Inspection on 23/06/09 for Ashmill

This inspection was carried out on 23rd June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashmill 23/04/09

Ashmill 06/02/08

Ashmill 25/08/06

Ashmill 22/11/05

Ashmill 02/06/05

Ashmill 07/01/05

Ashmill 01/07/04

Ashmill 26/01/04

Ashmill 07/08/03

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Ashmill 141 Millfield Road Handsworth Wood Birmingham West Midlands B20 1EA     The quality rating for this care home is:   zero star poor 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: Jill Brown     Date: 0 1 0 7 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 42 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 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 42 Information about the care home Name of care home: Address: Ashmill 141 Millfield Road Handsworth Wood Birmingham West Midlands B20 1EA 01213586280 01213586280 ashmill141@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashmill Residential Care Home Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 18 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) 18 Date of last inspection Brief description of the care home Ashmill is registered to provide personal care and support to 18 adults with a physical disability, who have been assessed as requiring full assistance with daily living tasks. The service is staffed twenty four hours a day. A number of adaptations are in place in order to meet peoples assessed needs. People who live at Ashmill are encouraged and supported to maintain links with their families and the local community. The service is situated in the Handsworth Wood area of Birmingham in a quiet residential road. It is close to local amenities and there is parking available at the front of the premises. The fee for this home is 650.00- 850.00 pounds per week. Additional charges include Care Homes for Adults (18-65 years) Page 4 of 42 Over 65 0 18 Brief description of the care home those for aromatherapy, hairdressing and chiropody. Care Homes for Adults (18-65 years) Page 5 of 42 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 peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without notice on 23 June 2009 and 1 July 2009 to complete a Key Inspection. During this inspection we looked at the majority of the National Minimum Standards. The home had an Annual Service Review in February 2009 before which we sent surveys to people involved in the home. We received some information that some people were unhappy with the service. We completed a Random Inspection in April 2009 and found that the home was failing to give a good service in some areas. It is recommended that this report is read with the Annual Service Review and Random Inspection reports. We have received information from different sources about the service in the form of concerns and complaints. We have been made aware of shortfalls in the service from Health and Social Services as part of our safeguarding processes. Care Homes for Adults (18-65 years) Page 6 of 42 During this inspection we looked at the care needs of three people. We spoke with three people living in the home, two relatives, seven staff including two night staff, the deputy manager, the responsible individual (who represents the company who owns the home) and the manager of the sister home Little Ashmill. We looked at written records including care records, risk assessments, complaint records, some policies and procedures and Health and Safety records. We toured the building twice, looked at the arrangements for medication and food. Care Homes for Adults (18-65 years) Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: Although the health care of people is improving the home needs to be able to: identify when people need further health care, contact the appropriate people and act on the results of those consultations. Peoples records need to be ordered in such a way that they support the care given to people. Information needs to be available about peoples health conditions and how this health condition affects the individual person. Information needs to be available to staff about how this person would like their care to be given and any special considerations in delivering this care. Risks to people from the equipment they use needs to be identified. This includes type of equipment used, how to use it and the checks that need to be made before it is used. All equipment needs to be clean, odour free, in good condition and suitable for the person. There should be records of checks of equipment. Although there are some activities available some people do not get the activities they want. The arrangements for supplying activities are not in place for all people to have activities that suit them. The service needs to be able to respond to the support people want. The home did not log all of the concerns and complaints raised. This means that people do not feel they Care Homes for Adults (18-65 years) Page 8 of 42 are listened to and appropriate actions are not always taken. We noted that a number of professionals, people living in the home and relatives did not want their concerns raised as they fear this will make relationships difficult in the home. The cleanliness of the home needs to improve. There is not enough staff to ensure that all day to day cleaning tasks and deep cleaning tasks are undertaken as well as the staffs other roles. There are not a good enough checks on infection control issues and this means that people are at risk of becoming unwell. People we spoke to were unhappy about this part of the homes care. We observed that peoples hygiene needs were not always met well. We are taking enforcement action about this in order to make the home adn the staff practice safer. Regular required training has not been provided for some time and this means that not all staff have had the training they need to give care safely although some training is now being planned. At the time of the inspection there was not a registered manager in place and there was not enough checks to ensure that people were safe. The home did not have a quality assurance system of checks and audits that would find problems quickly and put them right. This means the service is not responding to peoples needs quickly enough. We have asked the home to provide us with an improvement plan and will be monitoring this service to ensure that improvements are made. 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. Care Homes for Adults (18-65 years) Page 9 of 42 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 42 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. Information is not fully available to people to ensure that they are empowered to make choices and raise concerns. People receive an assessment before they are initially admitted to the home reassessments should be undertaken if needs change to ensure that people receive the care they need. Evidence: Information was available to people before they were admitted to the home in the form of a service user guide. We found gaps in this information as it does not identify who the registered service provider, responsible individual or the care manager are. This may make it difficult for people to access the right person if they have queries and concerns and this information is required under the regulations. The information about fees for the home have not been updated since the last key inspection in February 2008. There have been no new admissions to the home since the last inspection. We looked Care Homes for Adults (18-65 years) Page 11 of 42 Evidence: at the homes process of readmitting a person who had some time in hospital for a person and found that there was little reassessment to determine whether the home could still meet the persons needs. Care Homes for Adults (18-65 years) Page 12 of 42 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The risk assessments and care plans made for people are not detailed enough, reviewed or monitored sufficiently to ensure that people receive safe care. People cannot be sure that they will be involved in planning their care and at times people do not receive the care that is stated in their plan of care. Evidence: We looked at the records available to staff about how