Inspection on 24/09/09 for 8 Coriander Close

This inspection was carried out on 24th September 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

8 Coriander Close 03/07/07

8 Coriander Close 12/07/06

8 Coriander Close 01/12/05

8 Coriander Close 06/07/05

8 Coriander Close 03/02/05

8 Coriander Close 22/09/04

8 Coriander Close 14/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOME ADULTS 18-65 8 Coriander Close Northfield Birmingham West Midlands B45 0PD Lead Inspector Jill Brown Key Unannounced Inspection 24th September 2009 09:10 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 8 Coriander Close Address Northfield Birmingham West Midlands B45 0PD 0121 453 7292 0121 453 0831 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) joannesp@trident-ha.org.uk Trident Housing Association Ms Sophia Kinina Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 categories: Physical disability (PD) 5 Learning disability (LD) 5 The maximum number of service users who can be accommodated is: 5 3rd July 2007 2. Date of last inspection Brief Description of the Service: 8 Coriander Close is registered to offer long-term residential care to five people who have learning and physical disabilities. All of the people have complex health needs and all are wheelchair users. The home was purpose built in 1995 and is owned and managed by Trident Housing Association. The house is designed on two levels. On the ground floor there is a spacious open plan lounge and dining room, a sensory room, two well equipped bathrooms with mechanical baths, shower trolleys and hoisting facilities to aid lifting. The kitchen is also on the ground floor and is accessed from the lounge area. The first floor is accessed via a stairway. Located on this floor is the office, the laundry and staff facility including a bathroom and bedroom and is not accessible to people. Currently all communal areas are open plan and there are no private areas for people to receive visitors apart from their own bedrooms. The fees depend on people needs and are assessed at time of admission. Fees are not inclusive of items such as toiletries, hairdressing, outings, and reflexology. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. An inspection took place on a day in September without prior notice. This was a key inspection, which looked at majority of the national minimum standards. During the inspection one persons care was case tracked. Case tracking involves looking at all the records and information about them, including their medication and personal rooms. Another two peoples records were looked at in parts. This information was used to make a judgement about the care given. People living in the home do not have verbal communication and cannot access written or picture communication. Most people do not have family or representatives. We received two comment cards from Health professionals involved with the people in the home. We spoke to three staff the home manager and a representative of the organisation. We also took into account information we had received from all sources about the home since the last inspection. Services are required to complete an Annual Quality Assurance Assessment (AQAA) on a yearly basis telling us about their assessment of the homes performance and improvements they intend to make. Information from this was used in this report. We have received no complaints about this service since the last inspection. We are aware that the organisation intends to place the care homes it owns into a charitable trust and this will mean the organisation will change its name and will be registered again. What the service does well: People living in the home have their day to day care provided in a kind and caring way. We saw staff talking to people, maintaining eye contact and assisting people appropriately when giving them meals. Staff spoke about the people they care for in a sensitive way. Staff took responsibility for the care people receive and one member of staff said of new and agency staff They have to shadow us we will not leave them until we are confident they know how to care for the people here. Feedback from Health professionals said staff appear to be motivated and genuinely care for the wellbeing of the service users. They seem to be welcoming of health professionals and keen to talk about how they may be able to improve the care they provide. And (they are) considerate when dealing with clients; always respectful. (They) Respond to new demands/needs as they arise. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 6 People in the home looked well cared for with attention given to their personal hygiene, hair and nail care. The home has a vehicle and takes some people out to day services and people have the opportunity to have activities inside and outside of the home. People have a holiday arranged every year. The home is decorated and furnished to a good standard with bedrooms containing people’s personal items, so providing a homely environment. People get regular visits from health professionals such as their GP, dentists opticians and so on, and get support from health specialists where this is needed. There are care plans and risk assessments in place to support the way staff undertake the care of the people in the home. Medication administration was of a good standard, so ensuring people receive the medication prescribed by health professionals. What has improved since the last inspection? What they could do better: There is large amount information about the people that live in the home on care files. There is no easy way for new staff or agency staff to gain information from quickly. Information is not easy to update when a persons needs change. Information is repeated in a number of places and this means that information recorded is not always consistent. We were told in July in 2007 that the home planned to have raised beds for planting in the garden area and that there was a desire for a summerhouse and these have yet to be put in place. This limits the quiet areas available for 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 7 those people who find loud noises hard to tolerate. We understand that there are few representatives of the people living in the home and this affects the amount of independent views about the service delivered. We found on the day of the inspection one staff member was left in the home with three people whilst other people were taken to their day services. Rotas showed us this had happened before this is not sufficient staff to ensure the safety of the people remaining in the home. We also found that at the weekend staffing levels were lower with periods where only 2 staff were on duty during the day. We found the records of repairs was poor with little detail about the problem, any interim measures put in place to keep people safe and when the problem had been resolved. This included problems with hoists and call alarms. There are systems in the organisation to check the service however there are few monitors external to the organisation that would be invaluable to ensure the service moves forward and this could be improved upon. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available and this helps people and their representatives decide whether the home can meet the persons needs. There are suitable arrangements in place for information to be collected about people and this helps in ensuring that people get a good service. EVIDENCE: We were told in the homes Annual Quality Assurance Assessment that the organisation is looking to reorganise so that the care homes part of their work has charitable status. This will mean the organisation will change its name. As part of the change they are looking at reissuing the statement of purpose and service user guide. They will be taking the opportunity to make it easier for people that live in these services to use them. They are currently working on a website that will allow downloads of these documents including audio versions. A copy of the Statement of Purpose, Service User Guide and the last inspection report were displayed in the home. People living in the home have lived there for a number of years and there have been no new admissions since the last inspection. We were given a copy of the likely assessment paperwork under the new organisation. This was comprehensive covering areas such as basic details of the person; name, 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 10 ethnic origin, religion and so on. It covered the persons health and personal care needs, risks to them, people important to them and as well as the persons abilities, dreams and aspirations. If this is completed well then the home should be able to develop care plans that are detailed and are individual to the person. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate information is available to staff to assist and minimise the risks to people. Information is not always in form that it can be retrieved quickly. EVIDENCE: We looked at all of one persons care records and looked at parts of another 2 peoples records. The home has large amounts of information about the people they care for and plans for how this care is to be given. People living in the home have complex care needs, as they require support in every area of their day to day life. Detailed information is provided to support instructions of how care is to be given. However this information is not organised in a way to enable new workers or agency workers to get information quickly so that they can deliver 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 12 care well. The information is not easy to update as there are several places where the information needs to be updated. As well as information about peoples health and care needs, there is information about how the individual people show that they are happy or sad and any ways they can communicate their mood, changes in their health and it what ways the person can assist in their care. This information helps staff to respond to changes in peoples needs and maintain skills that the person has. People have an essential life plan which showed how they like things done which has been collected together over a long period of time. For example for one person it states, to put the light on dimmer switch for 15 minutes to assist the person waking and that the person can choose their clothing. These details ensure that plans are individual to the person. The majority of staff have worked in the home for a long time and know the people very well. Efforts are made to enable people to be involved in their care but in the homes Annual Quality Assurance Assessment (AQAA) it was recognised that this is not easy and the management is looking at new ways of increasing choices. The service is moving to working with the Eden principles. This includes ensuring that people are involved in all aspects of daily life and that people have good interactions with staff and their environment. Staff look at peoples care plans on a monthly basis and check that these still meet peoples needs. Information about reviews with the persons funding authority was not always available. We saw staff playing with, assisting people to eat and communicating with people and this was done well. Staff maintained good eye contact with people and spoke to them respectfully whilst talking to or assisting them. To ensure people are safe risk assessments are undertaken and for one person this included risk assessments about epilepsy, use of a nebuliser and some aspects of their personal care, going out in the sun, moving and handling, ensuring the persons skin remained healthy, actions to ensure that the person does not choke whilst eating and the provision of bed rails. We noted that staff were asked to sign to say they had read these and this did not match all the staff currently working in the home. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13, 15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have activities that they enjoy and this enhances their lives. People have appropriate food to meet their needs and to keep them as well as possible. EVIDENCE: On the day of the inspection two of the five people attended a day service. One person went out for a period of time and two people remained in the home. People going to day services are taken in the homes transport and one persons needs mean that this needs two staff. On the day of the inspection this left one member of staff in the home to look after three people, this is not sufficient to ensure people were safe. (Please see staffing and management sections) 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 14 On inspection of records it was found that people undertake a range of activities both inside and outside the home, so providing them with stimulation. Activities included visits to the cinema, shopping, going to a party at another care home, going through woodland, going out on public transport, the theatre, reflexology and going out for a meal. We received comments that there is sometimes not