Inspection on 08/01/10 for 3 Welholme Road Care Home

This is the latest available inspection report for this service, carried out on 8th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Welholme Road Care Home 25/03/08

3 Welholme Road Care Home 22/01/07

3 Welholme Road Care Home 13/02/06

3 Welholme Road Care Home 27/10/05

3 Welholme Road Care Home 21/02/05

3 Welholme Road Care Home 20/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for adults (18-65 years) Name: Address: 3 Welholme Road Care Home 3 Welholme Road Grimsby North East Lincs DN32 0DY     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: Jane Lyons     Date: 0 8 0 1 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 36 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 36 Information about the care home Name of care home: Address: 3 Welholme Road Care Home 3 Welholme Road Grimsby North East Lincs DN32 0DY 01472359574 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd Name of registered manager (if applicable) Michelle Elizabeth Holliday Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia physical disability Additional conditions: Date of last inspection Brief description of the care home 3 Welholme Road is a care home that is registered to provide personal care and accommodation for up to 16 service users with a mental disorder (excluding learning disability or dementia), 8 of whom may also have a physical disability. Prime Life Ltd owns the home. The home is on a main bus route to the centre of Grimsby and overlooks Peoples Park. It is in keeping with other properties in the area and has large enclosed gardens with a car parking area. Accommodation is based on two floors. All bedrooms are for single occupancy. Bathrooms and toilets are provided on both ground and first floors. There is a range of communal areas including two lounges, dining room, and a kitchen for people who use Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 16 8 1 2 0 3 2 0 0 9 Brief description of the care home the service to use. The home is comfortably furnished and is domestic in character. The current fees for the home are variable depending on individuals needs but start at £311.62 per week. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use the service experience adequate quality outcomes. The site visit to this home was unannounced and took place on the 8th January 2010. This inspection report is based on information received by the Care Quality Commission including information gathered during a site visit to the home which took approximately eight and a half hours. As part of this inspection process surveys were sent to people using the service, relatives and staff who work there. Surveys were received from three staff members, four individuals and one relative. Anonymised comments from surveys and discussions on the day of the site visit have been included throughout the report. Care Homes for Adults (18-65 years) Page 6 of 36 Throughout the day we spoke to people staying in the home to gain a picture of what life is like at Welholme Road. We also had discussions with the manager and staff. During the visit we contacted the local safeguarding team leader, the duty care manager from N.E.Lincolnshire Care Trust Plus and the homes senior manager to look into our concerns about the management of an individuals escalating behaviours and the need to protect the other people in the service. The duty care manager, a psychiatrist and the homes senior management attended the home and arrangements were made to increase the staffing levels to provide appropriate support until further reviews could be carried out the following week. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were to be met while they were staying there. Also examined were medication practices, activities provided,records of incidents and accidents, nutrition, complaints management, staffing levels, staff recruitment, staff training, how the home monitors the quality of service provided and how the home is managed overall. We also checked with people to make sure that privacy and dignity is maintained, that people can make choices about aspects of their lives and that the home ensures they are protected in a safe, clean environment. We observed the way staff spoke to people and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people who were staying at 3 Welholme Road, the staff team and the management for their hospitality during the visit and also thank the people who completed surveys and spoke with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations, but only when it is considered that people who use the service are not being at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? Aspects of the care plan recording has improved; all care plans are on the new format and are written in a person centred style. The manager now maintains a complaint record which gives an overview of the complaint details and outcome management. Storage of medication has improved. One of the care staff has a lead role in this area and is generally managing the systems well. Work is continuing to improve the environment and make it a pleasant and suitably equipped place for people to live. A lot of redecoration and refurbishment has taken place since the last visit with very positive results. 