Inspection on 01/06/09 for 153 St Marks Road

This inspection was carried out on 1st June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 153 St Marks Road 153 St Marks Road Chapel Ash Wolverhampton West Midlands WV3 0QN     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: Deborah Sharman     Date: 0 1 0 6 2 0 0 9 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 38 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 38 Information about the care home Name of care home: Address: 153 St Marks Road 153 St Marks Road Chapel Ash Wolverhampton West Midlands WV3 0QN Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Denise June Cahill Type of registration: Number of places registered: care home 5 Select Lifestyles Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 153 St Marks Road is a modern three story detached building along a quiet residential road close to Wolverhampton City Centre. It is close to local amenities and local transport links for Birmingham, Dudley and Walsall. There are five bedrooms, two of which are on the ground floor, each with ensuite facilities. In additional there is a communal bathroom on the first floor. On the ground floor there is a kitchen, lounge and conservatory. There is a large rear grassed garden. St Marks provides care and accomodation to five young people whose primary needs on admission are learning disabilities. These people have moved from residential schools as part of their transition from children to adult services. 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 38 Brief description of the care home Weekly fees have not been published in the Service User Guide as they should be. Therefore we are unable to quote them in this report. Fee levels should be sought directly from the service. The home is managed by a new company Select Lifestyles Limited. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One Inspector carried out this key inspection. We arrived at 10.00am and left the premises at 7.00pm. No one knew that we were coming so they were not able to prepare for the inspection. As this was a key inspection the plan was to assess all National Minimum Standards defined by us as key. These are the National Standards which significantly affect the experiences of care for people living at the home. This is a new service so we did not send an Annual Quality Assurance Assessment or AQAA to them to complete prior to this inspection. This is a document that asks the service to tell us what they do well, what they need to improve and what they have improved over the last 12 months. The service has not been open for 12 months, so we will send an AQAA for them to complete prior to the next inspection. Care Homes for Adults (18-65 years) Page 6 of 38 We took surveys with us on the day of inspection and distributed them to five staff to complete, four of which were completed and returned to us before we finished the inspection. The results of these have contributed towards our judgement about the quality of the service. We left five surveys for the people who live there to complete to tell us about their experience of living there as they would need time and support to complete them. At the time of writing none have been received back. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. Managers were not available when we arrived but following our arrival we were joined by the director and responsible individual Ms Grice, the acting care manager and the operations manager who was on annual leave but popped in to introduce himself. The director and acting manager were available for the rest of the inspection day to answer questions and support the inspection process. We also spoke to three staff and observed practice particularly with one person living there as other people were at school throughout the day. We assessed the care provided to two people using care documentation and we sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. We toured the premises looking at all communal areas and two bedrooms. All this information helped to determine a judgement about the quality of care the home provides. Care Homes for Adults (18-65 years) Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: There is a casual approach to the management of the service and a number of systems need to be either developed or improved to demonstrate accountability, effective management and compliance with national standards and regulations. This will better ensure that peoples needs and risks to them are identified and known to staff so that these can be met and managed in a structured and accountable way. It is important that the service organises its records so they are available on the premises, again to demonstrate that the service is being managed openly and transparantly in line with their regulatory responsibility. Records were not always available to us which does not support the service to demonstrate the quality of its service. It is particularly important that the service improves how it manages and accounts for physical intervention, medication and the safe recruitment of new staff. The rota must better account for staff working on the premises and staff shift patterns should be reviewed to ensure that there are always sufficient staff on duty at peak times to meet peoples one to one assessed needs. These omissions are significant and must be addressed. We did not find any evidence at this inspection that these omissions in systems have adversely affected the people living there and therefore at this stage have concluded that the service provided is adequate. However, it is important that the service updates us about its progress and any incidents or events affecting the welfare of people so we can continue to monitor the service. Care Homes for Adults (18-65 years) Page 8 of 38 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 38 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 38 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 can decide whether they want to move into the care home because they, and people close to them, can visit the home and talk to the staff. The service could not show us what they had done before admission to assure people they were fully aware of the support they would need. Evidence: It appears that all five people newly admitted to this new service have settled well. In practice it appears that the service has worked closely with all parties to ensure a smooth transition from childrens services. People were able to visit the service several times before deciding to live there and the service is working with Social Services, the funding agency to review how each of the individuals is settling. Systems to support