Inspection on 07/07/09 for 44 Castle Road

This inspection was carried out on 7th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

44 Castle Road 24/08/07

44 Castle Road 01/11/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 44 Castle Road 44 Castle Road Cookley Nr Kidderminster Worcestershire DY10 3TF The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Seel Date: 0 7 0 7 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 39 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: 44 Castle Road 44 Castle Road Cookley Nr Kidderminster Worcestershire DY10 3TF 01562852405 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) : www.dimensions-uk.org Dimensions (UK) Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following catgeories: Learning disability (LD) 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 39 A bit about the care home This is a small sized home for up to four people with a learning disability. The home is on a road near to some other houses, shops and bus routes. Everybody who lives at the home has his or her own bedroom. The home also has a car, and the staff support the people that live there to go out in the car. Care Homes for Adults (18-65 years) Page 5 of 39 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 Care Homes for Adults (18-65 years) Page 6 of 39 How we did our inspection: This is what the inspector did when they were at the care home The inspector was showed around the home by a person who know it well. The inspector talked to some of the people who live at 44 Castle Road. The inspector talked to some of the staff working at the home. The inspector talked to family and friends of people who live at 44 Castle Road. Papers in the office were shown to the inspector to tell them how the home is run. What the care home does well A book that tells people about how the service works has pictures so people can see what it is like to live at 44 Castle Road. Some people are helped to look clean and dress in good clothes by staff. Staff help people to go to see their doctor and other people if they are unwell or need a check up. Family and friends of people who live at Care Homes for Adults (18-65 years) Page 7 of 39 the home are welcomed by staff. Staff can tell if people who live in the home are unhappy and let the manager know. Staff know how to care for people and what they like and dont like. The manager is looking at all the plans that tell staff how people like to be cared for and supported. What has got better from the last inspection Peoples bedrooms have been painted and people have their own things around them. How medicines are kept and given to people who live at 44 Castle Road has got better. The manager told us this. Plans that tell staff how to keep people safe have been checked Care Homes for Adults (18-65 years) Page 8 of 39 What the care home could do better A book that tells people who the service is for needs to be where people can see and get it. A book that tells people how the service works needs to be where people can see and get it. People who come to live at the home should be able to get on with other people who live at 44 Castle Road. All staff need to read and follow the plans that tell them how to keep people safe so that they are not in any danger. People living at the home should be able to use the lounge, kitchen and hall ways without any fear. Plans should be written down that show what training staff have had and what they need to make sure they can give the care and support people need. The manager must make sure the lounge and hall ways are painted so that people live in a nice home. Care Homes for Adults (18-65 years) Page 9 of 39 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sally Seel 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 10 of 39 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 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to help them decide if the service is right for them. Peoples needs are assessed and they are encouraged to visit the home. Although a review of this process should be considered to make sure people who move into the home fit in with the people who already live there. Evidence: The statement of purpose and service user guide are currently being up dated. The updated statement of purpose was shown to us on the computer. It tells people who are considering moving into the home what it would be like to live there. Details about the temporary manager, what qualifications the staff hold together with the facilities and services that are offered. The service user guide is now available and pictures are used which make it easier to understand for people who might have difficulty reading. These documents provide information to help people decide if the service can meet their needs prior to people moviing into the home. Therefore it is now recommended that copies are printed from the computer to be displayed and copies made available for staff to be able to give them to people who may be considering moving into the home. One person moved into the home in April 2009 from another of the organisations homes that has closed. We looked at this persons care plans to see if their strengths and needs had been Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: assessed properly. This has to be done to make sure that the home has the important information it needs to plan peoples care and support. All the plans we looked at contained a detailed assessment. These were all current and importantly had been reviewed as the person had some behaviours that staff needed to support them with. We were told that this person had visited the home prior to moving in. The AQAA says, the last person moving into Castle Road, visited the home on a regular basis, they were kept informed about what they would be able to do and were provided with the information in Photographic and Symbol format. Also it was positive to note that a member of staff who knew this person came to work at 44 Castle Road to help them settle in. Despite these practices family members, advocates and staff have raised their concerns about this person not being compatible with the other people living in the