Inspection on 23/06/09 for 33a Forest Road

This inspection was carried out on 23rd June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

33a Forest Road 22/07/08

33a Forest Road 17/04/07

33a Forest Road 08/08/06

33a Forest Road 30/11/05

33a Forest Road 04/07/05

33a Forest Road 26/02/05

33a Forest Road 20/05/04

33a Forest Road 06/02/03

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 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 33a Forest Road 33a Forest Road Kingswood South Glos BS15 8EW     The quality rating for this care home is:   one star adequate 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: Paula Cordell     Date: 2 4 0 6 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 40 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 40 Information about the care home Name of care home: Address: 33a Forest Road 33a Forest Road Kingswood South Glos BS15 8EW 01179677447 01179677239 forestroad.manager@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Shaw Healthcare (Specialist Services ) Ltd care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 9 33a Forest Road is a purpose built home providing personal care with nursing for 9 adults with a learning disability. The home is owned and operated by Shaw Healthcare (Specialist Services) Ltd, an organisation that specialises in providing accommodation and support that promotes independence.The accommodation is set over two floors and a lift is available. Individual rooms are spacious with en-suite facilities; some rooms have small private garden areas. Communal space includes lounge, relaxation room, kitchen/diner, therapy room and a large Jacuzzi tub. The home provides individual support to people who use the service using a variety of approaches determined by a detailed assessment of individual need. Individuals are encouraged to be involved in the everyday running of the home, and activities in the local community are organised on a regular basis. The home opened on the 6th January 2003. Presently the home is managed by Ms J Boyce who has submitted an application to become the registered manager. The fees for the home are in the region of 2512 pounds per week at the time of publishing this report. Care Homes for Adults (18-65 years) Page 4 of 40 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 40 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: This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in July 2008 and monitor the care provided to the individuals living at 33a Forest Road. There have been no additional visits since the visit in July 2008. Mrs Boyce is the manager and has submitted an application to register with the Care Quality Commission she commenced in post in September 2008. The visit was planned using information that has been received over the last twelve months including regulation 37 notifications that effect the well being of the individuals Care Homes for Adults (18-65 years) Page 6 of 40 living in the home, surveys from people who use the service (3) and staff (9)and correspondence received from the home. The visit was conducted over two days for a total of 10 hours with structured feedback being given to the manager. A tour of the home was conducted which gave an opportunity to speak with staff and the people that live in the home. Records were viewed in respect of the running of a care home, including care records, staff recruitment and training and those required in accordance with health and safety. What the care home does well: What has improved since the last inspection? What they could do better: There are a number of requirements made during this visit. Areas where the home could do better is in the plans of care ensuring they are kept up to date and reflect the changing needs of the individuals. A review should be completed on the documentation to ensure that is appropriate for supporting people with a learning disability and current good practice. Care files would benefit from an index and information that is no longer relevant archived. Some individuals may benefit from more structured activities with a timetable. Individuals must be assured that their medication is administered in accordance with Care Homes for Adults (18-65 years) Page 8 of 40 the Royal Pharmaceutical guidelines and that prescribed medication is sought promptly. Individuals must be assured that their health needs are met. Individuals must be assured that the recruitment process is thorough where staff start on a POVA first that safeguards are put in place. Individuals must be assured that competent staff work in the home in the event of fire with each member of staff attending a fire drill once in a six month period. 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. 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 40 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 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be assured that their care needs are assessed prior to moving to 33a Forest Road and that they have sufficient information available to them. Evidence: The home has a statement of purpose and a Service user guide. This met with the National Minimum Standards and the care home regulations. The statement of purpose has been reviewed and amended to reflect the change in management. The service user guide was in an accessible format. Individuals confirmed in completed surveys that they had information about 33a Forest Road prior to moving there. It is acknowledged that for some individuals there was little choice on whether to move to 33a Forest Road, as this is a specialist service for individuals that challenge. For some of the individuals this is the only option available to them, enabling them to succeed at living in the community. 