the admissions processes however are weak. We could see that written information had been received from the funding authority about one person. This described the persons needs to help the service decide if they could meet these needs. The service could not demonstrate it had supplemented this information by Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: carrying out their own assessment. For a second person whose care we looked at, information had not been obtained from the funding authority and there was no evidence available to show that a representative of the service had carried out an assessment of need to help the decision about offering a place in the home. This is not compliant with the regulations and provides an element of risk when someones needs are not assessed and known. Information about the service is available but needs updating in parts to accurately describe our new name and address. There was no evidence that information about the service had been made available to the people living there in accessible formats that they can understand. The range of weekly fees is also not stated in brochures so is not readily available to people who may request copies. Care Homes for Adults (18-65 years) Page 12 of 38 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. 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. However staff do not have adequate information available to them to help them to fully understand and respond to peoples needs and risks providing an element of risk. Evidence: From observing care, looking at records and talking to staff, we can see that people living at St Marks are offerred choices within their day to day lives and are supported with these. Residents meetings have started and minutes show us that the people living there have been asked about activities, menus and whether anything could change to make living there better. Records show us that people have said they are happy and we can see that decisions made in meetings have been acted on. For example people said they would like a paddling pool and we can see that this has been provided and used in the back garden. We also observed the people living there who Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: appeared happy and relaxed. Systems however to support staff to understand and meet peoples care needs and associated risks are poor. Care plans are not adequate and do not show staff how to meet peoples assessed needs. Risk assessments are not in place to help to identify and control all known risks to individuals e.g fire risk. When there has been a significant change in risk, the care plan and risk assessment have not been reviewed and updated. For example behaviour guidance and guidance about the use of physical intervention has not been reviewed and provided following a serious incident between someone and a staff member. This serves to place staff and the people living there potentially at risk. There is evidence too, that guidance that is in place has not been implemented. On one occasion that we could see, rather than employing a low arousal approach to the management of behaviour in accordance with the care plan, a staff member took an opposite approach and behaviours escalated into an incident. We talked to this staff member who understood the need to diffuse behaviours and could demonstrate a partial if not a full understanding of peoples assessed needs and personal hazards. People are generally cared for adequately and there is some evidence of good practice and good experiences for the people living there. However, based on the evidence, there have been some unfortunate incidents, which with better guidance could have been avoided. It is important that steps are taken to improve systems to ensure any potential risks are identified and minimised.. Care Homes for Adults (18-65 years) Page 14 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 a very wide range of suitable in house and community leisure activities. People have healthy, well-presented meals and snacks, at a time and place to suit them and choices are offerred in ways that people understand. Evidence: The house is a very busy place, full of activity and energy generated from a motivated and young staff group who are supporting young people just entering adult hood. During most of the inspection, there was only one young person at home with the others being at school for the day. We observed this person to be supported with a Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: wide range of activity. We saw her hang washing out, clean windows as well as play on the trampoline and with a ball in the garden. We also saw her play dominoes in the house with a staff member. In addition to this she went out several times during the day including visits to the shops and to the park. Perusal of records confirmed what we could see, that activities and stimulation are prioritised. We saw photographs of almost daily trips and visits during the Easter holidays. These included trips to Drayton Manor Park, Telford Park, the Safari Park, a butterfly farm and to Blackpool. Other trips this year have taken place to the Black Country museum, Cadburys World and the RAF museum. In addition to this we could see that people are routinely engaged in domestic tasks to develop their skill levels and are also supported to go to church when they want to go. We could see the young people are also engaged in baking and arts and crafts. Systems to help people choose and shop for their meals are in place and one young person told us he finds this helpful. We could see, for the people whose care we looked at that their meals are varied and in line with dietary advice. We could see for example that one person whose aim is to increase his in take of fruit and vegetables eats a wide range of breakfasts which include different varieties of cereal, egg at times supplemented with fresh fruits. Staff are to be commended for the impressive start they have made to engaging people in meaningful lifestyles. Care Homes for Adults (18-65 years) Page 16 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to keep clean and tidy. Systems to support health needs are poor but people are young, mobile and healthy and their health needs have not changed in the time they have lived at St Marks. Medication management is poor and action is required to ensure improved safety and accountability so the home can demonstrate people receive their medication as prescribed. Evidence: People present as well groomed and records we saw confirm that people are able to maintain their personal hygiene with support where necessary. We saw staff interacting with people positively