home. This has been illustrated with practice examples within the other section sof this report. Surveys received from family members and advocates told us: Very concerned about the behaviour of a new resident who I believe has been inappropriately placed at the home. Staff told us: This home is not the right place for X and Since X has moved to the home the other three people that we support are at serious risk. In the light of these concerns the management team may want to review their decision making to ensure people moving into the home would be able to live with those already there. Also the practice of how other people living in the home and their representatives are consulted about the compatibility of new people who move into the home. This should demonstrate the effectiveness of the admission procedure and ensure people are protected from harm, where their choices and lifestyles are not restricted by a new person moving into the home due to their behaviours. Also any new person moving into the home will not have the disruption in their lives in having to move into alternative living accomodation which can cause increased anxiety. On the day we visited the regional director of Dimensions and care manager from the community learning disability team were considering an alternative home for this person to move to. Surveys we received from: Family members and advocates told us: The overall care given to the residents is very good. I believe the care X has received has been very good. Staff told us: Staff always put the people we support first and are dedicated to the job. Staff team Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: work together well. Good staff team e.g. caring, willing, able, good at working together and individual roles. Care Homes for Adults (18-65 years) Page 14 of 39 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. Care plans have been reviewed, these will help to make sure people get the care they need in ways that suit them best. Risks assessments are in place but there is room for improvement to make sure that these are put into practice so that people are supported to stay safe from harm. Individuals choices and options are sometimes restricted which puts into question whether people living in the home are currently experiencing a good quality of life. Evidence: One persons care records were looked at indepth and anothers checked briefly. They include relevant background information, their photograph, a pen picture, and a map with people who are important to them. Each person has a detailed care plan that is drawn up in an appropriately person centred way. Plans therefore show their wishes and goals as well as their needs, with actions needed to meet their personal goals specified and any outcomes. Each persons likes, dislikes and preferred daily routines are outlined. It has been recognised that some people living in the home have somewhat limited involvement in drawing up their support plans because of their learning disabilities. However, the temporary manager has recognised this in their AQAA as an area that could be improved Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: upon, Support Plans could be written with Photographs and Symbols to make them more accessible to the people. It is clear that the staff team are very aware of peoples needs and wishes which must always be put first and foremost. Support staff are allocated to certain people as their key workers. They spend more individual time with them and take a leading role in making sure their needs are met, such as obtaining toiletries and clothes and maintaining contact with their family. Key workers are also fully involved in drawing up and reviewing peoples support plans. They get to know and understand peoples needs and wishes and advocate on their behalf. We are told in the AQAA that, progress is reviewed at least 6 monthly. Also each person has a yearly support meeting which is again reviewed at least 6 monthly. The funding authority arranges a placement review each year. This is where people who live in the home and their representatives are invited to share any concerns, whether their needs are being met satisfactorily and whether there are any changes to the persons care needs. Daily records are kept by the home which provide very helpful information about peoples ongoing lives, their health, welfare and progress and show their plans are being followed. Also staff hand over information about how people who live in the home spend their day, when they change shift, to their colleagues. This information sharing is in relation to people living in the home and describes life events, their behaviours, moods, health problems and activities taken part in. Each person who lives in the home has a communication profile including an assessment of their verbal, non verbal, receptive language, opportunities and needs. We observed staff during our visit using different communication styles to ensure each person is understood and people are enabled to make choices as their abilities allow in their daily lives. One improvement the AQAA informs us of is, To try to access communication training for staff who have not recieved it to enable them to be more proactive in communication skills. We were also informed that there are plans to extend the use of pictures and objects of reference for menu planning and food shopping lists, which will be another positive development. Relevant risk assessments are carried out and included in plans showing that staff are taking appropriate steps to keep people safe, whilst promoting their rights to lead a normal lifestyle. Some risk assessments relate to general areas such as moving and handling, bathing, financial management and within the home environment. There are also individualised protocols to help staff manage individuals particular behaviours and medical conditions. They show the staffing and other support needed, to enable each person to go out and take part in activities in the community for example. On the day we visited a manager from another of the organisations services made a decision to take a person out on their own in a car. As mentioned