90 of the staff have now achieved NVQ level 2 or 3 in care which is a very positive achievement. Care Homes for Adults (18-65 years) Page 8 of 36 The home has up to date records to support that the fire safety systems have been checked regularly and staff have been involved in safety drills to make sure they know what action to take in the event of a fire. What they could do better: All incidents must be properly recorded and reported so this information can inform the staff and health professionals to determine the care the individual needs. Staff must look more closely at incidents of challenging behaviour in the home to see if they managed the situation well or if people need other support. Staff must have more training and support on how to deal with verbal and physical aggression in order to maintain or develop their skills and knowledge in managing these situations. The home must make sure they report all serious incidents to the appropriate agencies to make sure people are protected from harm. More complete records to support the investigation of complaints and concerns should be held to demonstrate that they have been dealt with properly. Care plans and risk assessments must be in place to support peoples moving and handling needs. These will inform the staff of the support and equipment needed to move people safely. Not all the staff have had a training up date in moving and handling, not all the staff have had training in how to use the hoist; staff need to be competent in moving and handling techniques to ensure they support people safely. Self - medication should be risk managed to ensure people are competent and safe to administer their own medications. There werent enough staff on duty at the time of the visit to ensure peoples needs were being met and that they were adequately protected from harm. Action was taken during the day to ensure more staff were provided. Systems must be developed to review the staffing numbers in line with the changes in dependency levels which will provide more effective staff rostering and ensure adequate staffing levels are in place. The homes quality assurance programme needs to be fully implemented to improve the monitoring systems in the home and demonstrate that the service is run in the best interests of the people who live there. Accidents and injuries to people must be recorded and reported properly to protect peoples safety. Staff must be provided with mandatory fire training and this must be updated annually to ensure those who live and work in the service are protected. Care Homes for Adults (18-65 years) Page 9 of 36 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 10 of 36 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 11 of 36 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. Peoples needs are assessed prior to admission and the home has good procedures in place to ensure people would feel supported on admission. Evidence: The manager stated that admissions to the home were always planned in advance. This enabled her to implement the homes admission procedures with the person who would be using the service. This included a pre-assessment meeting and a visit to the home with lunch provided. People were provided with information about the home and the manager arranged for the person to be introduced to a host friend during the visit. The manager had introduced these measures to enable people to feel comfortable on admission and to establish links with other people living in the home and the staff. Records were maintained to evidence that these processes had been completed, in one of the files we looked at there was very good evidence that an individual had visited on numerous occasions with their family before deciding to move in. We examined the care files for three of the people living in the home. There was evidence in each file that peoples needs had been assessed before they came to live Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: at the home. All contained assessments of need and care plans from the placing authority, the home added to these with their own assessment and risk assessments. The information was used to provide plans of care for people. Comments from people we spoke with included: Most of the people here and the staff are very friendly, this helped me settle in and Ive lived in other homes and I like it here. Care Homes for Adults (18-65 years) Page 13 of 36 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. The manager had continued to try and improve the care planning processes and there was some good practice in this area. However there needs to be more consistency to ensure all risks have been identified and care plans detail all the care people require. People living in the home are able to make decisions about their life and are supported to be as independent as possible. Evidence: We examined three care files during the visit and each contained detailed assessment information on which to formulate plans of care. There has been improvements noted in the care plans and a new format of care plan has now been fully implemented which has improved the process further. The plans generally give a clear account of the individual and their needs, they give a good level of information to staff regarding how their needs are to be met and are individualised to their particular preferences, however plans to support people regarding their moving and handling needs did not provide clear information to staff on how to support with transfers or what equipment Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: was to be used. People living in the home had not always signed to agree their care plans, this was identified at the last visit we made. The staff had also completed plans for people that have behaviours that are challenging to others.The ones examined gave staff information on possible causes of the behaviour, what triggers to look out for, how to prevent occurrences and direction on how to manage situations that do occur using different approaches. We found some inconsistencies in the recording of incidents and follow up action taken by staff, some of the records were very minimal with no record of any injury sustained or outcome action taken. Records show that care plans are evaluated monthly and generally updated where needs had changed. Staff complete very detailed daily records however some of the informal language used should be addressed, which was passed on to the manager. There