and respectfully. Managers have sent out surveys to staff and to date one completed one has been completed. The questions in this are detailed and indicate to staff the standards of care expected. The completed one we saw showed a high level of satisfaction with the service provided but had prompted the staff member to think about practice and some shortfalls in care practice had been identified by the staff member. Managers intend to use the results of these as a bench mark to encourage improvement. Health assessments have been carried out in respect of the people whose care we Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: looked at. Care plans to ensure these needs are met have not been put into place. We talked to a staff member who was not aware of peoples main health needs. However health was screened prior to admission and there have not been any significant changes in peoples health. The manager needs to establish the dates that these prior appointments took place so that further appointments can take place at the appropriate frequency. Documents are ready to ensure appointments are recorded well but we found a couple of appointments had not been recorded. It is important that all contacts with health professionals are recorded and in sufficient detail to show the outcome. At the next inspection once people have been resident for 12 months, we will be looking to see that people have been supported to attend all specialist and routine screening appointments such as dentist and optician and that the outcomes of such appointments are recorded and followed up where appropriate. Only two people take prescribed medications regularly. We identified a number of weaknesses in the medication management. Gaps in the medication records for one person do not assure that this person has received her medication as prescribed. Controlled drugs are not being adequately managed. Although they are not readily accessible, they are not stored to comply with legislation to prevent their fraudulent use. We did not find anything to show that staff had not administered this medication to the person. But records are not robust and indicate a lack of understanding amongst the staff team about their responsibilities in respect of these schedule 2 drugs. The controlled drugs register indicated that a quantity of the drugs had been destroyed. When we looked into this further we were told that they had been returned to the pharmacy but paperwork required to evidence this was not available. Further enquiries the next day showed that contrary to the records, these drugs had not been destroyed but were still on the premises but had been removed from the medication cabinet. Staff have not received sufficient medication training, although we are told this is booked for August. In the absence of sufficient training it is important that the service assesses the competency of staff members to administer medication. The service is aware of the need to do this and has a format to carry the task out. Staff competency assessments have not however been completed and this must be prioritised. At the time of writing our enquiries are continuing and we are working with the service to ensure that matters identified relating to controlled drugs are handled correctly. Care Homes for Adults (18-65 years) Page 18 of 38 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. People have not made complaints but information is available to tell them how to do so should they feel they need to. The service has demonstrated that it can respond quickly to protect people but systems in relation to behaviour management and physical intervention have been weak and need to improve to ensure the future safety of people living and working at St Marks. Evidence: The service has not received any complaints and none have been made to us. Pictorial complaints procedures were available in the home by the front entrance and staff we spoke to knew what to do in the event of receiving a complaint. Staff have received training about abuse and protection from their manager and half have also received training from an external training company. Training records however need to improve to better evidence this and to help the service better plan and monitor future training needs. Staff we spoke to understood what abuse is but need to know what to do in the event of becoming aware of possible abuse as currently the knowledge they have is inaccurate. Having said that the staff team on duty acted quickly and appropriately to signs of possible abuse and a matter is being handled by Social Services and the Police. The Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: allegation was not against the service and staff are to be commended for their proactive response in reporting and protecting the person concerned. Systems are in place to protect and account for peoples money and expenditure. Transactions are signed for by two staff, records are detailed and receipts are available. It is positive that the organisation is making money available to people for personal spending as they are not able to access their money at the moment whilst applications for appointeeship are being processed. People are not being disadvantaged because of this and have been able to attend all trips and events that have required payment. The biggest area of our concern is with respect to behaviour management and physical intervention. Systems to support this are not adequate. Care plans are not in place to authorise the use of physical intervention. A physical intervention took place in February following an attack on a staff member by someone living at the home. The service is satisfied that the use of physical intervention was warranted on this occasion in the persons best interest but documentation to account for it is insufficient. Consequently, we cannot see that the intervention was for a minimum period of time, and potentially lasted for up to an hour. This is unsafe. This had not been identified as a concern or investigated by managers and care plans and risk assessments had not been reviewed as a result of this traumatic event. An emergency review was called following the incident but minutes do not show us that this matter was discussed and formalised strategies are still not in place. We had been informed of the incident but we had not been informed that the incident had culminated in a physical intervention. This does not help us to keep the quality of service provision under review or to respond to any concerns. Records describe another incident which led to an attack on a different staff member. This did not result in physical intervention but we can see how the approach