previously in this report this persons behaviour has been unpredictable and requires staff support. This person had already thrown objects around the kitchen at lunchtime (further discussed in the lifestyle section of this report), prior to the manager going out with them. Whilst in the car the manager sustained an injury to their arm which was a result of the persons behaviour towards Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: them. The manager needed to attend the accident and emergency department of the local hospital to be medically assessed. This injury occurred whilst the manager was in the driving seat of the car and the person being supported was in the passenger seat. We looked at this persons support plans and risk assessments to see what information they provided to staff when going out in the community. We found that documentation said that the person needed to be seated in the rear passenger seat of the car when going out with staff. Therefore, we are concerned that support plans and risk assessments may not always be put in to practice to safeguard people from harm. We discussed this incident with the management team on the day of our visit who acknowledged that the plans and risks in place had not been followed. We have made a requirement that all support plans and risk assessments are followed in practice so that people who live in the home are protected from harm. People living at the home clearly can make decisions about their lifestyle and choose daily routines. Although some choices are limited due to the nature of their disability (and so dependence on staff assistance) or safety risks. From our observations and reports from visitors and staff we have been made aware that on occasions peoples choices and decisions are being restricted. For example, people were not able to finish eating their lunches in the kitchen and people are guided by staff to leave certain areas of the home for their own safety. It is now a requirement that in these situations agreements are made with those involved and or their representatives about the restrictions placed on individuals. This will make certain staff can meet individuals choices to the extent feasible and keep them safe. Such agreements should be recorded and any informed consent issues considered by referring to the guiding principles of the Mental Capacity Act together with the DOLS, (Deprivation of Liberty Safeguards). This practice should make sure that people living in the home and or their representatives are making choices about their lives to enhance them. Also individuals are not being deprived of their liberties without going through a formal process. Regarding issues of equality and diversity the homes philosophy focuses on meeting individual needs, such as, same gender care and needs due to physical disabilities are met. The AQAA confirms, All staff when joining Dimensions receives Diversity training as part of My Approach. Surveys we received from family members and advocates informed us: They treat each person as an individual with their own likes and dislikes and give lots of encouragement if something has been achieved. The staff who look after X are kind and dedicated. Staff told us: We always try to support residents with all their needs and give encouragement. Work well as a team, staff always put the people we support first. Care Homes for Adults (18-65 years) Page 17 of 39 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. People can do things they value and go to places they like. Recently, in practice this has been somewhat restricted and improvements should be made in order to ensure that people can meet their goals. Generally healthy food is offered and enjoyed. Evidence: The activities coordinator is currently away from work on leave. Therefore one of the managers who is assisting at the home is reviewing the opportunities of both in house and external activities for people who live at Castle Road to take part in. We were shown a board in the office with a daily plan for each person who lives at the home for staff to see at a glance. In the AQAA the temporary manager told us they are looking into providing photographs and symbols for activities. This would be an important improvement in making sure people who live in this home are able to take part in planning and choosing activities that they are interested in. We found in the care records that we sampled that peoples plans show what activities people enjoyed doing and what they disliked. There were examples of people taking part Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: in a range of activities, such as, making cakes, going to the local shops, car rides, fish and chip shop, going to Tescos, car rides, cooking and preparing tea, helped when supplies delivered to home, walking outdoors in countryside, discos, cinema and pub. The temporary manager told us in their AQAA, We are looking into individuals being more involved in work and leisure activities outside of the home environment. This action should make sure that people have the opportunity of a wide and varied choice of activities that are meaningful to each person. It was concerning that on some occasions restrictions are placed upon people in regards to their daily activities. We were told by family members, advocates and staff that this is because of managing and supporting the behaviours of a person who moved into the home, (as mentioned earlier in this report). For example, on the day we visited people were having their lunches in the kitchen when a person began throwing items around the kitchen. Therefore staff had to remove other people from the table to make sure they were safe from being hit by kitchen objects. This incident meant that people could not continue with their meals and staff moved peoples meals into the hallway. The inspector was told that these meals would be thrown away. Due to this staff took people out for their lunch. This is an example where people living in this home are not always able to have their choices considered and or their daily lives are being interrupted by staff supporting a person with their behaviour. Family members, advocates