Inspection on 10/09/09 for 7 Newgate Lane

This inspection was carried out on 10th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

7 Newgate Lane 19/10/09

7 Newgate Lane 18/02/09

7 Newgate Lane 12/09/08

7 Newgate Lane 10/01/07

7 Newgate Lane 14/12/05

7 Newgate Lane 21/06/05

7 Newgate Lane 25/01/05

7 Newgate Lane 12/08/04

7 Newgate Lane 10/12/03

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 24/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 7 Newgate Lane 7 Newgate Lane Fareham Hampshire PO14 1BQ zero star poor service The quality rating for this care home is: 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: Craig Willis Date: 1 0 0 9 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 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 Information about the care home Name of care home: Address: 7 Newgate Lane 7 Newgate Lane Fareham Hampshire PO14 1BQ 01329667041 01329667041 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.c-i-c.co.uk Community Integrated Care Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 4 4 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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: Learning disability - LD Date of last inspection 1 8 0 2 2 0 0 9 A bit about the care home 7 Newgate Lane is a care home that offers care for up to four people who have a learning disability and sensory disability. The property is owned by Knightstone Housing Association and is managed by Community Integrated Care. The home is situated in a residential area near to the town of Fareham and the village of Stubbington. The home has easy access to local recreational and health care facilities. 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: zero star poor 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 How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 10 September 2009. We spoke to the person managing the home during the visit, staff that were working and we observed the way staff listened to people who live there. While we were in the home we looked at some of the records that staff keep. The registered manager had left the home in August 2009 and a new appointed manager was on a period of leave. The registered manager of another CIC service has been placed in the home 3 days per week to cover the managers leave. What the care home does well People are supported to plan a healthy menu that takes into account their likes and dislikes. Mealtimes are flexible and people can choose a different meal if they want to. People receive personal care in the way they prefer. The home has provided information about how to complain and the services they provide to people on a CD. This makes the information more accessible to people. The home is well maintained. Peoples bedrooms and the areas they share are comfortable and safe. Staff working in the home have been thoroughly checked. This helps to keep people safe. What has got better from the last inspection What the care home could do better Care plans and risk assessments need to be reviewed and updated. This will ensure staff have the right information about how to meet peoples needs. Staff are not always able to support people to take part in the activities they have planned. Staff need to make sure people are supported to receive their medication safely. All staff working in the home need to know what to do if there is an allegation of abuse. The manager needs to ensure all staff have regular supervision meetings. This will help to ensure staff have the support they need to do a good job. The provider must ensure all actions in inspection reports are met on time. 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 Craig Willis Care Quality Commission – SE Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems to assess peoples needs before they move into the home. This helps to reassure people that the home will be able to meet their needs. Evidence: The manager reported in the annual quality assurance assessment for us that no one has moved into the home in the last three years. Community Integrated Care has procedures in place for the referral and admission of new people into the home, although these were not inspected during the visit. The home does not currently have any vacancies and the person managing the home at the time of the visit reported that she did not anticipate this changing in the near future. 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. The homes systems to develop and review support plans and risk assessments are not always followed and some plans are out of date. This means staff do not get accurate, up to date information about peoples needs. Evidence: We looked at the records of two people who live in the home during the visit. Both people had a care and support plan, which set out how their assessed needs should be met. The plans included peoples personal care, communication, mobility, social relationships and travel. The plans we looked at had not been reviewed since June or July 2008. Both of the people whose records we looked at had a person centred plan, which set out peoples wants and aspirations and covered how people should be supported to make decisions. The plan for one person had not been reviewed since November 2008. Both people had a set of risk assessments, which identified hazards people face and contained actions necessary to manage the risk of harm. There were examples where the actions to manage the risk were not being completed. One example was that the bed rails used by one person to prevent falls should be checked weekly by a nominated person. There was no record that these checks were being completed. The home had a weekly health and safety check, but the form used to record these checks had been copied incorrectly and the section that included bed rails had been missed off. The person managing the home was unable to tell us whether the checks had been completed. The risk assessments were also not being regularly reviewed. The manual handling risk assessment for one person stated that it should be reviewed at six monthly intervals. The assessment was completed in July 2008 and the homes previous manager had signed to say it had been reviewed once, but this had not been dated. There was only one recorded review of the assessment since July 2008. Evidence: The files inspected contained a lot of detailed information about peoples needs, but it was confusing and not clear that all the documents were current. Some of the documents seen were not dated or signed. During the visit we spoke to three staff who were working at the home. One was a permanent staff member, one had been moved to the home temporarily as cover for staff shortages and one was a member of agency staff. Two people told us the care plans were working documents and were mostly up to date but did need some changes. The member of agency staff said they were given brief information about peoples needs when they first started, but this was provided by another agency worker. 