of the staff member may have inflamed rather than diffused the situation. Managers told us this has been dealt with and although we couldnt see evidence of this in supervision records as described to us, discussion with staff involved assured us that they are now better aware of how to manage the behaviours of the person more appropriately. Positively, we are told there have not been any further physical interventions and the decision has been taken not to use this approach with the person. It is vital that care planning and risk assessments now reflect this decision so staff know how to intervene. Additionally whilst there is a physical intervention policy on the premises, this does not fully comply with national guidance available and documents from the Department of Health and the British Institute of Learning Disabilities should be made Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: available on the premises to staff and managers to ensure they have the knowledge to ensure their actions comply with best practice. Care Homes for Adults (18-65 years) Page 21 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises provide a well maintained, clean, homely and stimulating environment for people to live in that is generally safe. We identified some matters that require attention in order to provide people with assurance that all risks have been minimised. Evidence: The premises provide light, bright and modern living accommodation which are fresh, clean and odour free throughout. Accommodation is domestic in style in an ordinary residential street. Although the garden needs developing and maintaining, it was positive to see so much equipment in the garden for the young people to use and enjoy such as a trampoline, swing ball, paddling pool, garden furniture and a pet rabbit called Asbo. We were told that the intention is to develop raised beds and to get a gardener to cut the grass. We toured the premises and could see that the premises meet peoples needs and that peoples bedrooms have been personalised. There were no evident hazards with all hazardous products being locked away. However, we pointed out a window restrictor in someones bedroom had been unlatched leaving the window wide open and people at risk of falls. Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: We did find that not all areas suggested for action at the point of registration have been acted on. For example showers in ensuites do not have screening and people cannot access temperature valves to change their bedroom temperatures to meet their personal preferences. Liquid soap dispensers and paper towels have not been provided in the laundry and kitchen areas, so there was an absence of soap and equipment to encourage appropriate hand hygiene in these high risk areas. A hand rail has not been fitted to the bath as suggested. Since registration however, a rear garden gate has been provided as have first aid boxes. Furthermore a lock has been fitted to the laundry door. We have asked that this be urgently reviewed with the Fire Service as it has been fitted in such a way that it can only be locked and unlocked from the inside of the laundry, meaning in the event of fire, people would be unable to use the fire exit in the laundry to leave the premises. In addition to the need to improve access to hand washing products, we have asked the service to review infection control risk resulting from the need to transport soiled laundry through the lounge. Red dissolvable laundry bags are not being used to minimise the handling of soiled articles. These issues remain outstanding from the point of registration. Care Homes for Adults (18-65 years) Page 23 of 38 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. People are supported by a motivated and caring staff team who are beginning to receive the training and supervision they need. Systems to support the effective staffing of the home must improve to clearly demonstrate that people have safe and appropriate support from sufficient numbers of staff who have been trained and checked to ensure their suitability. Evidence: A programme of training has started and the staff have told us they feel equipped and supported to carry out their roles. We could see that the staff group is young, enthusiastic and energetic. Interaction between them and the people living there was very positive and there is a lovely atmosphere within the home, busy and vibrant with lots of laughter and fun. Systems however are poor and do not sufficiently support the staffing function in an accountable way. The approach is casual and it is important that this is improved to ensure that as the service develops adequate systems are in place to meet both regulatory duty and the efficient running of the home. Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: Training records are not up to date and do not help the service to evidence training or the service to monitor training provided and needed. Staff are however receiving training. Full medication training and competency assessments however are a priority for action. Formal staff supervisions have begun but records are held in a number of places and could not easily be produced to evidence sufficient supervision of staff. Rotas do not accurately account for staff on the premises and only 4 months of rotas could be produced. The registered manager is on the rota when she no longer works at the service. One person was identified by an initial only and it took a while to establish who this person is. Bank or casual staff are not on the rota and new staff on the premises have not been included on the rota if they were not involved in personal care. They should be on the rota but the role of each person should be clear to demonstrate there are sufficient care staff to meet the care and supervision needs of people. One day shortly after the first resident moved in it appeared from perusal of the rota that all staff had the day off and we are at the time of writing pursuing with the service, alternative ways of showing us that staffing arrangements on this day were sufficient. At the point of registration we understood that staff would be provided on a one to one basis. Three and four staff are being provided at peak times for five residents. We were told that only four of the five people need one to one support. However they are not receiving this if they are sharing their staffing with a fifth person. The other issue we recognised is that although staff are available, shift patterns are not being organised to the best effect for the benefit of the people living there, with for example 3 staff being on duty thoughout the day when all but one person is at