and staff informed us that they felt that individuals liberties are sometimes being deprived due to the physical aggression shown by a person who lives at the home. The temporary manager reported in their AQAA, Individual files include information on their Relationship Circle. This is used to illustrate the circle of support that is important to each person and how the staff at Castle Road can help people maintain their relationships. On the day we visited we met with one family member and an advocate who visit the home on a regular basis. We were told by the family member that they are fearful for the safety of their loved one and themselves when visiting the home due to the physical aggression showed by a person living there. We were told by the management team that advocates are being sought for people who have no representative to make sure that individuals have support to make choices and follow through decisions. This is particularly important as some people living in this home would need a great deal of support in expressing their choices in any decisions that require to be made. The food is purchased locally and staff prepare the meals as needed each day. Records showed a balanced and varied diet is being offered. It was positive to see that people are offered fruit and vegetables to help them maintain the recommended five a day to promote a healthy nutritional diet. There are no set times for meals and drinks, and snacks are available throughout the day. We observed people being offered drinks and at lunchtime people chose to sit around the table in the kitchen to have their meals. The temporary manager told us in their AQAA that Each person supported could be provided with their own cupboard in the kitchen to store personal food items that they have chosen. Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: Environmental health officers visited the home earlier this year and a certificate was displayed which confirmed that a four star award had been given which means food hygiene is very good within the home. Care Homes for Adults (18-65 years) Page 20 of 39 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. Further improvements in the recording and storage of all medications are needed to give greater confidence to people that medication is being managed safely and effectively at all times. Medication aside, people can be confident that their health and care needs are documented and attended to, and that they are treated with respect. Evidence: During our visit we were able to meet with most of the people currently living at 44 Castle Road. We saw that they were all well dressed in clean clothing of good quality. What they wore reflected their individual personalities, and was appropriate to their age and gender. We could also see that they had received the support they needed with their personal care and hygiene. We saw and heard staff interacting with people. Some of the staff have worked at the home for a good number of years. This helps to promote continuity of care. We saw people approaching the temporary manager and members of staff for support. They treated them in a respectful way, with warmth and friendliness. It is clear that they are comfortable in each others company. As we reported above, people all have detailed care plans, so staff have clear guidance about how they like to be supported. Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: We looked at peoples records to see how their healthcare is planned and managed. There are health action plans, (HAPs), as recommended by the Department of Health. HAPs meet with the Department of Health guidance for people with learning disabilities as they help to ensure that their health is monitored; any problems identified and their good health is being promoted. They can also help to show that individuals special health care needs are recognised and understood and that people are being supported to stay healthy through preventative as well as routine and specialist health care input. We were told that these are being currently reviewed but from sampling peoples care records there were appointments with health professionals and other members of the multidisciplinary team. These included GPs, consultant psychiatrists, dentists, opticians, and social workers/care managers. On the day we visited a person was being supported by staff to attend their consultants appointment. This shows that people living in this home are receiving healthcare where required to help them stay healthy. We now recommend that each persons health action plan is updated and reviewed in a timely manner so that it gives a good account of individuals medical conditions, any treatment needed and action taken for staff to follow. We found behavioural protocols in the care records for one person we case tracked. These are important as this person has behaviour that requires managing. We also received action plans from the regional director which reflected how staff and other professionals were assisting staff to support this persons challenging behaviour. This included advice, guidance and training from the persons consultant, behaviour therapist and speech and language therapist. The care manager from the community learning disability team was also involved and visited the home to offer the person and staff support. At the previous inspection it was noted that Plans for the coming year include a change to the medication record system currently used and work towards people keeping their medication in their own rooms. It was disappointing to see that this remains outstanding but we were advised by the temporary manager that medication storage is an area that will be improved. In the AQAA the manager said, To have individual medication cabinets in each person supported bedroom. Medication changed over to the Boots blister pack system. This should improve the way medications are received, administered and leaving the home or disposed of. As it was concerning that we were unable to audit peoples prescribed medications with a member of staff. We found all medications were stored in their original containers but we could not accurately audit these