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 have an individual plan of activities, however, they are not always provided with the support they need to take part in them. This means that peoples choices about the lifestyle they lead are not always met. Evidence: The manager reported in the annual quality assurance assessment for us that people are encouraged to take part in activities of their choice to reach their full potential. Some people who live at the home are supported to attend a local day service. Personal activity plans are in place for each person who lives at the home, however, the person managing the home during the visit reported that some of the activities do not happen because of staffing difficulties. Examples given were one person who was due to go swimming each week but it was reported this only happens approximately every other week; one person was due to go out to a sports bar each Saturday afternoon but this is not happening; and one person was due to go to church each Sunday but again it was reported this was not happening. One staff member spoken with said staffing difficulties over the last six months had impacted on the activities that people were supported to take part in. The home has a menu that is planned each week. The person managing the home reported that the menu is planned with input from people who are able to and taking into account the known likes and dislikes of other people who live at the home. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for managing medication are not effective and previously identified shortfalls in medication administration have not been well managed. This places people who use the service at risk of not receiving their medication or of receiving the wrong medication. Evidence: Following the last key inspection we made a requirement that accurate records must be made when medication is administered to people. We did a random inspection of the home on 18 February 2009 when we found that records were being kept of medication administered to people, but people were not always receiving the medication they had been prescribed. As a result, we made a requirement that people must be supported to take any medication they have been prescribed. Since the random inspection in February 2009 we have received notification from the home that on two occasions people did not receive their medication and on another occasion one person was given the wrong medication by staff. During this visit we inspected the medication administration records and storage. We found that there were 15 occasions since 18 February 2009 when staff had not signed the medication administration record to say they had administered peoples medication and one person who did not receive the medication they had been prescribed for 18 days because the home had run out of the medication. We also found 16 tablets that were held in the medication cabinet were past their expiry date. As a result of the on-going concerns about medication practice at the home and the failure to comply with a previous requirement we have issued a statutory requirement notice. The provider and manager must ensure that action is taken to comply with requirements. The care plans we inspected contained details of the personal care support people need and how it should be provided. Staff spoken with during the visit demonstrated a good understanding of peoples personal care needs. The personal records also contained details of the health appointments people have had, Evidence: including any advice from the practitioner. Both people whose records we inspected had a health action plan, although one of them had been completed in 2003. These plans are assessments of the services that people receive and an assessment of any other services that people may need. One person whose records we inspected had been weighed monthly until January 2009, but there was no record after that. Another person had been weighed each month until April 2009, with nothing recorded after. 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. The home has responded well to allegations about staff practice. However, the lack of available procedures, available records and understanding of some staff increases the risk that peoples concerns and complaints will not be dealt with promptly. Evidence: The home has a complaints procedure that is provided to people who live there in audio format to make it more accessible. The complaints section of the annual quality assurance assessment had not been completed when it was sent to us. During the visit the person managing the service could not find the complaints records, but did say she thought there had not been any since the last inspection. Community Integrated Care has procedures for keeping people safe from abuse, although the person managing the home at the time of the visit could not find a copy. The home did have a copy of the Hampshire safeguarding procedures, although it was from July 2003 and there is a more recent version of the document available. There has been one allegation since the last key inspection that a staff member did not provide care in the right way. This was reported to adult services under the safeguarding procedures and was subsequently dealt with under the homes disciplinary procedures. The records of this investigation were not inspected as they were held in a separate office. Three staff members were spoken with during the visit. Two staff confirmed that they had completed the safeguarding training and demonstrated a good understanding of different types of abuse, signs of possible abuse and action to take if abuse is witnessed, reported or suspected. The other member of staff was employed through an agency and reported that she had not received any safeguarding training and said she was not aware of the reporting procedures. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a clean, comfortable and safe environment for people. Evidence: All of the shared areas of the home were seen during the visit. Each person has their own bedroom and shares the lounge, dining room, kitchen, bathroom and garden. There is a separate laundry room with machines that are capable of washing soiled clothing. All areas were clean during the visit and staff spoken with said that maintenance issues were resolved in a reasonable time. Since the last inspection a new sprinkler system has been fitted throughout the home as part of the fire safety equipment. The manager reported in the annual quality assurance assessment that she plans to re-decorate throughout the home over the next year. 