school. This reduces staffing available at peak times such as rising times, evenings and weekends. This should be reviewed to ensure staffing is provided efficiently and to ensure people are supervised and supported sufficiently at the times this is needed. Recruitment is poor with managers not having a full understanding of their responsibility. Staff have commenced and have worked on the premises prior to receipt of Criminal Bureau checks and without a POVA first having been sought to check applicants suitability. In one case we looked at, in addition to these omissions, one person had commenced with only one reference. We are assured these new starters were not involved in the provision of personal care and were not unsupervised. However suitable systems were not used to account for this. They were not added to the rota where the person responsible for supervising them could be Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: identified. If the service can account for its need to appoint people prior to receipt of a Criminal Record Bureau check, they must not be on the premises without a POVA first check and all other checks and references being obtained. We requested recruitment information for one further staff member and this was not made available to us as nothing was on the premises in respect of him. He had confirmed to us that checks had been received albeit belatedly. We were unable to verify this and therefore the service cannot demonstrate effective and safe recruitment practices. All records must be available for inspection. In spite of these serious omissions in meeting regulatory duty, we have not identified anything arising from them which has resulted in poor outcomes for the people living there. People are happy and settled, hence our judging this outcome group as adequate. However, we will expect our requirements for improvement to be met to ensure any potential risks are minimised. Care Homes for Adults (18-65 years) Page 26 of 38 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 have been supported to lead meaningful, busy lives and to settle and feel comfortable in their new home. This has been at the expense of the development of management systems to ensure that regulatory duties are met and that the home can account for its decisions and practices. To date this has not affected peoples overall experiences so we currently judge the home to be providing an adequate service overall. However, there is the potential for future error if remedial action is not taken. Evidence: When we arrived at inspection we found that the registered manager is not working in this role. Although contingency arrangements have been put in place, we had not been informed of these changes in the management of the home and on arrival there appeared to be some confusion amongst staff as to who was in charge. An application for registered manager must be submitted to us as soon as possible. The new acting manager has attended training about new deprivation of liberty legislation and is enquiring about training for the staff group. One person has an allocated Independent Mental Capacity Advocate to represent her or his interests. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: This is a new care home. Five people have moved in since the service was registered and have been supported to settle and are being provided with a good quality of life. However, although some management systems are in place there is a casual approach to this, which undermines the overall quality of the home as often evidence was not available through often poor record keeping and underdeveloped systems for the accountable management of risk. This delayed and extended the time the inspection took to complete. Improvement is required in respect of pre admission assessments, care planning, risk assessments, health documentation, the management of medication, physical intervention and infection control. Some aspects of the environment need remedial action and review. Improvement can be better managed with the implementation of a quality assurance system. Staff have been surveyed by the organisation and it is intended to use the results when received to plan improvements. However a more formal quality assurance programme is not in place to support managers and is not planned until the end of the first year. Administration within the home must improve to ensure that all documents requested are available for inspection in future and not at head office. This will also better enable managers on the premises to monitor and manage the performance of the service as sufficient information will be available to them. Documentation relating to pre admission decisions, rotas, recruitment, training, supervision, team meetings and regulation 26 visits must be accurate, up to date and available on the premises. Care planning, risk assessment, medication, physical intervention and infection control management as well as staffing levels, rota management and recruitment practices must improve. We have advised managers of the home to ensure that all requirements and recommendations made as a result of this inspection are met by the target date and can be fully evidenced by the time we next inspect. Care Homes for Adults (18-65 years) Page 28 of 38 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 29 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Steps must be taken to ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This will ensure that risks are identified, are known to staff so action can be taken to minimise such risks to ensure the safety and welfare of each person living at St Marks. 31/07/2009 2 20 13 The competency of staff to administer medication must be fully assessed prior to receipt of medication training and must thereafter be regularly assessed. This will assure that staff are competent to administer medication safely and continue to be safe to administer medication safely to promote the health and 31/07/2009 Care Homes for Adults (18-65 years) Page 30 of 38 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 well being of residents whilst minimising any associated risks. 3 20 13 All Controlled Drugs held within the home are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs Safe Custody Regulations 1973 and the guidelines from the Royal Pharmaceutical Society of Great Britain. 31/08/2009 This will ensure that controlled drugs are held securely minimising the use of fraudulent or unsafe usage. 4 20 13 Staff who handle prescribed medicines must be trained and competent and their practice must follow current written policies and procedures to ensure that individuals receive their medicines safely and correctly This is to ensure that people receive their medication safely as prescribed and that risks posed by medication are minimised. 