Inspection on 14/04/09 for 4 Granville Road

This inspection was carried out on 14th April 2009.

CQC found this care home to be providing an Poor 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Granville Road 28/04/08

4 Granville Road 16/10/07

4 Granville Road 05/06/07

4 Granville Road 13/12/06

4 Granville Road 09/12/05

4 Granville Road 05/05/05

4 Granville Road 21/07/04

4 Granville Road 04/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report CARE HOME ADULTS 18-65 4 Granville Road Reading Berkshire RG30 3QD Lead Inspector Yvonne Souden Unannounced Inspection 14th April 2009 10:30 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 2 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 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Granville Road Address Reading Berkshire RG30 3QD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0118 959 9370 0118 959 9370 granville@paramounthousing.org.uk HVHS Housing Group Ms Denise Williams Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 9. Date of last inspection 28th April 2008 Brief Description of the Service: 4 Granville Road is situated in a residential estate approximately 2 miles from Reading town centre and provides residential care and accommodation for 9 people with mental disorders, excluding learning disability or dementia. The home is furnished and decorated to a basic standard; the building is owned by Reading Borough Council, and has been identified by Reading Borough Council and the organisation as requiring refurbishment. There is a large enclosed garden and parking facilities at the front of the house. There are 9 single bedrooms, 1 has a toilet and wash hand basin and the others have a wash hand basin only. There is no lift or stair lift and therefore the first floor would be unsuitable for wheelchair users or those who cannot manage stairs. 4 Granville Road has a Statement of Purpose and Service Users Guide available on application to the home. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The manager completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided, by the commission. The AQAA was used by the manager and provider to review their service and inform the commission of their findings. The AQAA was used as part of the evidence to inform this report. Other evidence used to inform the report included a 10.5 hour site visit to the service by the inspector. This enabled the inspector to observe care practice and speak to people who use the service, staff and management of the home. The Care Quality Commission received completed questionnaires from people who use the service, and from staff who work there, and received completed questionnaires from health care professionals who have regular contact with the people who live in the home; their views of the service provided have been used to inform the report. Other evidence used to inform this report was documentation viewed by the inspector at the site visit. What the service does well: What has improved since the last inspection? 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 6 Staffs job descriptions have been reviewed to enable staff to meet the personal care needs of the residents. A good training and development programme is in place to enable staff to meet the needs of the residents with confidence. Residents bedrooms have been redecorated to improve the homeliness of the home, and blinds have been fitted to some windows to promote the residents privacy. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live in the home have their needs assessed prior to their admission, and have their health and social care needs reviewed following admission to the home. EVIDENCE: A new resident came to live in the home in May 2008; all other residents have lived in the home for several years. The new resident said that he has settled into his new surroundings, and is pleased with his room and the support given by staff. Health and social care professional needs assessments and risk assessments gave the home the information they needed to make a decision on whether they could meet the persons needs, prior to agreeing to a plan of care. All of the residents assessments link with their individual plan of care and risk assessments, as signed by the resident. The health and social care needs of the residents are reviewed regularly. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the 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 who use the service have a care plan that mostly promotes their independence and decision-making, whilst risk assessments mostly promote their safety within the decisions they have made and care needs identified. EVIDENCE: A health care professional said about the service provided within the home, They participate in CPA (Care Programme Approach) meetings and usually contact myself on the caseloads if there are problems/new developments. The health care professional went on to say that staff are committed to meeting the residents needs and have a good relationship with the residents. A CPA is an opportunity for resident, staff and health and social care professionals, to meet and agree the best way forward to meet the assessed needs of the resident, and for this to be recorded within the residents plan of care. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 10 Another health care professional said They prepare well for CPA meetings, and always provide valuable feedback (written), there appears to be genuine feelings of warmth for the residents. The records of three residents were examined. Some changes have been made in the way staff record daily reports since the last key inspection of the home. The manager said that they are looking at ways of reducing duplication of records. Those examined were well-written clear and concise and key workers continue to work with the residents to review, and record most changes to the residents health, personal and social care needs within the residents care plan and risk assessment documents. The care plan of one individual did not include the need to use a wrist pendant 24 hours a day. This was because the individual concerned had no other means to contact staff for assistance. The resident is unable to leave their room without help. The risk assessment staff had completed did not reflect the need for the person to have the wrist pendant continuously, nor of the risk to the resident should the wrist pendant be taken from them/removed. This is referred to elsewhere in the report (see sections Personal and Healthcare Support; and Concerns, Complaints and Protection). The section would have had a higher quality rating but for the fact that a person had purposefully been denied a means of calling for help in an emergency or when they required help potentially exposing them to the risk of harm. A safeguarding referral was made to the local authority and a requirement has been made at the end of this report concerning the above matter. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the 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 who use the service are enabled to maintain contact with family and friends, and are involved in decision making about the running of the home and choices they have made within daily living; residents who have a physical disability are not supported to maintain their chosen lifestyle. EVIDENCE: A health care professional said, A number of the residents have negative symptoms of schizophrenia - including loss of drive and motivation. Staff sometimes find it difficult to engage them in activities outside the home because of emphasis on choice (e.g. if a resident refuses - they may simply respect this - where as the refusal may - be part of the symptom of the chronic schizophrenic illness - and the resident may benefit from a more assertive approach. Staff said, It would be useful to have more training in mental health, to have more of an understanding of the residents particular 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 12 mental health need. Training records indicate that staff are supported to access a good training and a staff development programme that has been recently implemented. The home employs a cleaner/rehab assistant. The member of staff said that they have not had any specific training to assist them to deliver a full and varied activity programme or programme that would promote the residents independence within daily living tasks. There was no specific time allocation to assist residents within recreational activity, or within a programme of rehabilitation. Residents share in the responsibility of tasks within the kitchen and dining area before and following meals. One member of staff said within a questionnaire on how could the home improve, Perhaps more efficiency in the process of moving to the next stage in the rehabilitation process for service users, without this it is likely that service users meet a dead-end. It was evident that the cleaner/rehab assistant spent most of their working day on cleaning tasks and preparing and serving food with little time left to spend with the residents. Support staff said they do not have as much time as they would like to spend with residents on recreational activity or programmes of rehabilitation due to staff shortage. Most of the residents within the home are fairly independent and say they are happy in the home and have a good relationship with staff and residents, and are able to go and visit family and friends. These residents are able to access areas of the home and the community independently and maintain a lifestyle that mostly respects the choices they have made within a risk management framework. Residents who are less independent due to increased frailty are not properly supported by the home to maintain a lifestyle that promotes their independence or choices they have made. For example, the ability of individuals with limited mobility to go out and to use the amenities in the local community is constrained. This is because of the manager and staff who said, to promote staff safety, staff are not to push residents in a wheelchair within the community. Staff would benefit from receiving training about activities that could help to promote the lifestyle of those residents whose ability to access the community is limited. The homes management should look at ways of supporting all people living in the home to use amenities in the community to further improve their lifestyle and to help them exercise choices they have made. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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 who use the service receive support to meet their health, psychological, personal and social care needs as identified within their agreed plan of care. There remains the risk that people who use the service who require assistance with personal care will not have their personal care needs met as and when required throughout the day and that they may miss out on health care appointments due to low staff numbers. EVIDENCE: Improvements are being implemented to improve the home’s ability to meet the personal care needs of the residents’. The home has reviewed staff job descriptions, to include assisting residents with personal care, and has secured funding to employ extra care staff. This is in order to reduce the use of care workers supplied by a domiciliary care agency who also provide people living in the home with help with their personal care needs. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 14 At the time of this key inspection the risk that the personal care needs of individuals are not fully and properly met remains high. This is because although funding for additional staff at the home had been approved by the local authority this will not be made available until new staff are actually in post. This will coincide with a reduction in the use of care workers supplied by a domiciliary care agency. Also waking night staff are not deployed and individuals who require assistance with personal care and whose mobility is impaired are unable make staff aware of that need because they do not have the means to do so (see also sections Individual Needs and Choices; Concerns, Complaints and Protection). The continued use the service of domiciliary care agency to supply care workers to provide personal care for of some the people living in the home. was described as unsatisfactory by some of permanent staff working in the home. They said this was because individuals often refuse assistance even at a set time and therefore may be more open to staff providing personal care at a time that is agreeable to them, as this may vary from day to day. Consequently an immediate requirement was made (see also section below, Staffing) to ensure sufficient staff are on duty in the home at all times in order to promote the welfare and safety of the people living there. A health care professional made reference to the home no longer having the use of their own vehicle, and said, This is creating problems with residents who have appointments, and limiting opportunities for the more physically disabled residents to go out. Evidence found during this inspection indicates that there were not enough staff on many shifts to assist residents to appointments whether by car or by other means of transport. Staff confirmed that the hospital and GP surgeries are within walking distance of the home, that hospital and GP transport can be arranged and that residents have companion bus passes to enable staff to assist them to attend appointments should this be required. There was evidence that on occasions health care appointments for individuals had to be rearranged because of the unavailability of staff due to competing interests. The home must ensure that people living in the home are able to attend health care appointments when required and avoid as far as possible having to rearrange such appointments. A health care professional said that staff, understand the mental health issues of the residents and deal appropriately and respectfully with them. Some staff said in discussion and in questionnaires that they would like more mental health training. Records indicate that not all staff have attended relevant mental health training, but recent improvements have been made to enable staff to receive such training. Two residents have diabetes. Staff give out medication from a monitored dosage system provided and dispensed by a high street pharmacist who also provides medication training. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 15 Records matched medication kept and all medication was stored securely. Staff give a resident insulin as delegated and monitored by a health care professional. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and action taken to protect the people who use the service from abuse, but the home does not recognise some forms of poor practice that would be viewed as abuse, and poor induction of new staff does not ensure they are familiar with safeguarding adult policy and procedures. EVIDENCE: The home has reviewed its complaint procedure to ensure it is accessible to the people who use the service and has a complaint book to log any concerns or complaints that may be raised. Residents mostly said that they know who to speak to if they are not happy and know how to make a complaint. A health care professional said, I have had no reason to raise concern about my patients care, but I am confident that the service would respond appropriately if I did so. The commission has received no complaints about the service provided within the home. The home has a copy of Berkshire Safeguarding Adults Policy and Procedures 2008, and this is accessible to staff. The home has a whistle blowing policy and staff are mostly aware of the policies in place to safeguard the people who use the service. A new member of staff despite having received awareness training in safeguarding as part of the home’s induction training was not able to provide comprehensive responses when asked about her knowledge of such matters, but knew where to locate relevant procedures in the staff office. Staff 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 17 induction is discussed further within the staffing section of this report. All staff, have attended some adult safeguarding and equality and diversity training. A safeguarding referral was made by the commission to the adult services department of Reading Borough Council due to the following concerns identified during this key inspection of the home: • • Staffing levels were insufficient to ensure that the health, personal and social care needs of the people living in the home were being properly met. An individual who spent a lot of time in their bedroom did not have the only means of contacting staff in an emergency (i.e. a wrist pendant) made readily available to them at all times (see also sections Individual Needs and Choices; Personal Healthcare and Support). The fact that the homes staff failed to recognise that purposefully restricting the ability of an individual to summon help or assistance in the circumstances above could constitute restraint i.e. a form of abuse and also breach their human rights, has resulted in the overall quality rating of the is section being rated as poor. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to provide a safer, homelier and comfortable environment for the people who use the service, but further improvement would be required to ensure the layout of the building continues to meet the changing needs of the people who live there. EVIDENCE: The home had a wet rooms installed prior to the last inspection in April 2008. This has improved conditions for those residents who require assistance with showering. Hot water outlets are regulated to ensure they are within a safe temperature. Radiator covers have been fitted to protect residents from burns and fire procedures/testing is followed weekly to ensure the homes fire alarm system is in working order. The laundry has been redecorated to promote infection control and the washing machine has a sluice facility. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 19 The communal areas of the premises had been redecorated at the time of the last inspection and this had improved its overall homeliness. Following a requirement at the last inspection in 2008, residents bedrooms have been redecorated and blinds had been secured to the hall and bathroom windows to promote the residents privacy. At the time of this site visit the home was clean and fresh with no offensive odours. Although improvements have been made to the environment to make it a safer and homelier place to live, further refurbishment is required to bring the home up to a good standard. For example window frames need replacing and narrow corridors and lack of en-suite facilities may provide difficulties because of the changing physical needs of the people who live there, in particular those who are have limited mobility and are wheelchair users. This was raised at the last key inspection of the home. Following the key inspection in April 2008 the provider sent to the commission an improvement plan that detailed how the home would meet the requirements made at that time. In the plan the provider stated that, decisions with regard to major changes to fabric of the building have been delayed by the owners - Reading Borough Council. The narrow width of the corridors remains a concern and presents difficulties for people living in the home who are wheelchair users or who depend on walking aids. Should an individual suffer a fall in a corridor it would be difficult for staff to assist the resident safely. The home does not have a hoist, but the use of a hoist within the narrow corridors may prove difficult. The registered provider must inform the commission of how it intends to improve the environment in order in order to meet the specific needs of all people living in the home. Infection control policies and procedures are in place and staff have attended infection control training; protective clothing is provided for staff use when assisting residents with personal care. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a staff team who are caring and enthusiastic in supporting and meeting the needs of the people who use the service, but low staff numbers put the safety, and meeting the needs of those people at risk. EVIDENCE: Staffs job descriptions have changed to include assisting residents with personal care, and the home has secured funding to employ extra care staff. The home continues to use the services of a domiciliary care agency to meet the personal care needs of three people in the morning and evening. The home plans to stop the use of domiciliary care staff once they have a full complement of care staff in place. The home stated within their Annual Quality Assurance Assessment that Despite recruiting difficulties we maintain staffing levels of a high quality. There was no evidence from rotas viewed, and from discussions with staff to support this statement. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 21 Some staff said that they are feeling the stress from the extra work created due to low staff numbers and one said, We work a late shift followed by a sleep over and early shift next day. We do not always get a full night sleep due to a resident who is frequently up at night and this can put a strain on us the next day when working the early shift. Another staff member said in a questionnaire, Due to being one staff member down it can sometimes be a strain in terms of ensuring two staff members are on duty all the time. The home employed one full-time and one part-time staff member following the last key inspection in April 2008, and a thorough recruitment procedure was followed. The full-time staff member has since resigned. The rotas examined indicated that the homes staff complement was short of the equivalent of two full time staff. Some of these hours have been covered by agency staff, but predominantly the hours are left unfilled. Agency staff mostly cover annual leave and other absences. Such shortages put residents and staff at risk particularly should an emergency occur. The Rota indicates that the home has mostly one carer on duty at any one time, with support from the manager and cleaner/rehab assistant who works from 7 a.m. to 1 p.m. Monday to Friday. The late shift carer has support from the part-time carer from 4 p.m. to 8 p.m. Monday to Friday. Where it indicates that there should be two staff are on duty, there are often gaps on those shifts with only one staff member on shift between the hours of 8 p.m. and 11:30 p.m., and between the hours of 3:30 p.m. and 4 p.m. At weekends it indicates that only one carer covers each shift with no backup support from the manager, cleaner/rehab assistant or part-time care support assistant. The personal, health and social care needs of some of the residents who live within the home have changed considerably over the years. Support from one carer to meet the needs of all the residents at any one time is not a safe number to ensure that the welfare and safety of people living in the home is properly promoted. Low staffing numbers impact considerably on the service provided and this is reflected within the judgments made within some sections of this report. This is disappointing for the dedicated staff who work within the home, as it is evident that they do their best with the resources they have to meet the needs of the people who live there; this is also reflected from the comments received from health care professionals and from the residents who live there. An immediate requirement was at the time of the site visit to ensure sufficient staff numbers are on duty at all times to meet the needs of all the people living in the home. The responsible individual representing the registered provider/organisation confirmed the day after the site visit that they have 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 22 taken steps to ensure the minimum specified staff numbers are in place and that they would address the issue of employing waking night staff as quickly as possible. Records viewed and discussions with staff show that staff are supported to meet their training needs. Staff say they feel supported by their manager and receive regular formal supervision. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is a competent and caring manager who has the qualifications to ensure the safety of the people who use the service and the staff team. The manager ensures records are kept mostly up-to-date. People who use the service feel listened to and feel confident that their views contribute to the running of the home. EVIDENCE: The home promotes the residents safety by ensuring fire equipment and alarms are regularly checked. Radiators are covered and hot water outlets are monitored to protect residents from burns. Health and safety policies procedures are reviewed and staff attend health and safety training, for example, fire safety, infection control and moving and handling. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 24 The manger generally ensures up-to-date records within risk assessments and care plans, and has good working relationships with health care professionals that ensure the review of residents’ health and social care needs are complete. However, the need for a resident who is unable to leave their room without assistance to have a means of contact with staff throughout the day has been highlighted elsewhere in this report (see sections, Individual Needs and Choices; Personal and Healthcare Support; and Concerns, Complaints and Protection). This matter was not recorded within the residents care plan or risk assessment. The manager confirmed that the alarm pendant was taken from the resident through the day due to the possibility that the resident could lose it at considerable financial cost. It is disturbing the cost of replacing an item of equipment should be considered more important than the individuals comfort and safety. Consequently the matter was referred to Reading Borough Council in accordance with their adult safeguarding procedures (see also Concerns, Complaints and Protection). Records and observation indicate that people living in the home are listened to and their opinions about the service respected and valued. Residents said that staff treat them well and listen and act on what they say. The commission have been informed that the process of recruiting extra care staff is underway. Domically carer workers are still used by the home to provide personal care to people living there and this arrangement of morning and evening visits will continue. This does leaves large gaps in staff cover at other times of the day when individuals may require assistance with personal care. Speedy recruitment of staff is therefore essential to ensure that the needs of the all people living in the home can be properly met at all times. The home has quality assurance monitoring systems in place. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 2 X Version 5.2 Page 26 4 Granville Road DS0000011054.V374921.R01.S.doc Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA33 Regulation 18 Requirement The registered persons must ensure sufficient staff with the competencies necessary to properly meet the needs of people living in the home are on shift twenty-four hours a day. This is to protect and meet the personal, health and social care needs of the people who use the service. Requirement from the 28th April 2008, not met. 2. YA24 23. -(2) (a)(b) The registered persons must install aids and adaptations and make whatever alterations are necessary to the environment to enable the assessed needs of all people living in the home to be properly met. This is to ensure that individuals with specific or special needs can continue to be accommodated at the home. Requirement from the 28th April 2008, part met. 29/05/09 Timescale for action 16/04/09 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 27 3. YA6 YA9 14.(2) The registered persons must implement a system that ensures care plans and risk assessments accurately reflect the specific needs of all individuals living in the home and describes fully how they are to be met. This must include where relevant reference to the use of equipment for calling staff and the risk to individuals if it is not available to them at all times. This is to ensure staff are aware of potential risks to residents and know how to minimise those risks. 12/05/09 4. YA13 YA16 16.- (2) (m)(n) The registered persons must 29/05/09 make arrangements to enable people who live in the home to engage as fully as possible in local, social and community activities and use amenities in the local community according to their individual expressed wishes. To enable people who use the service to pursue their chosen lifestyle and activities. 5. YA19 13. 1 (b) The registered persons must ensure that people living in the home are supported to attend health care appointments when required. This is to ensure the people who use the service can access health care services to meet their health care needs when required. 12/05/09 6. YA42 13.4 (c) The registered persons must 14/04/09 implement a system that enables all people living in the home to DS0000011054.V374921.R01.S.doc Version 5.2 Page 28 4 Granville Road contact staff in order to receive the help and support that they require or in the event of an emergency, at all times of the day and night. This is to ensure that the welfare and safety of the people who use the service are promoted. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA13 YA15 Good Practice Recommendations The provider and manager should look at information and/or training for staff that would inform them on activities that could be implemented to promote the lifestyle of the people who live in the home and are limited in their ability to access the community. It is recommended that staff receive diabetes training to be aware of the symptoms associated with this condition. Management should give some consideration in the planning of staffs induction so that the individuals induction period is reflected within the staff rota. Staff doing induction training should be added to the rota as an extra person to enable the process to be thorough. 2. 3. YA19 YA33 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 29 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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. 4 Granville Road DS0000011054.V374921.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!