medications to ensure that it had been given as prescribed by individuals doctors. The staff who were on duty at the home were unable to locate information relating to this matter but informed us that they were not surprised by what we found. Complete and accurate records about medication are important so that all medicines can be accounted for and people are not at risk from errors, oversights and receiving their medicines incorrectly. We were concerned that this practice did not provide safeguards for individuals health and wellbeing. As a result of our concerns during this inspection an immediate requirement was made. These are things the service must do immediately to ensure concerns are Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: resolved. The immediate requirement has now been met within the agreed timescales by the temporary manager who has developed a clear audit trail of documentation for each persons medications. This should make sure that peoples health and safety is protected until the new medications arrangements are in place. However, medications will be checked when we next inspect the home. We were told that medications are only given to people who live in the home by trained staff. At the previous inspection it was noted that not all staff who were giving medication were trained. We were given a sample of the training matrix which is currently being updated and found that it shows six members of staff out of eleven have received medication training. We looked at a sample of the staffing rotad which show that at least one member of staff who has received medication training is on each shift so this should ensure people living in the home are given their medications by trained staff. Care Homes for Adults (18-65 years) Page 23 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people are happy that their concerns are listened to and taken seriously. Others may need more support to ensure that any concerns they have are raised and dealt with. A framework is in place to help protect people from abuse. Evidence: There is a clear complaints procedure and process which staff are aware of. This is important as people who live in this home may find it difficult to raise complaints in a traditional way and would rely on staff to recognise when they are unhappy. As mentioned earlier in this report each person has a key worker who represent them and efforts have been made to involve representatives and advocates. The complaints procedure is also detailed in the statement of purpose and service user guide in formats using pictures to illustrate the written word. The temporary manager has told us in their AQAA that there have been no complaints raised in the last twelve months. The Care Quality Commission, (CQC), have received four complaints which have been in relation to the physical aggression shown by a person who lives in the home to other people who live there. There is a clear policy in place regarding the recognition of abuse and the actions to be taken. We have raised safeguarding referrals to the local authority in relation to the incidents where people living in the home have been hit and or had objects thrown at them by another person who lives there. On some occasions people have sustained injuries. The regional director has developed an action plan to ensure that this person is supported by external professionals who have the skills and knowledge to respond to Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: traiin staff in supporting behaviours such as agitation or aggression. This has been difficult to achieve at times and has resulted in people living in the home having decisions made for them and their choices restricted due to staff protecting individuals from harm as mentioned earlier in this report. The temporary manager confirms in their AQAA that one area for improvement in the next twelve months is for staff to attend training in relation to the Mental Capacity Act. Also the Deprivation of Liberties Safeguarding, (DOLS), which examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. Survey responses from family members and advocates: X is withdrawn and miserable due to X being frightened. X is a very placid and cant communicate very well. X has been attacked several times and injured. Staff spoken with knew what was expected of them and had knowledge about abuse and how to recognise this. It is also commendable that staff have raised their concerns, as mentioned previously in this report, which show they have the knowledge to recognise abuse and how to report it. In the AQAA it tells us that staff have received training in adult protection. We could not find how many staff have received training on the planner given to us, (discussed further in the staffing section of this report), and we therefore recommend that this is now updated. This will make sure people living in the home are in safe hands at all times. We also looked at staff records as detailed in the staffing section of this report. We saw that checks had been carried out with the Criminal Records Bureau (CRB) prior to employment. This shows that the service takes action to ensure that people are fit for their jobs. Two peoples finance records were looked at. Receipts of each purchase were available. Staff sign monies in and out of the home in front of the person whose money it is this means that peoples monies should be safeguarded. However, one persons monies were short by twenty pence but we were assured that this, would be put right. Each person now has an up to date inventory of their possessions to ensure that staff know what possessions each person has and it is easier to track if things should go missing. Care Homes for Adults (18-65 years) Page 25 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home was clean and tidy, some parts of the home need further redecoration and are not homely, which could impact on the well being of the people living there. Evidence: The home is in a residential area and blends in with the other houses in the road. We completed a tour of the home with the regional director. Following the last inspection, a number of issues were highlighted as needing attention, for example, there is now a shower above the upstairs bath and the bathroom flooring has been repaired. This shows that the management team are making sure that the home is well maintained. Some of the bedrooms of people who live in the home were seen. These are individual, with personal possessions that reflect peoples tastes and interests. Attention and support from staff have helped people to make their rooms homely and comfortable. It was also noted that bathrooms and toilets are fit for purpose and functional. In the kitchen there is a table with chairs where all the people living in the home can choose to sit to have their meals if they wish. It looked clean and we were told that people living in the home do complete tasks in the kitchen with some assistance from staff. On the day we visited we observed people sitting and having a drink in the kitchen as they wanted and their lunch together. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: Some improvements now need to be made to the decoration of communal rooms, such as, the lounge and hallways where the decor looked tired and in need of brightening up. We were advised by the regional director that there are plans for the landlords to decorate all communal areas. In the lounge area walls needed to be repainted and it lacked homely touches, such as, no pictures or paintings on the walls, no ornaments and so on which were relevant to the people who live in the home. We were told that all of these have been removed due to a person throwing objects which could cause injuries to people living in the home, staff and visitors. In the action plan it was noted, In all areas of the house pictures, ornaments, kitchen items have been removed for safety reasons, these will be replaced when Xs anxiety levels reduce. This has resulted in the homes interior looking bare and unlived which has the potential to reduce peoples sense of belonging. We found the homes environment to be clean and hygienic with no unpleasant odours. There is a cleaning schedule to make sure that the home remains clean and hygienic. There are hand washing facilities in place within the communal areas that we looked at therefore making sure infection control is promoted and people who live in the home are not placed unnecessarily at risk from infections. The fire alarms were tested on the day we visited the home. The kitchen door did not close automatically when the alarms were raised. Therefore the regional director contacted Nexus who complete maintenance duties in the home. Maintenance people arrived and ensured that the door did close on the sound of the fire alarms so that people in the home are protected should there be a fire. People living at 44 Castle Road benefit from ordinary, comfortable housing within the community, which is suitably adapted and equipped to meet their needs. Some aspects of the accommodation as mentioned earlier still need improvement to make the home look nicer and to provide updated and better facilities. Care Homes for Adults (18-65 years) Page 27 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the arrangements in place ensure that people living at the home benefit from a staff team that meets their individual needs. There is some room for improvement to make certain fifty per cent of staff have acheived NVQ Level 2. People are being protected by staff recruitment procedure. Staff are dedicated and kind. Evidence: A minimum of two staff are on duty during the day. This is often increased if the manager is working in the home. The minimum level has been increased to three staff recently to provide additional support to one person who lives in the home for the next three months. We were told that this is whilst this person is settling into the home and requiring staff to support their behaviour difficulties. This is confirmed on the action plan that we have received. We sampled the staffing rota for the last four weeks and found that three staff work during the day on various shifts with one staff member overnight. We were told that the sleep in member of staff does not need to change to remain awake overnight. This is because all people living in the home do not need assistance throughout the night time period. The staffing rota does document relief staff who work at the home on a regular basis covering for staff absences so that consistency is promoted when providing care and support to people who live at the home. Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: From our observations and conversations with staff we found them to be well motivated and worked together for the benefit of people living at the home. Reports on the conduct of the home and staff reflect however that they have needed to work hard on providing support to a person, who has moved into the home with their behaviour. Also the manager is currently away from the home and the temporary manager is updating all records. This has affected the frequency of staff meetings and supervision which clearly can impact on staff morale and so could affect team effectiveness. In the AQAA the temporary manager has recognised this and told us, Staff will be supervised more regularly and team meetings will be planned for the next 12 months. Management need therefore to also keep staff support under review and to make sure that staff feel valued. Feedback from surveys was positive about the staff team. They were described kind and dedicated within their role. We spoke to some staff in private. All staff were positive about the service provided to people living in the home but were concerned for the safety of three people who lived there due to a persons potential to be physically aggressive as mentioned earlier in this report. As already mentioned regular team meetings and supervision will enable staff to share their concerns. The Annual Quality Assurance Assessment (AQAA) shows that five staff are trained to National Vocational Qualification Level 2 (NVQ), or above, and that training provided meets national standards and statutory guidelines. However, there have been some staff changes and as required from the previous inspection this needs to improve to