33a Forest Road is made up of nine individual flatlets where individuals can chose to Care Homes for Adults (18-65 years) Page 11 of 40 Evidence: live separate from the others or when stable can interact with the other people in the home. There are intense staffing packages, which enables individuals to have their own allocated staff member during a shift. For two of the individuals two members of staff support them when in the home. A number of individuals have additional staff to support them when out in the community. Admission to the home is through the care management approach and each admission is usually planned. The home is fully occupied with nine people living in 33a Forest Road. The manager and the operations manager stated that this is the first time the home has been fully occupied since it opened 5 years ago. The statement of purpose described the admission process. It was evident that the home would complete a full assessment of need prior to an admission to the home. There was evidence that the two newly admitted people had visited the home prior to agreeing to move there. The manager said there is a query as to whether someone has a diagnosis of learning disability. Where this person is assessed as not having a Learning disability then an application must be forwarded to the Care Quality Commission for a variation to the certificate of registration. From talking with the manager and staff it is evident that the person has settled in well and the home is meeting the needs of the individual. The manager stated that the person had previously lived in a home for people with a learning disability and was placed by the learning Disability Team. Where the diagnosis changes then the homes care documentation will need amending. Copies of placing authorities assessments and care plans were seen on files for the individuals and it was evident that these inform the homes assessment and care planning processes. Of the nine people living in the home, two people require two staff when out in the community and one person requires three staff due to the behaviors that are exhibited. The manager said that this is kept under review and discussed at care reviews with the placing authorities. Individuals who use the service are offered an opportunity to visit the home and are offered a trial period of three months. This is then formally reviewed with the individual, the placing authority, relatives and other professionals where appropriate to ensure that all parties are happy with the care provision. Comments from relatives at care reviews were generally positive. Contracts were seen for two of the individuals. It was noted that this was not in an accessible format and one of the individuals had signed the document but it was not clear whether the person had capacity. The contract includes the fees and what is and not included. Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: Care Homes for Adults (18-65 years) Page 13 of 40 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. Whilst it is evident that some of the care needs of the individuals are being met. There is some gaps in the care planning processes which clearly could put individuals at risk. Staff are not consistently documenting how plans are being implemented. It is evident that the service strives to provide an individualised package of care, but could be holding on to more traditional forms of care planning which could be hindering practice and not focusing on the needs of the person as a whole. Evidence: Three peoples care was looked at as a means of determining the processes the home goes through to support the individuals living at 33a Forest Road. Comprehensive assessments were available that informed the plan of care. The home uses the model of activities of daily living to document the needs of the individuals. Concerns are raised that some of the documentation lends itself to a medical model rather than that of social care. Whilst it is acknowledged that the home provides Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: nursing care the main aim of the home is to support individuals with social inclusion and community participation. Concerns again are raised that individuals have pressure sore assessments (where it was evident that the person was not at risk of pressure sores), fluid monitoring charts (where it was not evident that the person was at risk of dehydration) and other assessments that were not particularly relevant to the individual. It was expressed by the previous manager that there was an expectation that these were in place as part of the audit measures set by Shaw Health Care and if these are not in place then the home does not score well. The planning model does not lend to a service for people with a learning disability to allow for individuals aspirations to be met and addressed. Two of the care plans seen were that of people who had recently moved to the home. It was noted that there were gaps in the documentation and a number of areas had not been recorded including the person centred plan, the community map and a health care map. There was no information in either of the care files about how the person likes to spend their time or a structured activity plan. Monthly key worker monitoring records were incomplete and not consistently being completed on a monthly basis. One person has not had their care plan reviewed formally since August 2008. The National Minimum Standards recommends that care plans are reviewed at least once in a six month period or more frequent where needs change. One person had been assessed by the GP as having weight management issues, there was no evidence of a care plan on how to assist with this. In