Inspection on 26/03/09 for Park House

This is the latest available inspection report for this service, carried out on 26th March 2009.

CSCI found this care home to be providing an Good 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.

Other inspections for this house

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Park House 28 Sherford Street Bromyard Herefordshire HR7 4DL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Littler     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Park House 28 Sherford Street Bromyard Herefordshire HR7 4DL 01885483935 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Winslow Court Limited Name of registered manager (if applicable) Mr Richard Andrew Evans Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide the following category of care only: Care Home only To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 7 Date of last inspection Brief description of the care home The Home is part of a group of four local services for adults run by Winslow Court Limited. The company is part of the Senad Group who also own residential schools. The service became operational in October 2007. Park House is within walking distance from the local facilities in Bromyard. There are seven bedrooms with en-suite facilities, two of these have a living area with kitchenette attached and are being used as semiindependent flats. The service is for people with a learning disability some of whom have complex support needs due to their behaviours. The Service Users Guide does not contain information about the fees. Care Homes for Adults (18-65 years) Page 4 of 31 care home 7 Over 65 0 7 Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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: We, the Commission, carried out this Key inspection over one day. The service was last inspected in February 2008 when it was rated as 1 star. This means the people who use this service experience adequate quality outcomes. The manager, Mr Muldowney, was on duty and helped with the inspection. We spoke with three staff and looked around the house. Two people showed us their bedrooms. We looked at records such as care plans and medication. Care Homes for Adults (18-65 years) Page 6 of 31 Mr Muldowney sent information about the service to us before the visit. This is called an Annual Quality Assurance Assessment AQAA. Three people who live in the Home returned surveys to give us their views. This showed that they enjoyed living at the home and liked the staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People interested in the service will have their needs assessed and be given the chance to visit the service before moving in. The information provided about the home does not contain details about the fees. Evidence: There is a Statement of Purpose and Service Users Guide giving information about the service. Regulation 5 requires that the fees for the service are included in the Guide. The copy seen did not contain this information or details of the things people would have to pay for themselves. Since the last inspection the final place in the home has been filled. Mr Muldowney told us that, on the advice of the family, the man who moved in only visited once and did not stay overnight. A short transition like this would not have given others in the home time to form an opinion about whether they wanted to live with him. Fortunately the placement has been a success. A review meeting was held soon after the placement started and another was booked for the end of March 2009. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The assessment of the mans needs had been completed by another manager from the organisation, as the person was initially going to move into another home. The assessment had not been passed across to Park House. A copy was requested but was not received. The mans care file contained detailed information from his previous placements and the health professionals involved in his care. An initial care plan had been written before he moved in. This would have been very helpful to guide staff about his needs as they got to know him. It did not show how some historic health needs would be met by Park House. Mr Muldowney was however able to explain the local health arrangements for support should the need arise. Records showed that triggers for these health needs are being monitored. A good communication profile was in place to guide staff about the best use of speech, sign and body language. There was no intervention plan in place. One does appear to be needed as there have been two incidents when the person has become upset and needed staff intervention to become calm. An agreement had been made for one person to have a placement but to not use the central professional resources available at Winslow Court, such as speech therapy and psychology. The funding authority said they would provide this directly. Although clear needs have been identified in the last year this input has not been forthcoming. The home is providing it without any funding as they feel it is essential. The family confirmed this and said they are very pleased that the home is doing this. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of peoples care needs are reflected in their care plan. These are being monitored and kept under review. People are being supported to make personal decisions and take reasonable risks. Systems are in place to support people with complex behaviours, however, consultation about strategies can be improved. Evidence: Each person has a care plan and two of these were seen. The AQAA reported that care plans are read out to people who cannot read and can also be provided on a tape. The plan for the new person has been reported on under the Choice of Home section above. The plan for the other person covered a wide range of areas such as their likes and dislikes, personal care needs and family contact arrangements. There was a detailed intervention plan. This contained guidance on how staff should respond to the persons regular behaviours and emotions in a consistent manner. The plan also included risk assessments on areas such as fire evacuation and epilepsy. The persons hopes and dreams had been recorded after consultation with his family. For the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: coming year these