is a key worker system in place and staff maintain records of the one-to-one sessions. People told us that they are able to make decisions about what they do and how they spend their time. They told us they are supported in maintaining their independence and the records show that where this involves taking risks, there are assessments in place to show how these risks will be minimised. However, the use of risk assessments to identify risks to individuals health needs was seen to be inconsistent, improvements have been made to the identification and monitoring of some peoples nutritional needs, but this was not the case for peoples needs with regard to mobility. There were no risk assessments in place for people with complex mobility needs, for example, one individual uses a wheelchair and there were no clear directions for staff in how to support transfers or any equipment to be used. We also saw evidence during the day of one individual struggling to move from one of the sofas, the staff told us that this person has problems with mobility at times and sometimes they use the hoist , yet there was no risk assessment in place and the care plan did not detail the support this individual needed at times. A lack of clear risk management and detailed care planning in this area may mean that people are not consistently and safely supported with their mobility needs which could pose risks for the individual and also staff members. People said they often went out into the community with or without support from staff, choose what they wanted to do and whom they preferred to spend time with.Whenever possible, people are supported to manage their own money and this is recorded in the care records. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: People living in the home told us that they are involved in meetings with the staff and management of the home. Topics discussed focus on day to day life in the home such as refurbishment programme, activities and menus. We were able to see recent minutes of meetings that had taken place. Care Homes for Adults (18-65 years) Page 16 of 36 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 feel they are able to exercise choice in their daily lives and they enjoy the meals provided. Management and staff are continuing to find ways to improve the quality of life for people via increased social stimulation although access to and support with activities has been inconsistent in recent times. Evidence: People living in the home who completed our surveys and who we spoke with during the day said they are able to make decisions about what they do and how they spend their time. They told us the daily routines are flexible which we observed throughout the visit. Records show that previous interests, hobbies, likes and dislikes were detailed in personal histories and there was evidence that relatives contributed to these. The individual care plans included detailed action plans that would support people to Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: maintain and develop their social, emotional, communication and independent living skills. This included opportunities for people to fulfill their individual spiritual needs. Care plans seen also clearly detailed peoples social involvement and relationships. We looked at the activity records which support some of these care plans and noted there were many gaps in recording for the last few weeks. Staff told us that they had little time in recent weeks to provide support in this area, but also that a number of individuals werent very interested in participating in activities. During the visit we observed that no activities took place, staff were fully occupied in providing care support and preparing meals. We think that with the increase in staffing hours agreed during the visit that the management should support the staff to motivate more people to participate in lifestyle, social and leisure activities which will meet their individual needs. Discussions with some of the people using the service evidenced that they regularly enjoyed trips out to the shops or local public houses with the staff or their friends and family.They also told us about a recent trip to Blackpool and a Primelife party which they had really enjoyed. There was good evidence that the home have continued to support individuals to continue with community based education and training, one individual is accessing a range of computer and adult literacy courses, another individual attends creative writing and drama workshops. People are also encouraged to attend community clubs and social groups, with one individual attending the Mind support group. There was also evidence that people had been consulted about holidays and had chosen the option of day trips out to places of interest, these have included visits to Lincoln museum, Blackpool and Woodhall Spa. Individual records, discussions with people and surveys returned from relatives show that the staff support and encourage people to maintain their relationships where possible. The home does not employ any kitchen staff, however all of the care staff undertake food hygiene training and prepare the meals. People spoken to stated that they were happy with the quality of meals provided for them and confirmed that they had a choice of what they would like to eat. People living in the home are involved in meal planning during service user meetings. Records of food provided are kept and were seen to be up to date. The home has no formal menu system in place, therefore we advise that the records of meals provided are reviewed from time to time to ensure that people continue to receive a varied, balanced and healthy menu option which meets their needs. We saw evidence in the care files that in general, peoples nutritional status was more consistently monitored, however there was a recent incident whereby one individual with complex needs had choked during a meal, Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: although the risk assessment had been reviewed and the care plan updated, this has not been referred to the G.P. or dietician to follow up. Meal times were seen to be positive, social occasions, the majority of people take their meals in the dining room. The home had been inspected by the Environmental Health Officer in November 2009 and was awarded a three star rating. Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had access to a range of healthcare professionals. Staff were knowledgeable about individuals health needs and people felt well supported. Care plans reflected health needs and medications were well managed. Evidence: The care files evidence that people living in the home have access to appropriate health care professionals to meet their individual health care needs. This includes appointments with doctors, dentists, chiropodist, psychiatrists and clinical support specialists. There was evidence that staff support and encourage people to attend appointments. People living in the home confirmed that when they see health care professionals either in the home, or in the community then they always have the opportunity to be seen in private unless they ask for support to attend the appointments. Most of the people living in the home are able to look after aspects of their own personal care needs, some people need staff to encourage and prompt them and we saw good information about this in the care plans. People are very positive about the Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: level of care and support they receive and made comments such as The staff are excellent, they are very supportive and Couldnt be better here, the staff are great. Staff have a very good knowledge of peoples health and emotional needs. We were impressed with the empathic way in which staff communicated with people, this was particularly noticeable when people were upset or agitated. Care plans were generally detailed in relation to health care needs and diary sheets detailed the actions taken to meet peoples deteriorating health needs. We saw evidence in the care files that in general, peoples nutritional status was more consistently monitored, however there was a recent incident whereby one individual with complex needs had choked during a meal, although the risk assessment had been reviewed and the care plan updated, this has not been referred to the G.P. or dietician to follow up. During the visit we looked at the systems in place to support medication and there was evidence to support significant improvements in this area. One of the care staff now has a lead role in this area and it is clear that she has a good understanding of the systems and is committed to ensuring that they are maintained properly. All of the staff responsible for administering medication have received appropriate accredited training. The records for receipt, administration and disposal of medication have been maintained. Where staff have hand written entries on the medication administration records, the records had been witnessed by a second staff member to ensure accuracy. Also, where people are prescribed medication to manage their behaviours on a when needed basis, risk assessments are in place to support administration, which is good practice in supporting consistency in peoples behaviour management. There was good evidence that the staff had been pro-active in arranging for peoples medication to be reviewed by their G.P.s. Storage of all medications has improved: the trolley was seen to be clean and organised. Hot water pipes have been boxed in and regular temperature recording in this area show that the storage temperature for medications is currently satisfactory. New controlled medication storage facilities have been provided which comply with current legislation, we also looked at the administration and recording of controlled medication which was seen to be satisfactory. We were told that two people were self medicating with regard to their inhalers, risk assessments should be put in place in line with the homes policies and procedures.This was the only area for improvement noted. Care Homes for Adults (18-65 years) Page 21 of 36 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. Complaints procedures were displayed, recording of complaints had improved and people knew how to complain. Whilst safeguarding procedures were in place and staff had been trained, some incidents had not been referred to the commission or to the local authority safeguarding team, leaving people unprotected. Peoples finances were well managed. Evidence: 3 Welholme Road is part of a large organisation in this region, which has corporate complaints policies and procedures. The homes procedures are on display, they need updating to reflect our organisations change of name. People told us that they know how to make a complaint if they need to and know who to speak to if they are unhappy. Staff who completed surveys for us said they know what to do if anyone has a complaint about the service. The Annual Quality Assurance Assessment (AQAA) document told us that the home had received four complaints since the last inspection. The manager now maintains a complaint record which gives an overview of the complaint details and outcome management. However there were no records in this file of correspondence with people or records to support complaint investigation such as interviews with staff. We found some supporting evidence in one staff members personnel file. Advice was given to the manager to keep all the relevant records to support complaints management in the file, which will better demonstrate that complaints have been Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: managed properly.To maintain confidentiality the complaints file should have