addition there was some exercises the individual should be completing again there was no evidence that this person was being supported with this. Each person had two large lever arch folders containing care information. One held care planning information, assessments and correspondence and the other was the day to day recording. The information was again difficult to navigate there was no index in two of the files viewed and some of the information was no longer relevant. Records were quite often incomplete in respect of menu planning and fluid charts. The staff have a lot of paperwork to complete on a daily basis and it may be beneficial to simplify this. Behaviour was described in daily records and cross referenced to the behaviour monitoring records. Information included the triggers for the behaviour and how staff should support the person. There was still evidence the home uses the term off baseline to describe when a person is not happy. The manager and the operations manager said that this has been discussed with staff and they have been told to describe the behaviour that has been shown and they are continually monitoring this. Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: All staff spoken with during the visit conveyed a good understanding of the care needs of the individuals and commitment to providing an individualised package of care. It was evident that there was good communication between staff so that they could support the person consistently. Risk assessments were in place and described how staff minimised risks ensuring the safety of the individuals and the staff whilst encouraging independence. It was not clear whether these had been reviewed. Information was held securely however, the care plans were not in an accessible format for the individuals living in 33a Forest Road. Shaw Health Care Trust has deployed another manager, who is a registered nurse to audit the care plans that are in place at 33a Forest Road. Whilst it is evident that this may be beneficial consideration should be taken to ensure that the newly appointed care staff and registered nurses have training on record keeping and that this is specific to the expectations from Shaw Health Care Trust. Care Homes for Adults (18-65 years) Page 16 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are regularly taking place but these lack structure in relation to a timetable and whilst this may be suitable for some, others may benefit from a fixed structured time table offering guidance to the staff team and structure for the individual. Good contact is maintained with relatives. The newly appointed chef has improved the quality, the choice and the nutritious planning of the menus. Individuals are offered a choice of meals. Evidence: Care documentation included some information about the interests and hobbies of each individual. A member of staff said that the day is very much led by the individual from the time they get up to going to bed. Staff said there has been a period where individuals were not being supported in going Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: out in the community due to the high number of staff working in the home being new. During this time staff were getting to know the individuals. A relative highlighted that there has been a period where their relative had been not going out as regularly as what they are funded for. However, it was evident that this has increased over the last couple of months. Records were being maintained of activities that were being organised both in the home and the local community. Where appropriate this included the hours in respect of additional funding. A concern raised during this visit was that some of the individuals did not have any structure to their activities and staff were given only guidance on what the person liked but not when the activity should be carried out. For someone with a learning disability this may help with motivation and for someone who has autism it may be more beneficial to have a structured routine. On both days of this visit individuals were observed sitting in the lounge not interacting with staff or each other but just sitting quietly on the sofas. It was noted that five of the six staff were sat on the outer edges of the room. When we walked into the room a member of staff made the effort to put the television on. Staff said the individuals were either sleeping in their bedrooms or wanted to relax in the lounge. A review of the structure of the activities may offer some individuals stability and a focus and offer staff more direction. For the two individuals who have recently moved to the home, it was noted that one person has not gone out very much due to staffing levels and the other has only been out locally with the same activity being completed. For one of these individuals the social workers care plan identified that the person needs structured activities on a regular basis. Holidays were planned with individuals based on their preferences and staff in accordance with care plans. One relative said that their relative had not had a holiday for at least three years and then it was out of season so the person could not fully enjoy their trip to the sea. The manager said that this is being discussed with the local placing authority as additional funding is required for staffing. The relative said the organisation had tried to request additional funding from them for the cost of the staffing. This should be fully discussed with the local authority who would have an expectation that they already fund the staffing element through the fees already paid. Menus were viewed during the tour of the home. It was evident that comments made at the last visit about providing