enough staff to ensure that people have the activities planned. Only one person in the home has any relatives in contact with them but there was a record of that person being assisted to visit them. No people have advocates and the management were concerned about this. Inside the home there is equipment for people to listen to music, use a foot spa, have a hydro bath, play ball games and use sensory and tactile items. The home also has a multi sensory room. There is a garden which is shared with tenants in the row of buildings. It was clear that all involved with the people in the home thought that this could be developed more to provide a quiet and more sensory resource. Whilst in the home people were observed to have time in their supportive wheelchairs and time playing with sensory objects on the floor or spending time on supportive cushions. We were told that all people have a holiday at least once a year and in the past went abroad two people have had a holiday at the end of May and the remaining three are to go in October. Three of people were being fed by a feeding tube in order to maintain an adequate nutritional intake. Records were available regarding the management of the feeds and these appeared to be managed in a satisfactory way. We discussed with staff how they ensured the cleanliness and effectiveness of peg feeding and the staff were able to give good accounts of this however the supporting documentation still needs to be improved. Staff received training in this area from an appropriate health professional and were clear of how to contact these professionals if they had any concerns. We looked at the menu for a week for a person that took food orally and found that a good range of food was planned for them. Recommendations from the Speech and Language Therapy of what food should be supplied were available. We observed people being assisted to eat and found that people were in a good eating position and that staff were taking time when assisting them. Records were maintained in respect of food and fluid intake enabling staff to monitor that people were receiving an adequate intake and if not action could be taken. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home have staff that are interested in ensuring they receive care and medication in a way that promotes their health. There is a lack of clarity on the records that are needed to ensure that risks remain minimised. EVIDENCE: People living in this home as well as having care plans showing how their personal care needs are to be met have health plans. These indicate how health conditions are to be managed and have details of contacts with health professionals involved. These plans showed that people had routine contact with health professionals such as GPs, dentists, chiropodist and opticians. In addition specialist contacts were maintained if needed. We looked at one persons health plan in detail and found it difficult to track all the information clearly about the persons epilepsy. For example a contact with a health professional indicated that a new protocol had been devised but the one on file was dated before this, records of seizures were held in a number of 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 16 places and did not always correspond and the risk assessment for epilepsy was not always evaluated following a seizure so that any learning could be implemented. Comment cards from health professionals stated that staff appear to be motivated and genuinely care for the wellbeing of the service users. They seem to be welcoming of health professionals and keen to talk about how they may be able to improve the care they provide. And (they are) considerate when dealing with clients; always respectful. (They) Respond to new demands/needs as they arise. We found that people appeared well cared for and had their hair and nails cared for. Whilst touring the home it was found that there was a range of ceiling hoists, portable hoists and sliding sheets were available, so ensuring people were moved in the correct manner. People had their own hoist slings and sliding sheets, which is good practice in reducing the risk of cross infection. We found the home had bed rails in place and there were risk assessments in place however these did not determine that there was sufficient clearance between the mattress and the top rail and this was an issue when bed rails were used with specialist equipment. They were advised to look at the Health and Safety Executive website to ensure that their risk assessments have the level of detail required. People in the home looked well cared for with attention given to their personal hygiene, hair and nail care. The home uses a monitored dosage system for medication, which is delivered on a regular basis. The medicine cupboard was in the kitchen and additional stocks secured elsewhere in the home. The kitchen temperature was 24 degrees centigrade at the time of the inspection and when food is being prepared the temperature may be above 25 degrees, which is above the recommended safe storage temperature for medication. The Medication Administration Records (MAR) had been signed appropriately indicating that medication had been given as prescribed by health professionals. At the front of each persons MAR there was a photograph of the individual this is another check to ensure that the right person receives the medication. The medication folder includes details of the medication each person receives, the action of the medication and how it is administered, so providing staff with the information required to ensure safe procedures. There were copies of the prescriptions of medication which is checked to ensure the right medication has been prescribed and dispensed. On a couple of occasions the amount of medication prescribed was more than on the MAR and received by the home. This should be discussed with the prescriber. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 17 Where people are prescribed PRN (as required) medication a protocol is in place stating when, why and in what dosage the medication should be given. These are signed by the GP. One resident is prescribed ‘rescue’ medication in case of having several epileptic seizures. A protocol for giving this was in place and staff had received training in how and when to give it. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to protect and support people that live there and this assists in keeping people safe. EVIDENCE: The information provided by the home in the Annual Quality Assurance Assessment indicated that there had been no complaints. We have received no complaints or allegations in the last 12 months. The home has a complaint procedure that outlines that the service provider expects peoples complaints to be acknowledged within 48 hours and an outcome to be reached within ten working days. Details are provider of where people can get help in making complaints. People living in the home have difficulty with written and picture communication and the home were looking at any methods that can be used to determine whether people are happy with the service. Most people living in the home have no relatives that visit and this makes it difficult for the home and the people living there to use the complaint system to improve the service. (Please see management and administration section.) There is a safeguarding procedure in place which covers all of the service providers care homes. There is a flow chart available which gives staff information quickly should they have concerns. The policy determines that the persons safety is most important. The service provider employs adult 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 19 protection officers and staff interviewed understood that if they had concerns that were to speak to these people. However the policy also indicated the decisions about safeguarding were the local social services. Staff had received safeguarding training and when spoken to were clear of their own responsibilities to report their concerns within the organisation. Staff were able to name most of the agencies externally that may be involved. The home keeps a record of any small marks that find on people whilst delivering personal care and record how this may have occurred. With people with such complex needs this is good practice. People’s records included an inventory of their belongings, which was comprehensive, and this helps to keep their items safe. Two peoples financial records were sampled. A small amount of available money is kept for day to day needs such as a meal out, reflexology, hair dressing, cinema and so on. This is topped with money from the safe or the bank. The service provider ensures that there are a number of signatories available and that no money can be accessed without 2 of these named peoples signatures. The money is checked each day at the time of staff handover and regular financial audits are completed to ensure resident’s finances are protected by robust systems. We received a comment about the delay in money being available on occasions but could not find where money was not available on site for a person. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have the benefit of a comfortable, safe and fresh environment that meets their needs. EVIDENCE: People living in the home have access to the ground floor of the building. The first floor contains the laundry, sleep in room and office accommodation. The home was clean and fresh on arrival at 08:30 am and remained so throughout the day. People not attending day centres or out on activities spend their time in a large lounge and dining area. This contained an area where people could spend time on the floor, on a large cushion or in a hammock. The area was well decorated and gave the appearance of being homely. There was a pay phone in the entrance hall and a hand free set that can be used where 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 21 privacy is required. There was a television, video recorder and DVD in one corner of the lounge. There is a pleasant garden to the rear of the property that has a patio area where people can sit if the weather permits. This garden area is shared with the tenants of flats in the row of buildings. At the inspection in 2007 we were told that there were plans to have some of beds raised so that they are more accessible to people and that they would also like to have a summerhouse in the garden that can be used for people to sit with visitors. These improvements have not yet happened and were reported in the homes Annual Quality Assurance Assessment as improvements expected in the next 12 months. For one person this would provide an alternative private space to their bedroom when the lounge dining area became too noisy for them. The home does have a multi sensory room which some of the people enjoy. There were five single bedrooms that were well decorated and it was clear that items that may hold interest for people were purchased. Bedrooms contained several personal possessions, so making it a more homely environment. There are two well-appointed bathrooms with accessible bath and shower facilities. In addition one of the bedrooms has an en-suite toilet and shower facility. All areas have ceiling hoists to assist with lifting people into the bathing facilities. The kitchen is adjacent to the dining area and it was found to be clean and orderly with appropriate equipment to manage resident’s meals. The temperatures of fridges and freezers are recorded to ensure food is stored at correct temperatures. The fridge temperature according to the homes thermometer was higher than recommended to keep food safe; the fridges thermostat was adjusted during the inspection. There is a separate laundry on the first floor, which was equipped with two sluice washing machines and two tumble dryers. Procedures in respect of the laundry appeared good with the use of personalized laundry bags for each resident and alginate bags for soiled items, so reducing the risk of infection. The home keeps its mops outside, as there is little storage space inside, a mop store is recommended. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staff are recruited well and receive training there is not always enough staff to deliver the care safely or respond to emergency needs. EVIDENCE: Duty rotas demonstrated that there was three staff on duty at most times during the day and it was adjusted according to people needs. However on some occasions shifts had not been covered enough leaving one member of staff on duty in the home with a number of people when other people were being transported to day services. There are less staff allocated to the home at weekends with two staff being available over some day hours. All agency staff are given an induction, which includes the tour of the building, information about the people and some of the policies and procedures. This was confirmed on discussion with a member of staff and inspection of the records. One staff member said when discussing the needs of the people and 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 23 the use of agency staff, They have to shadow us we will not leave them until we are confident they know how to care for the people here. There is a low turnover of staff. Staff recruitment files were not available in the home; however, three requested were brought to the home for us to look at. We looked at the most recent member of staffs file and found that potential staff complete application forms, there is a good process of interview, collection of references and checks. We were able to see the outcomes of checks with the Criminal Records Bureau and the Protection of Vulnerable Adults lists and the organisation dealt with the outcomes well. All newly employed staff undertake a 6-month probation period, which would be made permanent upon satisfactory completion of this. The Annual Quality Assurance Assessment told us that 75 of staff have a National Vocational Qualification level 2 in care. This exceeds the standard that states at least 50 of staff should have completed the training. Staff supervision sessions records suggest that supervision is taking place regularly and is on target to meet the standard of 6 supervisions per year. Good recruitment and supervision of staff helps in ensuring the safety of the people that use this service. We looked at the training record for staff at the home and found that staff have had training in the key areas needed in the last year. We asked staff about the staff about training and were told We get quite a lot of training, if new staff need training we often sit in so we can get updated. As well as the required training there was recognition of newer issues such as the Mental Capacity Act which came into being this year and the implications should any person, resident or staff develop swine flu. Good staff training helps staff become confident about the roles they perform and helps to ensure good care for people. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are procedures in place to ensure that peoples best interests are safeguarded these are not always in place and this could mean that people are at risk of unsafe care. EVIDENCE: The manager of the service was registered with us last year for this service. She has had previous management experience and has the recognised qualification of a Registered Management Award. In addition to this she has an assessors award for the National Vocational Qualifications. A representative of the organisation visits the home on at least a 2 monthly basis and a report is written of what they find. From this action plans are made 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 25 for the manager to implement. The visits included checks on peoples money, staff issues, health and safety such as water temperatures, medication audits, checks on the environment and the homes paperwork. We discussed the lack of external monitors of the service provided as many of the people living in the home have no friends or relatives visiting and the only advocate has now withdrawn their support. This makes it difficult for the service to get an independent view of how the home can improve. We looked at the records of maintenance for the home and found it difficult to track how quickly repairs to the building or equipment were put right. In some cases there appeared to be repeat difficulties with hoists, call alarms and leaks without the information about how these had been resolved. For example a hoist was reported as not working on four times with no information of alternative interim arrangements and sometimes there was little information whether any one had been out to repair such faults. In addition faults such as the probe to measure hot water was left without batteries and not working for two weeks. This with the inadequate planning for staff cover increase the risks to people living in the home. We looked arrangements to ensure that services such as Gas, Electricity, and Fire Safety were checked and found that these were in place and this helps to ensure that people remain safe. The homes lifting equipment was due for its six monthly service but no date for this had been set. We looked at the accident records and found that there were no accidents involving people living in the home in the last year. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 2 3 X X 2 X Version 5.3 Page 27 8 Coriander Close DS0000016935.V377815.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19 Regulation 17(1)(a) schedule 3 (3)(m) Requirement Seizure records, protocols and risk assessments for people must be reviewed. This is to ensure that there is a clear expectation of what documents need to be completed and all documents are current. There must be sufficient numbers of staff for people that live in the home at all times to ensure the delivery expected and unexpected care. Timescale for action 26/10/09 2 YA33 18(1)(a) 26/10/09 3 YA42 This is to ensure that people remain safe. 23(2)(b)(c) There must be appropriate records of how repairs to the building and equipment are managed. Where equipment is essential to the care of people, how this is to be managed in the interim should be documented. This is to ensure that equipment remains safe and people are not put at risk. 26/10/09 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA9 YA17 Good Practice Recommendations A review of documentation should be undertaken so that that the actions staff need to take are more prominent and accessible for new or agency staff. Risk assessments should be reviewed to ensure all staff have read these and are aware of their contents. Details regarding the care of PEG feeding tubes should be included in the daily records and staff should record the care undertaken in order to demonstrate the care provided to ensure the tube is maintained in a satisfactory manner. A review of all bed safety rails should be undertaken to ensure they are suitable and maintain people safety at all times. This recommendation remains outstanding. The temperature of the kitchen should be monitored on a regular basis and if it is above 25 degrees alternative arrangements should be sought for the medication cupboard to ensure medication is stored at the correct temperature. This recommendation remains outstanding Where the amount of medication is over prescribed this should be discussed with the prescriber. 4 YA19 5 YA20 6 YA20 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 8 Coriander Close DS0000016935.V377815.R01.S.doc Version 5.3 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!