5 20 13 The records of the receipt, administration and disposal 31/07/2009 31/07/2009 Care Homes for Adults (18-65 years) Page 31 of 38 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 of all medicines, including Controlled Drugs, for people who use the service must be robust and accurate to demonstrate that all medication is accountable and is being administered as prescribed. This will help to demonstrate that demonstrate that all medication is accountable and is being administered as prescribed to support peoples health and welfare. 6 23 13 Systems in place for the management of behaviours must be reviewed and improved. This must include consideration of physical intervention to ensure that all associated practice complies with nationally agreed good practice. This will include but will not be limited to, obtaining copies of DOH and BILD guidelines, reviewing care plans and risk assessments and keeping them under review following any incident, obtaining multi agency agreement about the need to employ physical 31/08/2009 Care Homes for Adults (18-65 years) Page 32 of 38 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 intervention, keeping records which adequately account for all physical interventions including how the person was restrained and time limits of the restraint employed. CQC must also always be informed of any physical intervention employed. This will promote the safety of people living and working at the home and will ensure that practice is fully accountable and transparant and that peoples liberties are safeguarded and kept under review. 7 24 23 The registered person must 30/06/2009 without delay review the safety of the lock on the internal laundry door with the West Midlands Fire Service and in the meantime must carry out a risk assessment in respect of this lock. This is to ensure that peoples safe exit from the building in the event of a fire is not compromised and that people are neither compromised by hazards Care Homes for Adults (18-65 years) Page 33 of 38 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 associated with access to the laundry. 8 24 13 The registered person should ensure that windows are risk assessed based on the vulnerabilies of individual people and that the suitability of window restrictors are reviewed as part of this process. This will ensure that risks of entry and exit are identified and minimised in accordance with peoples needs. 9 34 19 The registered person must 30/06/2009 put in place arrangements at the home to ensure that persons are not employed to work at the home until such time as all the relevant information and documents as required by Regulation 19 (1)(b) and paragraphs 1 to 9 inclusive of Schedule 2 of the Care Homes Regulations 2001 have been obtained. This will ensure that people are protected from people being recruited to work at the care home who may be unsuitable to work with vulnerable people. 30/06/2009 Care Homes for Adults (18-65 years) Page 34 of 38 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 10 41 17 All records required by 31/07/2009 regulation must be available in the care home, must be kept up to date and must be available for inspection. This will enable the service to monitor and manage its performance and also demonstrate compliance with the Care Home Regulations. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service User Guide and Statement of Purpose should be updated to accurately reflect our new name and contact details in case people want to contact the regulator for the service. The Service User Guide should include the range of fees charged per week including the minimum and maximum rate. Steps should be taken to issue people living at the home with a Service User Guide in a format that is meaningful and understandable for them. 2 2 The service should always obtain a copy of the funding authorities assessment before admission, where this is not in an emergency. In addition the service should always carry out its own pre admission assessment for each individual so it can inform and account for the decision to offer a place and inform the plan of care. These records should be retained on the premises and Care Homes for Adults (18-65 years) Page 35 of 38 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 should be available for inspection. 3 6 Care plans should describe in sufficient detail how all current and changing needs in respect of health and welfare are to be met for each individual. Practice should comply with all elements of National Minimum Standard 6. Outstanding matters identified at the point of registration should be addressed. These include the provision of shower screening, safe access to thermostatic control valves in bedrooms so people can adjust temperatures to suit their personal preference. Also the fitting of a hand rail to the bath. Infection control practice should be reviewed to minimise the risk of cross contamination to people living and working at the home. Staff shift patterns and organisation of the rota should be reviewed to ensure that staffing levels provided reflect peak times such as rising times, late afternoons, evenings and weekends. A written training programme should be in place that accurately records all training undertaken and required by each staff member. This should be kept up to date to evidence training and to support the service to monitor and plan its training programme. Each staff member should receive a minimum of 6 formal and recorded supervisions in any 12 month period. An application for registered manager should be submitted to CQC without unnecessary delay. A quality assurance system should be developed to support the monitoring and management of the service. The rota should be reviewed to ensure it accurately reflects the people working in the care home. This should include their full name and designation. It should also show new staff on duty and who is responsible for supervising them throughout the course of their shift. It should easily demonstrate staff responsible for providing care and supervision to demonstrate that people are Care Homes for Adults (18-65 years) Page 36 of 38 4 24 5 30 6 33 7 35 8 9 10 11 36 37 39 41 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 sufficiently supervised and should account for any changes to staffing levels ie when residents are not on the premises due to schooling, day care or social leave. Care Homes for Adults (18-65 years) Page 37 of 38 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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