restricted access. There are policies and procedures in place to reduce the risk of abuse. Records show that the staff have received training in safeguarding adults. The AQQA detailed that the home had three safeguarding referrals in the last twelve months. The manager had also written in the assessment We involve others, if a concern is of a material nature, possibly involving an allegation of abuse or a criminal act, then we refer the matter to the local authority under the relevant POVA procedure. We of course refer any matters of concern to the Care Quality Commission under Regulation 37. However during the visit we found evidence in care records and incident reports that the home had not reported all incidents between people who use the service to either the local safeguarding team or our organisation. One individual regularly displays behaviour which is harmful to others, however only a small number of these incidents have been reported. Discussions with the manager and records evidenced that before Christmas the management had liaised with care management and the individuals nurse consultant to secure more funding (three hours per day) to provide more effective monitoring and care support for the individual,however records showed that incidents over the last two weeks had escalated significantly and people who use the service were being assaulted much more regularly. During the visit people told us how unhappy they were about this, comments included I dont like it when ... hits me and Ive made a complaint, its not right that I should be attacked like this. We decided to contact the duty officer at care management, the safeguarding team leader and the area manager for the home during the visit to ensure action was taken to ensure people using the service were properly protected. The duty care manager and a community psychiatrist visited the home and discussed with the homes manager and senior management the current situation and need for more one- to- one staffing during the day, which was agreed. Evidence from this inspection shows that people in the home were not being fully protected from harm by the lack of proper reporting procedures and the inadequate management of an individuals escalating challenging behaviours. There were clear records of all of the peoples financial transactions that the care staff supported them with. Finances were audited regularly by the companys accountant and a report compiled. The most recent report found the finances to be managed satisfactorily within the home and a recommendation had been made to replace the safe due to a faulty locking mechanism. Care Homes for Adults (18-65 years) Page 23 of 36 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 home provides a clean and better maintained environment for people. Evidence: A partial tour of the home was conducted as part of the inspection. We viewed some of the bedrooms, communal space and bathing facilities. People said that they enjoyed living in the home and felt it was kept very clean and tidy. Comments from people during the visit include The house is kept clean and the staff do well with this and I try and keep my room tidy and the staff help me with this. The home is spacious and has a homely atmosphere, people were observed to be comfortable in their environment throughout the visit. We saw evidence that a lot of improvement works have been carried out at the home over the last two years. In 2008 external work was carried out to the structure of the building, guttering, roof and decor. In 2009 the maintenance programme has focused on improvement works to the internal facilities and decor with positive effect. Both lounge areas and the dining room have been redecorated and refurbished, a bathroom has been refitted with a jacuzzi facility and the clients kitchen has been refitted to provide disabled access. Alongside this a number of bedrooms have been redecorated and refurbished and the programme continues to address this. There was evidence that the people who use the service have been consulted on aspects of the decoration Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: programme, the dining room has been restyled as an American Diner and the decor in the lounges is much more contemporary in style. A staff member spoken to said Ive worked here for many years and this is the best it has ever been. When we visited last time we made a requirement that staff must be more proactive in identifying and addressing issues that could be a hazard to people living in the home, and we identified that one of the coffee tables in the dining area had a glass top which could easily be dislodged and could be a hazard to people living in the home. Action had been taken in that the staff had moved this table to the side of the room, further action should be taken in respect of risk assessing the potential hazard and consideration given to securing the glass top. Care Homes for Adults (18-65 years) Page 25 of 36 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. There were not enough staff on duty to meets peoples needs. The staff vetting procedure was sufficiently robust to ensure the safety of the people living in the home. Not all the staff have had training to make sure they can look after peoples safety and welfare properly. Evidence: People told us that staff treat them well and take notice of what they say. The staffing levels at the time of the visit consisted of the manager, two care staff during the day with three hours extra funding for one-to -one support and two staff at night. The home now employs a cleaner. Care staff remain responsible for the cooking, laundry, providing activities and accompanying people to appointments etc. Staff returned three surveys: two of these detailed that they felt there were always enough staff and one detailed sometimes. Discussions with staff during the visit evidenced