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. Staff working in the home have been thoroughly checked, which helps to keep people safe. There is a high use of agency staff and lack of staff supervision. This has not ensured that peoples social and cultural needs are always met. Evidence: The manager reported in the annual quality assurance assessment that 5 of the 6 permanent staff have completed the National Vocational Qualification (NVQ) in care at level 2 or above and 1 was working towards the award. The home has a staffing rota and generally operates with 3 staff in the morning, 2 in the afternoon / evening and 1 awake and 1 asleep overnight. Staff spoken with said they though the number of staff available was sufficient to meet peoples needs, but the high use of agency staff has prevented some activities taking place, as described in the lifestyle section of this report. The home has not recruited any staff since the last inspection, although the person managing the home at the time of the visit said there were three new staff who had been offered jobs and currently being checked before they start work. We looked at the records for two current staff members and both had evidence of a Criminal Records Bureau disclosure, identification checks and written references on file. The home has a training programme and staff records indicated people had completed a range of courses including non-violent crisis intervention, food hygiene, first aid, visual impairment, safeguarding, autism, moving and handling and medication. Some of the training people had completed was out of date and the person managing the home reported refresher courses were being planned. Staff spoken with gave mixed feedback about the training, with one person reporting it was relevant to their job, while one person said they found some of the courses were difficult to relate to their day to day work. A member of agency staff who had covered regular shifts at the home reported that the only training they had completed was manual handling and medication. The two staff records inspected indicated that people had not received a formal supervision session since November 2008. Staff spoken with also reported that they had Evidence: not received formal supervision sessions recently, although one person did say they could raise concerns if necessary. The person managing the home during the visit reported that she and the senior support worker were planning to meet regularly with all staff for formal supervision sessions. 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 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 not been effectively managed, which has resulted in shortfalls in the service not being addressed. This means the home does not always meet peoples needs. Evidence: The registered manager left the home in August 2009 following a period of absence from the home since April 2009. The provider informed us of the management arrangements during the absence. A new manager has been appointed from within Community Integrated Care but is currently on a period of leave. The registered manager of another CIC service is managing the home during this leave and is available in the home three days per week. The provider must ensure that an application for the registration of a manager is submitted to us. The provider has a quality assurance system in place, with regular visits to the home by senior managers and audits of the documents. We looked at the reports of visits to the home by senior managers and found that they did not always assess the quality of the medication systems and records, despite there being requirements about medication in the previous two inspection reports and further incidents regarding medication that the provider reported to us. We also found some of the audits completed reported that care plans and risk assessments were up to date and that medication administration records had been fully completed with no gaps. This did not match the evidence that we found during this inspection visit. The reports did not identify problems associated with the high use of agency staff, the failure of the staff team to support people to undertake their planned activities or the lack of staff supervision. The home has workplace risk assessments in place. These identify hazards faced by staff and have actions to manage the identified hazards. These assessments were all reviewed in May 2009. We inspected a sample of the servicing and maintenance records. These demonstrated Evidence: that most equipment in the home had been serviced within the required time-scale, although the gas safety certificate had expired the week before the visit. The person managing the home said she would address this issue as a matter of urgency. 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 The registered person must ensure people living in the home are supported to take any medication they are prescribed. 30/04/2009 This will help to ensure people receive effective treatment for any medical conditions. 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 6 15 The registered person must 31/10/2009 ensure that care and support plans are regularly reviewed and kept up to date. This will ensure that staff receive accurate information about the support they need to provide to meet peoples needs. 2 9 13 The registered person must ensure risk assessments are regularly reviewed and kept up to date and action is taken to manage the identified risks. 31/10/2009 This will help to ensure that the risks people face are well managed. 3 20 13 The registered person must ensure that medication kept in the home is within its expiry date. 31/10/2009 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 This will ensure people do not receive medication that is past its expiry date. 4 23 13 The registered person must ensure that all people working at the home have a clear understanding of the safeguarding procedures. 31/10/2009 This will ensure any allegations of abuse are dealt with appropriately and people are safeguarded. 5 36 18 The registered person must ensure that staff members have regular, formal supervision sessions with their manager. 31/10/2009 This will help to ensure all staff are working in the right way and receive the support they need to do their jobs effectively. 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. 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