the home does not always empower people to voice concerns. Evidence: We have been informed of one complaint about the service since the last inspection and is ongoing at present. The home has a complaints log with information pertaining to complaints and the homes response to these. People and their representatives are aware of the complaints procedure. Easy read copies of the complaints procedure are included in the Service User Guide. We spoke to two members of staff and they told what they would do if they had any concerns about the people living in the home. They were aware of the safeguarding and whistleblowing procedures. It was evident from the supervision records for staff that they did express concerns to the management team if they had any. Staff told us they had not received training in the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. They did however demonstrate they were aware of choice on speaking to them on a one to one basis. However as stated in the lifestyle section of the report staff communication can be quite structured to limit choice and is not empowering but disabling. Further work is required in staff communication so they are aware of how to empower people living in the home. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Peoples finances are not managed by the service. Arrangements are made to look after/support people with their personal allowances. The service manages the personal allowances on behalf of people living in the home. Records and receipts are kept of transactions made by staff. Regular in house and company audits are carried out and any errrors are rectified appropriately. Care Homes for Adults (18-65 years) Page 20 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment in its present form is not meeting the needs of people living there. Evidence: The house is on one level. We were told that one person living at the home cannot access the home via the front door as their wheelchair is too wide, so they have to come in and out of the home via the patio doors. The corridor leading to the bedrooms is narrow in places meaning the turning circle for wheelchairs is limited and thus making maneouving around this part of the home difficult. We were told that there are plans to widen the corridors in the near future. The building at present is not meeting the needs of people living there. Areas of the home were also looking tired in parts, this may be resolved with the corridor work which will require redecoration in these areas. There is a combined lounge dining area at one end of the home next to the kitchen. The dining room table is narrow and is not suitable to accomodate the four people living there, three of whom are wheelchair users. Each person has their own bedroom which is furished with individual items. Three of the bedrooms have overhead tracking hoists fitted. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The bathroom is situated at the front of the house. The bathroom is a combination of shower area and assisted bath. The front of the premises and the rear garden was unkempt in places. The back garden area is split into two parts. The first part is a patio type area with raised beds. The other part of the garden is fenced off and not accessible to people living in the home. There are a separate laundry area and this has the necessary equipment in place to ensure infection control practices are maintained. Care Homes for Adults (18-65 years) Page 22 of 34 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. The deployment and numbers of staff need to be reviewed to ensure the needs of people living in the home are meet in a consistent and safe manner. Evidence: From our observation of the two days we visited the deployment of staff is not meeting the current needs of people living in the home. For example people living at the home having to wait an excessive amount of time for their morning bath and breakfast. We had concerns about the number of waking staff in the home overnight and the homes ability to meet peoples needs overnight with only one person available between ten oclock of a night till eight oclock in the morning. This in reality means people are put to bed before this time and have to remain in bed till the day staff come on therefore impacting on choice and dignity needs. We left an immediate requirement for the home to review the needs of people living at the home and the night time arrangements. The providers representative has sent a letter acknowledging receipt of this and stated they had increased night time levels as a temporary measure until they had carried out a review of needs. We are still awaiting the outcome of this review. We looked at the rotas which show three staff is on duty during the morning and early afternoon. The late afternoon and evening shift are covered by a minimum of two care Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: staff. The care manager is rota to the occassional care shift but mainly works Monday to Friday 9 to 4:30. We were told that the home had two staff vacancies at present. Recruitment checks were sampled for three staff. Independent Safeguarding Authority first checks (ISA first) are completed prior to awaiting a full Criminal Record Bureau check (CRB). The home had employed someone on an ISAfirst whilst awaiting a CRB but they had not carried out a risk assessment. If the home decides to employ someone only on an ISAfirst whilst awaiting return of the CRB they must carry out a risk assessment. The organisation has an agreement with the Commission to keep the orginal CRBs at there head office so these were not looked at during the inspection. We did find however a copy of a CRB on one staff members file but this was in relation to another organisation, however we found this concerning as this organisation had not been mentioned on the application form history. We also found that some staff files did not contain an references. The home was therefore unable to demonstrate a robust recruitment procedure had occured. Induction paperwork was very limited we found a sheet which stated they had completed 1 to 6 of the Skills for Care and of the three looked at two had not been dated. There is a mix of gender, ages and experience within the staff team. There is a core of staff team who have worked at the home for a number of years. We were assisted by the newly appointed care manager. Information supplied to us by the home showed that 66 of care staff had a National Vocational Qualification level 2 or above in care. The service had a training matrix overview of training undertaken by staff and when refreshers are needed. The service has introduced a training system called E-box. This is a training programme accessible via the homes own computer. Staff informed us Time constraints on doing training on duty....by the time set up, your needed to go and see to service users needs. The home needs to put systems in place for the training to have a protected time slot. The homes computer does not have internet access so that information available on the world wide web is not available to staff to meet the needs of people living at the home. For example suitable activities for people with complex needs, information about specific medical conditions and so forth. Staff supervision was taking place on a regular basis. Supervision was individualised. Supervision is about supporting staff to meet the needs of people living at the home, but also acts as a way of monitoring and maintaining care skills. Care Homes for Adults (18-65 years) Page 24 of 34 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. People can not always be confident that the service is run in their best interest. Evidence: The home has not had a registered manager in post for over twelve months. The home has appointed an acting manager but we are aware that the home has had two acting manager since our last key this making the third acting manager. The registered provider is in breach of the Care Standards Act 2000, section 11 for a person to carry on managing a care home without being registered by the Care Quality Commission. We are making a requirement of the home to meet this. We saw some evidence to show the service is monitoring some aspects of its own performance such as how it meets the dietary and social needs of people living at the home. However a more comprehensive quality assurance system should be implemented and an annual development plan produced and made available to all interested parties. This should provide people with more confidence that their views are listened to and acted upon and the service is meeting its own aims and objectives. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: We contacted West Midlands Fire Service following our visit as we had concerns about only one person being in the home of a night in case of a fire broke out. They checked the building and felt that structurally it was safe to leave people in their bedrooms until the fire service arrived. A sampled of health and safety records were checked, including fire, hoists and gas safety. They were all found to be satisfactory. Care Homes for Adults (18-65 years) Page 26 of 34 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 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 The home must make sure that peoples assessments are kept up to date and are a reflection of peoples needs They should do this os that peoples needs are recognised by the home and this will help reduce the risk to people living in the home. 30/07/2010 2 6 12 Care plans must be based on a though assessment of needs and show how care is to be delivered. Care plans must be accessilbe to staff delivering the care and be a reflection of the care being given. Care plans must be reviewed and amended at the point where a persons needs change or routinely and staff must be aware of these changes. 30/07/2010 Care Homes for Adults (18-65 years) Page 28 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people in the home have their health and welfare promoted and protected. 3 17 12 People living at the home must receive their meals in a timely manner. So they do not wait excessive long periods for meals or receive two meals within least than four hours of each other. 4 19 12 Care plans must be in place 31/07/2010 for short term conditions so that staff have clear instructions as to what is required to meets someones needs. This will ensure that people needs are identified, monitored and evulated. 5 20 13 All medication protocols 31/07/2010 pertaining to people living in the home should be reviewed to ensure they are current and up to date. To ensure the safety and well being of people living in the home. 30/07/2010 Care Homes for Adults (18-65 years) Page 29 of 34 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 6 20 13 Systems must be in place 31/07/2010 for appropriate pain control and documentation available to demonstrate appropriate pain relief has occured. To ensure pain relief is managed appropriately and meets peoples needs. 7 20 13 The medicine chart must 31/07/2010 record the current drug as prescribed by the clinician. It must be referred to before the preparation of the persons medicines and signed directly after the transaction and be an accurate record of what has occured. The prescribed medicine must be administered to the right person at the right time and at the right dose prescribed and records must reflect this. 8 34 19 Gaps or anomalies in the application form must be explored and there must be written evidence to demonstrate that this has occurred. This is to ensure a robust recruitment procedure has taken place. 31/07/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 9 34 19 The home must make sure 31/07/2010 that staff allowed to work in the home whilst awaiting a satisfactory CRB and only have an ISA first check have a written risk assessment completed and a copy of this risk assessment is kept in the staff members file. This will demonstrate how the home intends to protect the people living in the home when staff start work without all the required safety checks in place. 10 37 11 The registered provider must appoint a permanent manager to the home and then submit an application form to the Commission for us to consider their application for registration. So the Commission can be confident that the person in day to day charge of the home is competent to meet the needs of people living in the home. 20/08/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The home should amend its Service Users Guide so it Care Homes for Adults (18-65 years) Page 31 of 34 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 includes fees and specify any restrictions on visiting. 2 6 People living at the home and or their representative should be encouraged to part take in the drawing up of their care plan instructions so that their wishes and preferences are fully explored and meet. People should be provided with better opportunities and support to access facilities in the local community. (Recommendation following key inspection May 2009) The current system of using a code and staff initialing by the code should be reviewed as it is confusing. Clear guidance should be provided to staff about how to support a person prescribed as required pain relief medication to take it only when needed. (Recommendation following key inspection May 2009) Handwritten Medication Administeration Record should contain two signatures of staff checking in the medication to demonstrate a second person has checked and found the information to be correct. The home should obtain the NEWT Guidelines ISBN 09552515-0-8 pre ISBN 978-0-9552515-0-4 or contract the drug manufactures medical information department and ascertain what medications can be administered via PEG routes. It is recommended that the home obtain a copy of the Department of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training, so that staff are aware of their responsibilities and peoples rights are protected. The servcie should address general repairs and upkeep of the premises promptly to ensure people live in a well maintained environment. (Recommendation following key inspection May 2009) The service should ensure staff members on duty are available to meet peoples needs at all times. (Recommendation following key inspection May 2009) The keyworker system needs to be reviewed to ensure that people living at the home have a named individual who will promote their wishes and needs. 3 13 4 5 20 20 6 20 7 20 8 23 9 24 10 33 11 34 Care Homes for Adults (18-65 years) Page 32 of 34 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 12 35 Staff working at the home should have protected training time so that they obtain the skills and competences in an affective manner to meet the needs of people living at the home. The home should look at staff training in communication and customer care skills. Staff should receive this training so they are aware of their duty to promote and empower people living at the home. The home should keep a copy of the induction records for new staff. They shold do this so they can demonstrate new staff have been supported though the process and have received suitable induction to social care work. A comprehensive quality assurance ssytem should be implemented by the home and an annual development plan produced for people to be fully confident their views are listened to and acted upon. (Recommendation following key inspection May 2009) 13 35 14 35 15 38 Care Homes for Adults (18-65 years) Page 33 of 34 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. © 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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