that at times they felt they needed more staff to look after people properly. In recent weeks the staff group has had difficulties in managing the complex needs of one individual and incidents of challenging behaviour towards them and other people who use the service have escalated. There is evidence that the manager had tried to take some action to address this however more urgent action was needed to protect people and also to ensure their needs were being properly met. Appropriate action was taken during the day to ensure one-to -one staffing support was increased and provided for Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: twelve hours per day. It is important that staffing levels are continually reviewed in the service to ensure changes in peoples dependency needs can be met effectively. We observed staff speaking to people in a caring and considerate way, with light humour and banter used to encourage and assist people. Staff said that they really enjoyed working at the home and got a lot of job satisfaction. We found the staff were very enthusiastic and keen to improve the service further. They told us that the amount of training available had increased and the new training packages recently provided on mental health were very good, these training packages cover specific conditions and illnesses and also legislation for mental capacilty and deprivation of liberty. Records of staff training are held in staff files and the manager maintains a staff training matrix. When we looked at this we noted that there were a small number of gaps in mandatory courses such as moving/ handling, however the manager confirmed that she had contacted head office to provide an updated matrix, and any outstanding training in this area would be arranged. There are a number of people with complex mobility needs and it is important that staff are competent in providing support to assist with transfers safely. The company provides staff training in conflict management (NAPPI) however four staff have not received this training nor had some of the staff who had previously accessed the course received a training up date in 2009. Given the level of challenging behaviours that some individuals present in the service, staff need to be equipped with the appropriate knowledge of strategies and techniques to diffuse and manage incidents in the service effectively. There are good induction training programmes in place. The home has achieved and well exceeded the target for National Vocational Qualification with 90 of staff having gained level 2 or 3 in care. This a a very positive achievement. The employment procedures of the home ensure the safety and protection of the people who use the service. The recruitment and selection system is based on interviews, obtaining references and seeking pova first and criminal bureau checks. There has been no staff turnover since the previous inspection. Staff supervision files showed that the staff team receive ongoing supervision with a line manager. Staff also have annual appraisal sessions. Care Homes for Adults (18-65 years) Page 27 of 36 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 are benefiting from some improvements that have been made to the management and running of the home but these have not been consistent and the homes procedures do not fully promote the health, safety and welfare of people who use the service. Evidence: The manager has completed the Registered Managers Award and the NVQ 4 in care and has relevant experience of working with people with mental health needs. She has been proactive in trying to meet the requirements from the previous inspection and has visited other homes in the company to gather information and ideas on how to make service improvement. At the last inspection we made a recommendation that the manager should have some hours specifically set aside for dealing with management tasks such as monitoring systems in the home, evidence from discussions with the manager and the staff rota show that there has been very little improvement here and she has to fit in the management and administrative tasks around her work on the floor, supporting the care staff. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: People who use the service and the staff spoke very highly of the manager and said she is always available and very approachable. Regular service user and staff meetings are held at the home. These are used to identify if the services being provided are appropriate to the needs of people living in the home and allow individuals to air their views and to identify possible areas for development. When we visited last time, we noted that the quality assurance system had not been maintained and a requirement was made in respect of this. There has been very little improvements made towards fully implementing the system. Surveys have again been issued to all people who use the service, relatives and some health and social care professionals however the results of the surveys have not been analysed and action plans have not been drawn up to address any shortfalls raised. The manager has obtained some templates to assist her with these processes and plans to introduce them soon. There was no evidence of regular audits taking place other than the financial audits carried out by the company accountant. Auditing areas such as incidents, accidents, complaints, training and activities would support improved management of those areas and any shortfalls are consistently identified and addressed. There is evidence that senior management have visited the home regularly and complete reports to support regulation 26. The self- assessment form completed by the home indicated that the required maintenance and servicing of some systems/ equipment were not up to date; during the visit we requested to see these certificates. A current certificate was in place to