make sure 50 per cent of staff or over hold an NVQ Level 2. This will make sure that people who live in the home are assisted and supported by staff who have the appropriate knowledge and skills to meet their individual needs. As reported above, sampled files contained some information about staff qualifications and training. We were also shown the training matrix which is a planner that is used to document staff training. We found that this does not always correspond with what training staff have achieved, what training is outstanding and what refresher courses are required. T he lack of an up to date training and development plan for the staff team makes it difficult to assess fully the effectiveness of the training programme. As we have stated throughout this report we acknowledge that the temporary manager is reviewing all paperwork within the home. Therefore it is recommended that staff qualifications and training certificates are properly indexed on their personal files, for ease of reference and the training matrix is updated on a regular basis. This should show (for each member of staff) training completed and qualifications gained (with dates), gaps in training including refreshers, and dates when outstanding training is to be delivered. It was suggested that doing this could provide the manager with an effective tool for monitoring and updating the training and development needs of the staff team. Staff survey responses told us: Provide good staff mix and provide good training. Page 29 of 39 Care Homes for Adults (18-65 years) Evidence: Two staff files were sampled. These contained copies of completed applications, two written references and we found checks had been completed in relation to the Criminal Records Bureau (CRB). Examined files also contained copies of job descriptions, declarations of medical fitness to perform allocated duties, and copies of qualification and training certificates. This should make sure that staff employed are able to work with vulnerable people and peoples living in the home are protected from harm. Care Homes for Adults (18-65 years) Page 30 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager must now continue to ensure that necessary improvements to the way in which the service is run are put into practice. This will ensure that the home operates in the best interests of people who live there and that everyone is supported to stay healthy and safe. Evidence: We talked to the management team, family members, advocates and staff, to help us make a judgment about how well the home is run to promote good outcomes for people who live at 44 Castle Road. An experienced Manager from another part of the service has been drafted in to supervise the home as the permanent manager is away from work. The temporary manager, Mr. David Round is appropriately qualified and experienced to run the home. Mr. Round has been assisted by a manager from another service and the regional director. As stated elsewhere in this report, it has to be acknowledged that the temporary manager is working hard to develop and review all records of information within the Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: home. However, they have not been at the home for a sufficient length of time to fully update and develop all records which they openly told us on the day we visited the home. The temporary manager is currently engaged in assessing and agreeing priorities for taking the service forward which they have documented in their AQAA. These include: reviewing the staffing arrangements for the home developing a clear strategy for care management and residents support adapting work practices and ensuring that staff have clear direction, appropriate supervision, and the support they need to do their jobs more effectively. This shows the management team have a good understanding of the things they need to do to improve the service for the benefit of people who live at this home. It is the responsibility of the organisation to ensure that their representative visits the home on a monthly basis under Regulation 26 (Care Homes Regulations 2001) to ensure it is being well managed. Reports of these visits were available in the home. These provide the management team with an overall picture of what improvements need to be made. In the AQAA the temporary manager told us, This report will include views on the service from people who use the service, stakeholders & interested parties. This should make sure that the home is run in the best interests of people who live there. We found health and safety risk assessments had been completed, such as, cleaning tasks, changing light bulbs, hot surfaces, first aid and medications. These assessments are all new and therefore require to be read by all staff and then signed which the manager is aware of. We also looked at safety inspections for the fire alarm and emergency lighting systems which have been checked regularly and a written record of tests maintained. Some care needs to be taken to make sure that fire drills have the names of people who live in the home and staff whom take part with dates and times highlighted. This should ensure that people living in the home can be confident that if a fire breaks out there are well tested procedures in place for staff to follow. Fire fighting equipment has been serviced and a fire risk assessment is in place. Water testing is done to make sure people are protected from scalds and legionella. The gas safety and electrical circuit certificates are both in date. We were told the COSHH (Control of Substances Hazardous to Health) cupboard was secure, as required. As discussed throughout this report concerns have been raised with us about the safety of people who live at 44 Castle Road due to the support a person requires with their behaviour. The management team have ensured that the CQC, (Care Quality Commission), have received notifications about all incidents that have affected the wellbeing and safety of people who live in the home. We have also received action plans that told us how a persons behaviour would be managed and by who. Despite these measures it has been reported to us, as