were to use his tricycle and have a holiday. The plan contained some specific targets that are being worked towards. For example, pouring breakfast cereal out and putting dishes into the dishwasher. Staff confirmed that people are encouraged to develop, such as learning road and public transport skills. One person is now attending a day placement without staff support. The staff write daily reports to note each persons activities, meals, contact with family and health issues etc. The information gave a helpful overview of their wellbeing. Keyworkers are using this information to collate monthly summaries and these then inform the review meetings that are being held every six months. The psychologist supports staff in developing behaviour intervention strategies. Staff record behaviours and any actual incidents. Physical intervention is used with some people but this is reducing and is usually just enough to help the person move from the situation to go and calm down elsewhere. A new strategy was tried with one person without the agreement of others representatives. It was not affected, but for used again soon after. This resulted had a negative outcome for the resident and a complaint being made. Mr Muldowney told us that lessons had been learnt from these events. The standard of the care planning and monitoring records in the last year and an effective system is now in place. He needs to ensure that a plan is in place for all assessed areas of need. A new more accessible care plan format is being introduced. These have not yet been completed but the use of pictures and clear language will help people understand what their plan says. Mr Muldowney needs to make sure that information about all peoples assessed needs is transferred into the new format if these documents are to replace the existing versions. The AQAA reported that the plans for 2009 include staff training on person centred planning, and to continue work to enable people to show evidence of their developments at their care review meetings. The use of Makaton sign language and picture symbols needs to be increased to aid better communication and empowerment. Feedback indicated that people are supported to make decisions about their lives, such as what they do each day and who they spend time with. One person finds mealtimes stressful so she is given the choice to eat her meals in her bedroom. People are involved in food shopping so they can make choices about what food is purchased. Peoples ability to make decisions should be assessed in line with the Mental Capacity Act and a care plan developed to show how they will be supported to make decisions or how these will be made in their best interest. Care Homes for Adults (18-65 years) Page 14 of 31 Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People like living in the Home. They are taking part in activities they enjoy and are being supported to develop and be independent. People are being well supported to maintain personal relationships with friends and family. They enjoy their meals and their food preferences are taken into account. Evidence: The Home had a relaxed and friendly atmosphere and people obviously feel free to move around their home and use the communal areas as they wish. People reported in surveys that they liked living in the Home and choose how to spend their time. One person said, I enjoy it here. They use their bedrooms or flats when they want their own space. These have been equipped with personal possessions such as play stations, music or DVD collections and other hobby items. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: In the last year ASDAN awards have been introduced (Award Scheme Development and Accreditation Network). A coordinator has been appointed who is based at Winslow Court. She is supporting people to work towards these recognised national awards. Modules include everyday living, cookery, independent living, horticulture, pottery and being out in the community. Relatives gave mainly positive feedback in the homes annual surveys. One family felt that more activities needed to be provided to prevent their daughter becoming bored as she cannot occupy herself constructively. Mr Muldowney acknowledged that there had been shortfalls while there were staffing shortages. He confirmed that every person now has a full programme of activities they enjoy. One person now attends church more frequently since his father made a request about this. Records seen and staff discussions confirmed that people are taking part in activities they enjoy and that help them feel valued. Example include, working in a shop, trampolining, shopping, going out for meals or to the pub. All but one person went on holiday last year and everyone has a break booked for this year. People have chosen who they want to go away with. Staff reported that the group is quite compatible and that some strong friendships have formed. For example, two people go into town together regularly without staff, one person was bridesmaid at another residents family wedding and she goes out with him when his family visits. People are now getting known in the local shops and cafes. They are being supported to stay in touch with their families and transport is provided to assist if needed. One person was on holiday with their family at the time of the inspection. Meals are eaten in a relaxed manner and people were seen in the kitchen chatting to staff while food was being prepared. Peoples drink preferences are displayed by the kettle to remind staff. The menu is planned ahead but staff said they also offer a choice each day. A healthy diet is promoted as most people need help to prevent unwanted weight gain. Staff said people go food shopping so they can be involved in choosing what is purchased. Fresh fruit is accessible in the kitchen. The menu should state if meals are homemade rather than processed as this would better demonstrate the quality of the meals service. Staff told us there are no special diets but food had been softened for one person when he was discharged from hospital. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are having their personal support and health needs met. There are safe arrangements in place for the management of their medicines. Evidence: The staff were observed to interact with people in a positive and appropriately respectful manner and they knocked on their bedroom doors before entering. Records showed people were being supported to meet their personal care needs on a daily basis. The en-suite facilities help provide privacy. Information about the support people need with their personal care is included in their care plans. Staff have worked hard to support one person with his continence needs. Following a period of ill health and medication changes this support has been successful. This development will significantly increase the persons independence and dignity. Each person now has a Health Action Plan. Two of these were seen. The one for the newest person showed he has had his eyes tested and been to the dentists since moving in. One said the person needs a low fat and high fibre diet and regular exercise. He has now lost weight and he and his family are reported to be very Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: pleased. If advice is needed the team of professionals based at Winslow Court provide support. The team includes two nurses, a speech therapist and a psychologist, both of whom have assistants. These professionals contribute to the staff training programme, for example the nurses train staff in epilepsy and diabetes. Training has been provided by a community psychologist about one persons mental health disorder and training is being sought for another condition. All staff attend a first aid course that covers how to respond if someone is choking. One man was very ill in the autumn and he had surgery. Staff worked hard providing support around the clock while he was on the general ward. The company nurses worked in liaison with the district nurses to manage his discharge and convalescence. He has made a good recovery. His care file did not contain evidence of a specific care plan put in place to guide staff following his discharge. Mr Muldowney said the nurses may have this at their office. All care records should remain in the home and be available for inspection. Suitable storage for medication is in place, which was tidy and well organised. The seniors are responsible for keeping the keys safe. The arrangements for storing controlled medicines have been upgraded to comply with The Misuse of Drugs Regulations 1973. A controlled drug register is in use and a count showed the records to be accurate. The general administration records were clear and two staff are involved in the process. The care plans seen contained information about the medication people are prescribed and how they prefer to take it. In one case the information did not say what each medicine was for. One care plan contained a protocol for the use of emergency epilepsy medication and staff have been trained to use this. Sixteen doses were being held for one person who has not needed the medication for several months. Mr Muldowney should consider removing some of the stocks. As needed medication for certain behaviours is not being used regularly. One persons records showed she had been given two doses in March. Details of why this had been necessary were noted on the back of the chart for only one dose. This is good practice and should always be done. The nurses employed by the company carry out staff competency checks and quality assurance audits. Staff are provided with accredited training. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and their views are listened to. Arrangements are in place to help protect people from abuse. Managers have not always followed procedures about complaints and protection appropriately but have learnt from their experiences. Evidence: Company policies and procedures are in place for the management of complaints and any adult protection concerns. Mr Muldowney reported in the AQAA that each person and their representatives had been given a Service Users Guide that includes information about how to make a complaint. No complaints have been received by the Commission since the service opened. People living in the home said in their surveys that staff always listened to them and they know how to make a complaint. The 2008 in house surveys showed that relatives know how to raise concerns. Some said they had not done this but felt confident that they would be taken seriously if they did raise a concern. One persons family made a complaint about two things in December 2008. The lack of activities and how behavioural incidents were responded to. Mr Muldowney told us that activities have been greatly improved and that all staff are now clear about how to respond when incidents occur. He said the family had been reassured about this at a Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: review meeting. This and two internal minor complaints were received while Mr Muldowney was on long term leave. There were no letters in the complaints file to evidence how any had been responded to. It seems that complaints are acted upon but adequate records of these are not being maintained. A resident made a complaint in August 08 that due to its nature was referred by the organisation as a safeguarding alert. A manager from another home was involved initially until Mr Muldowney returned from leave. Both managers were criticised at the safeguarding strategy meeting for the way initial enquiries were conducted. All concerned cooperated fully with the multi agency once this began. The organisation has a good history of being open about safeguarding matters and they act promptly to suspend staff when allegations are received, as they did in this case, to protect people. The owners commissioned an external professional to investigate what went wrong in this case and have carried out all agreed action points to make improvements for the future. Staff spoken with confirmed that they have attended safeguarding training and that there is an open culture in the home and any concerns would be reported promptly. They have been trained how to respond appropriately to peoples behaviours. Intervention plans are in place that are overseen by the psychologist to help prevent self harm and challenging behaviours. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comfortable, clean and well-equipped home in a location that allows them to become part of a community. They have private bedrooms with ensuite facilities and a good range of communal space. Evidence: The location means people can easily access local facilities and transport links. The building was specifically converted for the purpose in 2007. All areas have been nicely decorated and comfortably furnished. There is art on the walls created by people living in the home. The lounge is an odd shape that means one section is not easily used. The dining room is large and airy and has a door to the garden. There is hard standing for parking and a good sized planted garden with two lawn areas. This has been made safer but the lower garden is not yet in use as some plants are poisonous. There is still no safe area for one person to ride his trike. There are plans to provide this and to turn the garage into a workshop area. There is a pay phone under the stairs. This does not provide privacy for calls, but some people also have their own mobiles. The room sizes meet the National Minimum Standards. Locks are fitted to the bedrooms and some people hold their own keys. There are seven bedrooms, two of which have additional kitchen diners next to them forming semi-independent living Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: flats. The bedrooms seen have been nicely personalised and people have their own bedding and towels. The house is due for a repaint. There are plans to enable people to paint their bedrooms in the colour of their choice. Some people have plastic mattresses and plastic pillows even though they are continent. Normal comfortable bedding should be provided unless there is a good reason. If plastic bedding is needed liners should be used to increase their comfort. All bedrooms have ensuite toilet facilities and some also have baths or showers. Communal bathroom and toilet facilities are also on both floors. These could be made more homely as they are currently very plain. On the ground floor there is a kitchen, dining room, lounge and large laundry. Five bedrooms are upstairs and there is also office space, staff sleep in room, and a training room that is used for meetings, one to one sessions and care reviews. This contains the homes computer and a worker said some residents are using this. One person is not permitted to go upstairs due to his epilepsy. This means he cannot access the training room facilities. Consideration should be given to a solution to this so he is not discriminated against because of his condition. All people living in the Home are mobile but some have a physical disability or epilepsy. Adaptations have been made to meet identified needs, such as handrails. One persons bedroom has been improved by a double bed being fitted. This will provide better protection if he has a seizure but staff said he also is very pleased with it. Some people are having their personal items locked away. This is understandable when people have damaged expensive electrical possessions. The practice of locking possessions away should be kept under review and people should wherever possible have a goal and be supported to learn to care for their possessions. The house was clean and tidy. People said in their surveys that the home was always clean and fresh. Cleaning schedules are in place as care staff are responsible for cleaning. People are encouraged to clean their rooms and be involved in doing their own laundry. Appropriate equipment has been provided and systems are in place to reduce the risk of infection. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are being supported by a committed staff team. Staffing shortfalls have caused some difficulties at times over the year. People are being protected by the homes recruitment practices. Effective training arrangements are in place for staff, however more of the team need to become qualified. Evidence: The staffing level is usually four during the waking day. At times there is a fifth worker during office hours to enable more activities to take place. At night a worker sleeps in and a waking night worker is on duty. The company provides management support at all times by phone. There is a good balance between male and female staff, which reflects the mix of people living in the Home. There are currently sixteen staff. Only two have left in the last year. There are two vacancies, one of which is temporary as a worker is on maternity leave. Mr Muldowney said occasionally there is no shiftleader on duty. He agreed to consider completing a risk assessment on these occasions and identifying who is in charge. The service is a complex one and clear lines of accountability for decision making would help to safeguard people. There have been staff shortages during the year and agency staff have been used regularly. Some staff have worked overtime to cover gaps and staff from Winslow Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Court have also helped provide relief cover. As detailed earlier the main staff team is supported by a team of specialised staff based at Winslow Court. Feedback from surveys was positive about the staff team. One person said, The staff are good here, they listen and are good at supporting us. The staff seen were professional and seemed well organised and motivated. Three staff spoken with in more depth were enthusiastic about their role and positive about how the service has developed. They felt there was good team morale. One said the service has been more settled since October 2008 when staffing levels improved. She felt the home was now a very pleasant and positive place to work where residents took part in lots of activities. All staff spoken with said they receive regular supervision and support. The seniors meet with Mr Muldowney and there are shift handovers. Staff meetings are not held often as the three teams work different shift patterns. A meeting had been arranged recently but had been cancelled. It would be positive if these can be arranged to help ensure all staff work consistently and have shared goals for individuals and the service. Training is managed centrally at Winslow Court where a rolling programme of core and basic training is provided. Existing staff who need refreshers are called to attend these sessions as required. New staff attend an induction and then go on core training during a foundation programme over the first three to six months. They then are encouraged to gain NVQ awards. Currently five staff hold an NVQ award and another three are working towards one. If there are no staff changes and all complete the award then the minimum standard of fifty percent qualified staff will be reached. Specialised training is also routinely provided for staff such as Autism Awareness, Safeguarding Adults, Epilepsy, Positive Approaches to Challenging Behaviour and Physical Intervention. Mr Muldowney is trying to arrange training on Attention Deficit Hyperactivity Disorder to enable the team to better meet one persons needs. Annual refreshers are provided appropriately to help ensure good practice is maintained. A shift leader development plan has commenced recently that the seniors are all enrolled on. This is module based over eight months and covering skills such as supervision and team development. The recruitment record was seen for a new worker. Appropriate references had been obtained and the person did not start until a full satisfactory CRB check had been received. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefited from a service that is promoting their independence and development. The homes policies have not always been properly implemented. This needs to be addressed to ensure people are fully protected. Evidence: Mr Muldowney transferred from Winslow Court in December 2007 to take temporary responsibility for the service when the manager, Mr Evans, became unwell. Mr Muldowney has now been appointed permanently to the post and is applying to be registered. He has many years relevant experience and was in the role of Head of Care at Winslow Court. He has responded to feedback about how the service needs to be improved. There is a positive ethos and the team is working well together for the benefit of the people living in the home. Mr Muldowney returned the AQAA on time and this contained the information requested. It gave a good account of the service, what has been improved and what the future plans are. This information reflected what we found during the inspection. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Mr Muldowney took prompt action to address shortfalls highlighted at the last key inspection such as fire safety and medication management. He has set up the companys record keeping and quality assurance systems during the year. Quality assurance audits are carried out such as health and safety. Feedback is received from supervisions, meetings, care reviews and annual surveys. The feedback has not been collated and reported upon. It would be positive if all those with an interest in the service could see they have contributed towards the next years action plan. The AQAA indicated that all policies and procedures have been kept under review. When Mr Muldowney was on long term leave at the end of 2008 some support was provided from other managers in the organisation. During this time two incidents of challenging behaviour occurred that were not appropriately reported to us and three complaints were not responded to in line with the homes procedures. The shift leaders should be trained to ensure they can follow all procedures fully in the managers absence or a post of deputy manager should be considered. As mentioned under Complaints and Protection one safeguarding matter was not managed in line with the local multi agency procedures. A sample of peoples finance records were seen. These were traceable and showed that people are being supported to buy appropriate personal items. Inventories of valuables are being maintained. Currently peoples money is being held in the office. It would be more person centred if people could keep their own tins with whatever support they need. Health and safety hazards have been risk assessed and records seen showed that routine monitoring checks are being carried out, such as daily checks on the fridge temperatures. One persons risk assessment for fire evacuation stated he may not respond to the alarm at night and for staff to close his door and tell the fire brigade. The person is deaf, consideration should be given to fitting a flashing light alarm to his bedroom to help alert him. The evacuation procedure should guide staff to alert him at an early stage. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 1 2 3 Include details about the fees and extra cost in the Service Users Guide. Keep evidence in the home of the assessment process had is carried out for any new person. Arrange a transition for any new person that allows them and current residents to get to know each other and form a view about sharing. Give current residents time to decide if they want to live together. Ensure people are their representatives are appropriately consulted about changes to behaviour intervention strategies and that these decisions are made in peoples best interest. Develop intervention plans for all residents who need support to manage their mental health, emotions and behaviours. Assess peoples ability to make decisions and develop a care plan to demonstrate how the mental capacity act will be implemented for each person. Keep all care records in the home and make them available for inspection. 4 6 5 6 6 7 7 19 Care Homes for Adults (18-65 years) Page 29 of 31 8 9 10 11 12 13 22 23 24 26 32 33 A record should be kept to show what action is taken when a complaint is received. Safeguarding referrals should be managed in line with local best practice procedures. Implement plans for the garden and garage. Make the communal bathrooms more homely. Replace plastic coated mattresses and bedding. If these are needed then provide cotton liners to improve comfort. Continue to promote NVQ awards until the majority of staff are qualified Fill the current staff vacancies and try to ensure staffing levels remain at a level that means peoples activities plans can always be fully met. The manager should designate a person in charge and complete a risk assessment when there is no shift leader on duty to help provide protection for people and accountability. Consider how people could be supported to keep their money in their private rooms. Review the management arrangements and ensure they are robust enough for procedures to be reliably followed in all events. Report to stakeholders following the quality assurance review and be open about the next years action plan. 14 33 15 16 38 38 17 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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