Inspection on 21/01/10 for 1 Church Road

This inspection was carried out on 21st January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

1 Church Road 10/11/09

1 Church Road 02/04/09

1 Church Road 21/11/08

1 Church Road 23/11/06

1 Church Road 15/02/06

1 Church Road 13/10/05

1 Church Road 18/03/05

1 Church Road 24/11/04

1 Church Road 27/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: 1 Church Road 1 Church Road Wembdon Bridgwater Somerset TA6 7RQ zero star poor service 10/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Poole Date: 2 1 0 1 2 0 1 0 Information about the care home Name of care home: Address: 1 Church Road 1 Church Road Wembdon Bridgwater Somerset TA6 7RQ 01278453635 01278456656 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Home First & Foremost Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 13 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 13 The maximum number of service users who can be accommodated is 13. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD Date of last inspection 1 0 1 1 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home 1 Church Road is registered to provide care for up to 13 people who have a learning difficulty and/or additional physical disability. The house is set in its own grounds in a quiet residential area on the outskirts of Bridgwater. All bedrooms are for single occupancy and all have en suite facilities. The registered providers are Milbury Care / Voyage. There is currently no registered manager at the home. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: This inspection was carried out by Jane Poole (Regulatory Inspector) and Lorna Somerville (Pharmacy Inspector.) The reason for the inspection was to follow up on requirements made at the last key inspection and to audit medication documentation and practises. Since the key inspection on November 10th 2009 the Care Quality Commission has met with the provider and managers of the service to discuss their improvement plan for the home. At the last key inspection requirements were made in respect of care planning and meeting health care needs. At the last inspection information about peoples health and social needs was spread over several files making guidance and information disjointed. Everyone living at the home now has one file containing an Individual Support Plan, one containing medical information and another for daily records. Daily records are summarised at the end of each month and entered into the individual support plan. All information about each person is contained within these files and there are no additional current files for people. As part of this inspection the files for three people were viewed. 2 support plans seen had been reviewed and fully up dated. They gave detailed information about the support that people required. The support plan for a person who has complex epilepsy gave clear information about the nature of the epilepsy and the observations required by staff to minimise risks. For example the care plan in respect of personal care now gave a clear instruction that at no time was the person to be left alone in the bath. The information about the persons dietary needs stated I dont have any dietary requirements. However a care plan was in place to show that the person needed a person to sit with them when eating, needed to have their food cut up and ate with a spoon. The medical file for this person showed that their care had been reviewed by a consultant Neurologist in November 2009. The only entry on the GP appointment sheet in the file was in September 09 when staff from the home had met with the GP. There were no other recorded appointments with the persons GP. There was a record from the doctor to show that the person had had a medical check but this was not dated and no visit was recorded in the appointments section of the file. A record of all epileptic seizures is kept with the daily records. These records were not in date order making it difficult to ascertain any pattern. Some entries did not have a time written on and some were not signed. There was no record to show how often this person had been seen by paramedics or taken to hospital. The second up dated support plan gave up to date information about the person. The Care Homes for Adults (18-65 years) Page 4 of 10 dietary needs had been up dated to show that they no longer had a specialist diet. There was a clear support plan in place regarding the use of a restrictive practise. The plan stated when the restrictions should be removed and how this should be recorded by staff. The daily records in respect of the removal of restrictions had been completed up to the 11/01/10 and then not again until the 19/01/10, there was no record for the 20/01/10 but records were in place for the day of the inspection, 21/01/10. Although staff felt that the person was making progress and goals were being achieved, without consistent records the effectiveness of the support plan can not be evaluated or updated in line with changing needs. The weight records for this person had been recorded. Until October 2009 records showed that the person maintained a stable weight. There were two different weights recorded for November 2009 (apparently recorded on two different sets of scales.) One showed that the person had lost 9 pounds the other showed a weight loss of just over a stone. Although the support plan stated that if there was a significant weight loss the manager should be informed and a referral made to an appropriate professional there was no evidence that this had occurred. There was no record in the GP appointments section that the person