reflected throughout this report that family members, advocates and staff have been concerned about the affect a persons physical aggression was having on other people who lived in the home for the past two months. Therefore information from these reports and what the inspector observed on the day of Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: the inspection, puts into question the outcomes people are receiving at 44 Castle Road. However, we were told by the management team that this has been a difficult time in the home due to the persons anxieties when they moved into the home. We were also aware on the day we visited the home that the regional director and the persons care manager from the community learning disabilities team, were looking at an alternative home for this person to live. Also the temporary manager told us in their AQAA that procedures are in place, such as, support plans, reviews, meetings with people who live in the home, to make sure that each person who lives at, Castle Road is fully involved in the running of their home and the way they live their life. These procedures need to be done in a timely manner, consistently documented and updated, robust in practice and informed by the Mental Capacity Act, and DOLS. This should make sure that each person living at 44 Castle Road is able to influence the running of their home and how they choose to spend their daily lives whilst their health and safety is promoted. Care Homes for Adults (18-65 years) Page 33 of 39 Are there any outstanding requirements from the last inspection? Yes  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 20 13 (2) Arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home must be made. Specifically this means that all staff must be trained in the safe administration of medication. 22/12/2007 2 32 18 (a) People working at the home must be suitably qualified, competent and experienced. Specifically this means that NVQ training needs to be undertaken to make sure that 50 of the staff team are suitably qualified. 22/12/2007 3 37 9 (1) The manager must complete 22/11/2007 an application for registration with the CSCI. Care Homes for Adults (18-65 years) Page 34 of 39 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page PAGE of NUMPAGES 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 Description 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 Description Timescale for action 1 7 12 14/07/2009 Choices should be given to service users but where this is not possible then this needs to be formally recorded and the guiding principles of the Mental Capacity Act and Deprivation of Liberties Safeguarding should be used in practice. This will make certain that service users are not having restrictions placed on them which affect the quality of their lives whilst living at 44 Castle Road. 2 16 12 Practices should be reviewed 14/07/2009 so that service users have unrestricted access to parts of their home they choose to be in, such as, the kitchen and lounge areas. This should make certaiin Care Homes for Adults (18-65 years) Page 36 of 39 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 Description Timescale for action that service users have the choice of where they would like to sit in their home so that their rights are respected and their quality of life is promoted. 3 32 12 The manager must ensure that fifty per cent of staff who work in the home acheived their NVQ Level 2. 07/10/2009 This should ensure that staff have the necessary skills and knowledge to meet the individual needs of service users which will demonstrate that service users are in safe hands at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide must be made accessible to people visiting the home together with people who already live at the home. Specifically this means that the temporary manager must now print both of these documents from the computer so that they are both made available. This will make sure staff can locate both information guides and people considering living at the home will be able to look through them prior to making any decisions about living at 44 Castle Road. It is recommended that the management team review their admission procedures to specifically examine how the compatibility of other people living in the home is considered together with how this is put into practice. This Page 37 of 39 2 2 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations should make sure that people moving into the home will be able to fit in with the other people already liviing in the home. 3 6 It is recommended that the acting manager should consider following through their idea of support plans being written in other formats, such as, using photogrpahs and symbols. This will make them more accessible to people living in the home. It is recommended that holidays are pursued with all people who live at the home to ascertain whether individuals would like to visit other places. This would ensure people are supported and have access to a full range of appropriate leisure activities that hold value to them. It is recommended that the Health Action Plans for all people who live in the home are reviewed to make certain these are all up to date so that people received health care as required and monitroing takes place to ensure early detection of any underlying medical conditions. It is recommeded that the redecoration of the communal areas, such as, the lounge and hallways continue to be pursued, with homely touches that reflect the tastes of the people who live in the home. This should ensure that people live in a home that is well maintained and homely. You should complete a training and development plan for the staff team, to ensure that staff have the knowledge and skills they need to do their jobs. You should ensure that all members of staff receive regular formal supervision, with written records kept of each meeting. Staff should also receive an annual appraisal of their performance. This is to make sure that they get the support they need to do their jobs well. 4 14 5 19 6 24 7 35 8 36 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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