evidence on how the individuals are given choice has been addressed. The newly appointed cook was very aware of the likes and dislikes of the individuals and has developed a more accessible menu planner. Comments from Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: staff and individuals was that the food has improved since the employment of the new cook.This included evidence that individuals were being offered at least five portions of fruit and vegetables per day. Presently the home does not cater for any specialist diets. Weight is monitored but as already said where a person has had a diagnosis of being obese there was no weight management plan in place. Individuals were observed using the small training kitchen to make drinks and snacks. One individual became angry whilst being supported and additional staff came to support the member of staff in assisting the individual to calm down. However, it was noted that the senior management did not go and check both the individual or that the member of staff was debriefed on the situation and no one had made sure the area was safe for other individuals to use. There was water on the floor which could of posed a further risk to other individuals. Individuals confirmed that they can keep contact with relatives. Individuals are supported by the staff to visit relatives on a regular basis and this forms part of the weekly activities that individuals undertake. Care Homes for Adults (18-65 years) Page 19 of 40 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. Individuals personal care is being met. However poor recording of health care needs could be putting individuals at risk and the lack of follow up with the appropriate professional. Gaps in the recording of medication and not ensuring prescribed medication is received promptly in the home is putting individuals at potential risk. Evidence: Individual care records included information that demonstrated that the people living in the home have access to a GP, dentist, optician and other health professionals. To support the individuals with their needs the home liaises with other relevant professionals in the planning of care that is provided and to ensure the individuals care needs are met. Care plans included daily routines regarding their personal care needs and the way they preferred to be supported. From talking with staff it was evident that where individuals express a specific gender of staff to support them this is accommodated. Care Homes for Adults (18-65 years) Page 20 of 40 Evidence: It was noted in records for one person that a GP had queried whether the individual was diabetic and concerns raised about the individuals weight. There was no evidence that this had been followed up with an appointment at the surgery to clarify the diagnosis of diabetes or guidance developed to address the weight issue. When discussed with staff they said that they believed that the person had been to the GP but this had not been recorded. Each person has an allocated group of staff to support them called a key work group, consisting of a registered nurse, a senior carer and four to five home support workers. It is evident that this could assist with a consistent service being provided to the individual but this has only been recently been introduced. Regular meetings will be organised to review the care provided within the core staff groups to discuss the individuals wellbeing and progress. Staff have training in first aid and health and safety as evidenced in conversations with staff and the manager. This will be discussed later in this report. Each individual had a medication profile, identifying health needs and medication including a current photograph. However less apparent was a health action plan. There is an expectation that all individuals with a learning Disability would have a health action plan as part of the valuing people white paper. Medication was stored securely. A registered manager from another home has been redeployed to audit the medications. Registered Nurses have the responsibility to administer the medication. They have recently attended training on the medication system in place. Medication and Administration records were looked at for the last couple of months for a random group of people. It was noted that there were gaps in the signatures of administration, the carers comments were not completed on the reverse in respect of omissions or when as and when required medication was administered or a refusal. It was also noted that one persons prescribed medication was out of stock for a period of five days. The home reported to the Care Quality Commission as part of regulation 37 notification a serious medication error where the local surgery had increased medication for an individual in error. The relatives raised this as a concern with staff and a full investigation was completed and appropriate action taken to address the concern with increased checks completed on medication entering the home and staff training. Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: The home has a medication policy as viewed at the last visit. Care Homes for Adults (18-65 years) Page 22 of 40 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. Individuals can be confident that their concerns would be listened to and acted upon. Safeguards are in place to protect the individuals Evidence: Policies and procedures relating to complaints and safeguarding are in place as evidenced at previous visits to the home. These met with the National Minimum Standards. The home maintains a record of complaints and compliments. This file was difficult to navigate. It would benefit from an index to prompt the reader. There has been one compliant since the last visit. This related to a serious medication error involving the local GP surgery, the pharmacy and the home taking on some of the responsibility. The manager had kept the Care Quality Commission informed throughout the investigation and the outcome. The manager has taken measures to prevent a further incident occurring including improving the medication system and training for staff that have the role of administration and ordering. The manager has made a number of referrals to the local placing authority in respect of safeguarding. These have been where individuals have hit out at other people living in the home. Again the manager has kept the Care Quality Commission informed through regulation 37 notifications. These will continue to be monitored. The Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: operations manager stated that the local authority is in the process of organising a review of individuals and they are waiting for an allocated social worker. This was viewed positively by both the manager and the operations manager. During the last visit some staff said that they did not have faith in the organisation to respond to concerns. However, staff this time said that the manager is proactive in listening to concerns and addressing the issues. One member of staff said they have worked in the home for a period of two years and there has been five different managers which has impacted on how issues have been addressed. Surveys from individuals living in the home indicated that they were aware how to make a complaint and would talk with staff, their key worker, the manager or relatives. Care files viewed indicated that the key team members have a sound knowledge and understanding of the complex communication methods of people who use the service, and changes in behaviour, body language and facial expressions are observed closely. People who use the service would be offered support in a sensitive manner to determine whether a problem existed and appropriate action taken to rectify it. Staff confirmed that they had attended safeguarding training as part of their induction and that some staff have attended refresher courses. All staff spoken with conveyed a good understanding of what constitutes abuse and the need to report information to the team leader and the manager. Policies and procedures were in place relating to restraint and the management of aggression as seen at a previous visit. Where restraint had been used there were clear records in placed detailing the time, the reason the well being of the person and a review of the incident to ensure that the restraint was used appropriately in each persons care file. Each person had a plan of care describing how the individual should be supported with their challenging behaviour including the triggers. The home has responded to a requirement from the last visit to ensure that where restraint is used, this is clearly documented in the care file. The manager said that she has tried to involve other professionals in the decision process but this has been difficult. Good practice would be for the individual to consent to the use of restraint where the individual has capacity. It was evident that the high staffing levels and the individualised care was having a significant impact on the reduction of challenging incidents. Body charts were maintained of any injury either caused by self injurious behaviour or that from an incident involving another person receiving a care service. These linked with other care Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: documentation including accident records enabling the staff to fully review accidents and injuries. A random check on individuals finances were conducted. The administrator has worked hard to improve the recording of financial transactions. The records corresponded with the amounts held in the home, and was supported by two staff signatures. There were good auditing procedures in place. Shaw Health Care complete six monthly audits on the finances and periodically the operations manager will complete an audit during a monthly regulation 26 visit. Individuals have varying responsibility for their finances as recorded in the plan of care. The administrator said presently all monies are held in the main office, there is an expectation that staff will request money between 9am and 10 am for that day and will return the receipts by 3pm. This could be very restricting if this was fully implemented and would not allow for individuals have some spontaneity when going out. The administrator ensures there is money available for the weekends and the team leaders have responsibility for this. Care Homes for Adults (18-65 years) Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals living in 33a Forest Road have benefited from the home being made more comfortable and homely. The home was clean and in a good state of repair. Evidence: 33a Forest Road is a purpose built building. Each person has a large bedroom, which exceeds the National Minimum Standards. These were furnished to suit the individual and had an area for sleeping and relaxing. All bedrooms have ensuites. Flatlets on the lower floor had access to a private garden. Concern have been addressed since the last visit in relation to areas of the home that are potential hazards namely the stairs and the corridor leading to the office. Mirrors have been sited on the wall to enable staff to have full vision of people coming around the corridor. There has previously been two incidents where staff have been attacked on the stairs both were serious and resulting in injury to the staff members. All areas of the home were clean and free from odour. The home was in a good state of repair with a rolling programme of decoration. Furniture was suitable for the environment and individuals are being protected by much of the furniture being bolted to the floor to prevent injury. Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: Areas of the home were secure with the training kitchen, activity room and the office being locked when not occupied to ensure the safety of the individual and visiting personnel. People living in the home were seen accessing both the communal areas and the training kitchen. The communal space includes two lounge/dining areas and a hydro pool room and as already mentioned a training kitchen. It was noted during the last visit that the communal area and the corridors look barren and lacked a homely feel.This was raised by relatives in completed surveys received prior to the last visit. It was evident during this visit that this was being addressed with pictures now adorning the walls and the recently purchased sofas and the curtains making the lounge area on the ground floor more comfortable and homely. Corridors now contain pictures which has reduced the institutionalised feel to the home. The manager said that the smaller lounge on the top floor is being changed to a meeting area for staff, visitors and care reviews. Whilst it is evidently a loss of a communal space and has been controversial with the staff team it is evident that this would be beneficial as there is a lack of office space in the home. The manager said that another area will be developed for individuals living in the home where they can sit and chat across the corridor. This will need to be risk assessed as this is sited at the top of some stairs leading to the hydro pool. The operations manager said that as each individual has access to a bedroom and living area with televisions that the loss of the smaller lounge would be minimal to the individuals living in the home. The home employs a maintenance person and records are maintained of repairs. It was evident that there was a good response time for maintenance work. It is evident that due to some of the behaviours that challenge the environment at times can be subject to wear and tear. The home employs a domestic to assist with the cleaning of the home. It is evident that the safety of the staff is paramount. Domestic staff attend positive response training and safe working practices are in place for both the domestic staff and the people living in 33a Forest Road. It was evident from reading care documentation and speaking with staff that the individuals have some responsibility for cleaning of their bedrooms as part of their daily routines. The home as already mentioned was purpose built. There is communal bathroom which has an assisted bath to aid individuals with a physical disability. There is a lift to access the first floor and handrails are situated throughout the home. In addition the home has recently obtained a hoist to use for one person. It is evident that an Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: occupational therapist has been involved with one of the individuals who has recently moved to the home and the staff have ensured that all the recommendations that were made, have been actioned. The home was inspected by an Environmental Health office in December 2007 and was awarded a four star rating. Good systems are in place that demonstrate that the home has adopted good food hygiene practices. The kitchen was clean with good records maintained of the daily, weekly and monthly cleaning tasks. The cook said that the kitchen is deep cleaned every six months. All food in the fridge was labeled, however, jars and sauces would benefit from the date they were opened being recorded. The cook said there was adequate equipment and some of this has been replaced recently including baking tins and cutlery. Staff that are involved in catering have completed their food hygiene award. The manager said that there is an expectation that all staff will complete this course. Care Homes for Adults (18-65 years) Page 28 of 40 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff support the individuals living in 33 Forest Road with individualised packages of care in place. Morale has improved with the employment of new staff which has meant there is less reliance on agency staff and the leadership and direction that is now being given to staff. Many of the staff are relatively new which has meant that training has focused on basis statutory training. Evidence: 33a Forest Road is a registered care home to provide both personal and nursing care. There is a registered nurse working in the home 24 hours a day. The manager has recently reviewed the staffing. This has been increased taking into account that two new individuals have moved to the home. The manager said they have spent a lot of time recruiting to the team to ensure that the home has adequate staffing numbers. The home is now nearly fully staffed with a staffing accomplishment of 51 staff. There was at the time of completing this report 3 home support worker vacancies. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: Within the group of staff there are teams of carers who have the responsibility for supporting specific individuals. This consists of a team leader (registered nurse), a senior carer and five care staff. Staff clearly described their roles and had a good understanding of the needs of the individual. On the day of the visit there were ten staff working in the morning and eleven in the afternoon. One person has 15 hours of support and prefers to have this in the afternoons and evenings. Two people require two staff each. One of the individuals requires three staff to support them in the community (additional funding is given for this). Records provided evidence that this was in place including staff being rostered on the rota to enable this to happen. A concern raised by staff and relatives from the last visit was the high staff turnover at all levels in the home. The manager said that she has been in post since September 2008 and only two members of staff have left. From talking with staff and the manager it is evident that only a handful of staff have worked in the home for more than three years with the majority being recruited in the last twelve months. Recruitment information was seen for three members of staff. There was a completed application which provided a history of employment and some personal details about the applicate. Two references were seen for two of the staff, whilst one person had only one reference. The manager said that this had not been forwarded to them by the Human Resources Department. Criminal Record Bureau records are held at the main office and the home is forwarded confirmation that they have been received. The manager said that an email is sent to the home when all the information is received stating that the person can start work in the home. It was noted that two staff had started work in the home prior to a full CRB being received, both were working as part of the numbers and providing personal care. It was not clear how the staff were being supervised at all times. One of these members of staff was a team leader who had responsibility to manage the shift on a day to day basis. Where staff commence employment before the full CRB has been recieved staff should be supervised at all times. On the day of the visit the computer system was not working so it was difficult to access staff training records, as the staff files did not contain up to date information. However, two newly appointed staff were spoken to during the visit and they confirmed they had completed the four day induction and were in the process of completing the Learning Disability Award Qualification. In addition as part of their induction they had been supernumerary for a period of two weeks working alongside more experienced staff. Staff have a probationary period of six months. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: Staff spoken with during this visit described improved working conditions with morale generally being better than previously experienced. It would appear that there is less reliance on agency, a manager now being in post and a general feeling that the home was moving forward had all assisted in improving morale. From talking with staff it was evident that they felt more supported and felt that the manager was approachable. One member of staff said that some changes have been implemented to the benefit of the individuals however it was work in progress. It was evident from talking with staff that they were enthusiastic and were embracing the changes. Staff attend a rolling programme of health and safety training including first aid, food hygiene, fire awareness, infection control, safeguarding and manual handling. Some staff were attending manual handling training on the day of the visit. As many of the staff were relatively new it was evident that staff were being given the basic statutory training. The operations manager said that there has been some issues with the positive response training (supporting people that challenge) and some staff need the full and the refresher course. Two courses have been arranged one for the end of June 09 and the other in July. All staff will be expected to attend. No requirements have been made during this visit as it was evident that this is now being addressed. The operations manager stated that one member of staff from the home will attend training to enable them to cascade positive response training. It was felt that this would improve efficiency in providing this training to the staff. Other training offered to staff included makaton (sign Language for people with a learning disability), autism, epilepsy, person centred planning and more recently training on the mental capacity act and the deprivation of liberties. Staff confirmed that the manager organised regular meetings. The newly appointed team leaders have responsibility to supervise staff in the key groups. This is still being developed however it was evident that staff were meeting up with their supervisor. The manager said she organises monthly meetings for the care staff and the team leaders. The manager has planned a number of training/meeting days for the team leaders to develop their skills and roles further. The manager said that the last team day addressed some of the issues around medication and the next one will be around care planning approaches. Care Homes for Adults (18-65 years) Page 31 of 40 Care Homes for Adults (18-65 years) Page 32 of 40 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. Individuals and staff have benefited from a more stable management structure being in place. It is evident that improvements are ongoing and staff were generally positive about the changes being made. Individuals safety is evidently paramount however this could be compromised in the event of a fire. Evidence: The home has not had a registered manager since December 2007. During this period there have been temporary managers from other homes assisting with the management tasks. Mrs Jackie Boyce has been in post since September 2008. She is in the process of becoming the registered manager and her application is being processed by the registration team. Mrs Boyce has been a registered manager with the former Commission for Social Care Inspection for a home for people with Learning Disabilities. Mrs Boyce has the relevant management experience but does not have a nursing qualification. There is a deputy manager in post who will assist with the clinical areas of running a care home with nursing. Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: It is evident that Mrs Boyce has made some positive changes in the home including leadership and management, the environment, the recruitment of new staff and general boosting the morale in the home. There is evidently still much work to be done to bring this home to a standard where individuals are supported in a more consistent manner including more structured activities, improved care planning documentation and staff having more clearer roles on how they can support the people living at 33a Forest Road. Mrs Boyce has developed an action plan along with the operations manager to address some of these areas. During the management changes it is evident that some of the administrative tasks have slipped as noted at the last visit. However, it is evident that the manager along with the administrators have addressed this and the office was more organised. Both the manager and the administrator were much more confident in finding documents and information. Quality Assurance systems are in place and regular audits are completed on the environment, finances, medication, complaints, staff support mechanisms, staff training and more recently care planning documentation. Another manager has been brought into the home to assist with the process. The home is audited on a monthly basis by the operations manager respect of regulation 26 visits. Records are maintained of these visits. Views of relatives and individuals are sought during care reviews and via annual questionnaires. Regulation 37 notifications are being received on a regular basis in the event of any incident occurring in the home that might adversely affect the people who use the service. There were good systems in place to ensure the safety of the people who use the service and staff. Information was accessible to staff including policies and procedures and risk assessments. Routine checks on the premises were being completed including the testing of the gas and electrical appliances as evidenced at previous visits and through the annual quality assurance assessment (AQAA). These systems also included checks on the water temperatures, food temperatures and fridge/freezer temperatures. Records were maintained on the checks on the vehicles. An opportunity was taken to review the fire log book. There were some gaps in the checking of the equipment and on investigation it was due to staff member being on holiday. This should be rectified to ensure that a further person is allocated this task when the other is absent. Staff take part in annual training as evidenced in the fire records, less apparent was staff participation in fire drills. All staff must take part in a Care Homes for Adults (18-65 years) Page 34 of 40 Evidence: fire drill at least once in a six month period. Generic risk assessments were viewed and it is evident that the newly appointed manager is systematically going through these as part of an ongoing review process. Care Homes for Adults (18-65 years) Page 35 of 40 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 (1)(a) To ensure that the documentation that staff maintain is relevant and tailored to the individual. This has not been met and individuals still have fluid charts and pressure care records when not relevant 22/10/2008 Care Homes for Adults (18-65 years) Page 36 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 To ensure that care plans and risk assessments are kept under review. Ensuring that these are current and reflect the needs of the individual. 23/09/2009 2 14 12 Ensure that care plans include how the person likes to spend their time and develop a structure activity plan where relevant. Ensuring individuals have structure and take part in meaningful activities. 24/09/2009 3 17 11 Where individuals have a need in relation to weight monitoring then a care plan to be drawn up to address. Ensuring individuals health is maintained 23/07/2009 4 20 13 Ensure that where 02/07/2009 medication is prescribed this is sought promptly. Care Homes for Adults (18-65 years) Page 37 of 40 Ensuring appropriate treatment is received promptly. 5 20 13 Ensure that registered nurses sign for all medication and the carers comments on the reverse of the MAR sheet. Safeguarding the individuals from harm. 6 34 18 Where staff start work on a POVA first then a risk assessment is drawn up and they work supervised at all times. Ensuring individuals are protected. 7 42 23 For all staff to take part in a 16/07/2009 fire drill at least once in a six month period. Ensuring staff have an awareness of the procedure to follow in the event of a fire. 24/07/2009 02/07/2009 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 5 6 6 For the organisation to review the Shaw Health Care contract for service users ensuring it is accessible. Review the daily records that are maintained to see if these can be simplified. Care documentation to be archived where no longer relevant and consider how information can be more accessible to the individuals living in the home. Care files would benefit from an index. Page 38 of 40 Care Homes for Adults (18-65 years) 4 6 Review present care documentation to ensure it reflects current good practice in relation to supporting a person with a learning disability. Review the use of charts such as fluid charts and risk assessments relating to pressure sores etc to ensure relevant to the individual. 5 6 Care Homes for Adults (18-65 years) Page 39 of 40 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. 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