had been seen or the situation discussed. The 3rd support plan seen had not been reviewed or up dated. This person was a wheelchair user and there was no support plan or risk assessment in place to minimise the risks of pressure damage to skin. Two of the three support plans seen gave comprehensive information about peoples needs and preferred routines but it appears that they are still not being used as working documents for staff, and recording is inconsistent. This makes it difficult to correctly evaluate the effectiveness of the plans in place. Since the last inspection individual activity plans have been created for people. On the day of the inspection some people took part in an arts and crafts session, some went out to hydrotherapy and others to a local garden centre. It was observed that there was a more relaxed atmosphere in the home and greater interaction between people living and working at the home. To improve communication some staff have undertaken training in intensive interaction. Additional signs, symbols and pictures have been obtained to assist people to communicate and make choices. Work has begun to turn one lounge into a sensory room where people can relax. We looked at the way medicines are kept and given to people in the home. We checked the records that are held in the home for medicines given to people, and we spoke to the area manager, the deputy manager and other staff working in the home about the way medicines are looked after. There are no people living in the home at the moment who look after their own medicines. We found that medicines are stored safely and correctly in the home for peoples safety and protection. There are suitable arrangements for any medicines needing cold-storage, and any controlled drugs. We found that records are kept of medicines received into the home and any medicines leaving the home. Clear records are kept of medicines that are given to people. These Care Homes for Adults (18-65 years) Page 5 of 10 records help to show that people in the home receive their medication as their doctor has prescribed for them. We watched some medicines being prepared to be given to people at lunchtime, and we found that they are given safely. Staff have been trained in safe handling of medicines, and policies and procedures are available to them for guidance. There are systems in place to check that staff are competent to give medicines safely. We found that there are clear management plans for people, for medicines that are prescribed to be given when required. These help staff to make sure people receive their medicines in the way their doctor has intended for them. However we found two medicines which are newly prescribed that have not yet had these management plans written. It is recommended to make sure that all these plans are up to date. There is a weekly audit system in place for checking medication but we found this had not been done for the last few weeks. It is recommended to make sure this system is used regularly, as if any problems are found with medicines, they can be sorted out quickly. What the care home does well: 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 2. Care Homes for Adults (18-65 years) Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 (1)[d] Care plans must be drawn up in line with the needs identified in pre admission assessments. All staff must be familiar with individual care plans. To ensure that people receive the appropriate care and support to meet their assessed needs. 30/11/2009 2 6 15 (1) [2] Care plans must be 31/12/2009 kept up to date and give clear guidance for staff. Staff must be familiar with the care plans for each person. To ensure that people receive care in line with their assessed needs and wishes. Also to ensure that the effectiveness of planned intervention can be monitored and evaluated. 3 6 15 The home must ensure that support needs and plans are reviewed This is to ensure that peoples individual and changing needs continue to be met appropriately or to assist the home in identifying when it is no longer able to 27/02/2009 Care Homes for Adults (18-65 years) Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action meet an individuals needs. 4 19 12 (1) The home must ensure that people receive the care they require to meet their healthcare needs. To ensure that people receive the healthcare support that they need and that peoples conditions are monitored and any concerns addressed. 5 35 18 (c) The home must ensure that all staff have the skills and training to meet the needs of people who live at the home. To ensure that people receive appropriate care and social stimulation. 6 37 8 (1) [a][b] A manager must be registered with the Care Quality Commission. To ensure that the home has consistent leadership and is able to improve and develop the service. 7 39 24 Quality Assurance systems must be more robust. To ensure that shortfalls in the service are identified and action can be taken promptly to address issues raised. 31/12/2009 01/03/2010 26/02/2010 20/11/2009 Care Homes for Adults (18-65 years) Page 8 of 10 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, 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 20 It is recommended to make sure that all management plans for when required medicines are up to date. It is also recommended to make sure that the weekly medication auditing system is done regularly. This is so that staff can give medicines to people as the doctor has intended, and any medicine related isues are spotted and sorted out quickly Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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