support the testing of portable electric equipment and current certificates for the gas systems and heating systems were provided after the inspection visit. Improvements were seen in the management of fire safety checks and provision of staff drills. Records showed that all equipment was checked regularly and a current fire risk assessment was in place. However staff training records evidenced that only six staff members had accessed fire training in 2009. All staff must have mandatory fire training/ updates annually. Improvements are needed with the reporting of incidents and accidents. Staff complete incident reports following all observed and reported incidents, however the quality of the recording is inconsistent and often does not detail if any injury has been sustained or any action taken in respect of the incident. Few accident reports are completed and given the number of assaults on people using the service in recent times, this must be addressed. Management need to ensure that staff fully understand their responsibilities towards reporting incidents and accidents and the level of detailed information to be provided on the reports. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: Overall the home has not been a safe place for some individuals in recent times, due to the complexity of peoples needs and the inconsistent management and recording systems. Staffing numbers were addressed on the day of the visit, however staff need further training and support in managing difficult situations. Recording of incidents and accidents and reporting to appropriate agencies must be more consistent. Recording of the support people require to meet their mobility needs safely must be addressed and some staff require further training in this area. Some staff also need training updates in fire safety. Care Homes for Adults (18-65 years) Page 30 of 36 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 31 of 36 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 13 People with identified mobility needs must have care plans which describe the staff support and equipment needed to meet their needs. To ensure peoples wellbeing and safety. 15/03/2010 2 9 13 Risk assessments to support 15/03/2010 peoples mobility needs must be put in place. To ensure peoples wellbeing and safety. 3 23 13 Incidents whereby people have been harmed or harmed others with their behaviour must be reported to the appropriate agencies including the safeguarding team. This will protect people from harm. 01/03/2010 Care Homes for Adults (18-65 years) Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 32 13 Staff must access and be updated in training to support people who demonstrate challenging behaviour. This will support the safety of the people who live and work in the home. 15/04/2010 5 33 18 Systems must be put in 15/03/2010 place to ensure staffing levels are reviewed in line with the changes in dependency levels within the service and sufficient numbers of staff are rostered to meet peoples needs. This will ensure peoples health, wellbeing and safety needs are met. 6 35 13 Staff must access and be updated in training to support moving and handling . This will support the safety of the people who live and work in the service. 15/04/2010 7 42 23 The management must 30/03/2010 consult with the local fire authority to ensure that they have made arrangements for persons working in the care home to receive Care Homes for Adults (18-65 years) Page 33 of 36 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 suitable training in fire prevention. This will protect the safety of the people who live and work at the home. 8 42 17 Ensure all accidents and injuries are recorded and reported appropriately. This will protect the safety of the people who use the service. 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 30/03/2010 1 6 Care staff should receive training and support with regard to the use of informal language in care records to ensure appropriate standards are maintained. Care plans and risk assessments should be signed by the individual or their representative to demonstrate agreement. Staff should be provided with training and support to motivate more people to participate in activities which are of interest to them and meet their diverse needs. The record of food provided should be reviewed periodically to ensure that people who use the service are receiving a nutritionally balanced menu. Self medication should be risk managed to ensure people are competent and safe to administer their own medications. The homes complaint procedure should be updated to reflect the change of our organisations name to CQC. 2 6 3 14 4 17 5 20 6 22 Care Homes for Adults (18-65 years) Page 34 of 36 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 7 8 9 22 23 37 More detailed records to support the action taken in respect of a complaint should be maintained. Incidents in the home should be recorded properly with detail of all action taken to reduce further risk of harm. The manager should have some hours that are specifically dedicated to management tasks (and identified on the staff rota) to ensure that systems are kept to date. Incidents of behaviour which pose a challenge to an individual or other persons should be audited regularly to identify any potential triggers which would inform best practice. Quality monitoring systems should be re-introduced to include audits of service provision and auditing and publishing of surveys issued to people who use the service, their representatives and other interested parties. The potential safety hazard of the glass top table in the dining room should be risk managed and appropriate action taken as necessary to protect people. 10 39 11 39 12 42 Care Homes for Adults (18-65 years) Page 35 of 36 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. 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