peoples care should be given and looked to see if care was given in that way. We found that people had lengthy care plans in place however these did not have enough detail on to ensure that people received their care safely or in the way they wanted. For example information about how people were to be transferred from place to place did not contain enough information about the equipment to be used, the number of staff needed and did not outline a safe system for the persons transfer so these could be followed by staff. We received information from two sources that told us that people were not always transferred from place to place well. Equipment used in day to day lives of people Care Homes for Adults (18-65 years) Page 13 of 42 Evidence: were not always identified well enough and details of how they were to be used and maintained were not in place. People had specific religious needs that were not recorded in their care plans and we were told that these needs were not being carried out on a regular basis. There was little or no information about peoples need for hair and nail care and where creams were used these did not say what type. A number of care plans looked at were not dated and they did not show that they had been written with the person receiving the care. People had specific details about their care written in care plans such as will request a bath, and likes to have a bath once a week. However the only bathroom was being used as a storage area for equipment and had been for some time, meaning that people could not have a bath and this was not reflected in the evaluation of the persons care. Care plans were not always reviewed six monthly, nor planned to be reviewed six monthly and changes to the care people needed was not clearly recorded as to why and when in the amended care plan. This means it is hard to see if plans are responding to peoples changing needs. Risk assessments did not show what the risks were, how they were going to be minimised and what monitoring steps needed to be in place. For example people that have bed rails on their bed need to have a risk assessment to ensure that these are the most appropriate option for them as the bedrails, in themselves, can pose risks to some people such as injuries from entrapment. Peoples risk assessments did not show that these were the safest measure to put into place, that the bed and the mattress needed could accommodate bed rails safely and the type of checks and frequency of checks to ensure that the bed rails remained safe for people. Instead they amounted to peoples consent to having these rails fitted. Risk assessments were not held with other information about the person and therefore could be missed. This means that people could be unsafe. We made urgent requirements about this and this was resolved for one person. We have made requirements for risk assessments for bed rails to be in place for all people that have them. ( Please also see Personal and Healthcare Support and Environment sections) Records of peoples care were not stored in a way so that an overview of their care could be seen if needed. It was difficult to determine a time line of events because some information was kept in confidential files on loose pages of paper. However we Care Homes for Adults (18-65 years) Page 14 of 42 Evidence: found information about peoples bowel movements in the dining area where they could be viewed by anybody. The home needs to consider what information needs to be available to care staff and where this information needs to be placed to maintain the privacy and dignity of people. It also needs to consider how people are enabled to own their care plan. We were told that the home was awaiting delivery of a lockable filing cabinet for confidential information. Care Homes for Adults (18-65 years) Page 15 of 42 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. Whilst the home has activities available some people are not being supported to have the range of activities and opportunities they would wish. People living in the home have a good choice of food but this is not always prepared in the best ways to meet peoples needs. Evidence: We looked at the activity arrangements for the people living in the home. The home has 2 activity co-ordinators each working part time. Included in their duties are escort duties to the bank and to day centre assessments. We found that in a staff meeting 3 months prior to the inspection that people living in the home were described as being bored and that outings were to be arranged to Twycross Zoo and West Midlands Safari Park. We understand the outing to the zoo happened and the co-ordinators are planning to take people to the beach. The homes action plan noted that there would Care Homes for Adults (18-65 years) Page 16 of 42 Evidence: be improved activities by June 2009. Peoples individual care plans did not identify an activity plan it only showed what they liked and disliked. The activity message book could not be found to show us records of what activities people enjoyed. This also included individual information about peoples aspirations and goals. There is no programme of activities for people to have in the home. However, we were told that some relatives assist the home by providing activities. People living in the home do some craft work and currently some people were making items to sell at the fete. Some people attend day centres and at least one person undertakes some volunteer work but there was little available to people at weekends and on an evening. This did not show that people were having individualised planning to meet their goals and aspirations. The home has a hydrotherapy pool available although this had not been consistently used for some time and requires 2 staff to be available for people to access this. People living in the home have televisions in their rooms some have media centres, computers and so on which they enjoy independently to the homes provision. Some people say that they are not able to have all the activities they would wish. Information about goals, activities and aspirations need to be part of the persons whole care provision otherwise it is possible for people not to have as full a life as they would wish. We looked at the food provision and meals for people living in the home. The cooks start work from 10 am and so part of the early morning food provision falls to night or day care staff to provide for people who have early health appointments or like to get up early. In addition to this people that attend day services may wish to take a packed lunch with them. The main meal of the day is usually provided in the evening and kitchen staff leave at 6pm. Peoples health needs are such that meals are prepared for people who require soft diets, liquidised food, diabetes, low potassium or salt and culturally appropriate diets. We found that the cooks were knowledgeable about the types of meals needed. People were offered a choice of three meals and there was a planned menu for 3 weeks. People that had soft food also had a choice of 3 meals and there was a week planned menu. People on a liquidised diet had the whole meal liquidised and this does not preserve the taste of individual items of food for people. We have been made aware that at times people had not had the diets they needed. Since theses concerns there was evidence that people had been assessed by the speech and language service and that the cooks had details of how these peoples diets. People are not routinely weighed and therefore the effects of their diet is not monitored. This is despite requests from both people living in the home and health Care Homes for Adults (18-65 years) Page 17 of 42 Evidence: professionals.(Please see Personal and Healthcare Support) There were issues about the cleanliness of food storage areas and this has been reported in the outcome area Environment. We have received comments that people are not happy with how people are assisted to eat. We also found records of a meeting with people who live at the home which stated that people do not want to wear blue plastic aprons and want staff to have eye contact when they are assisting them. We understand that some staff have recently received some training on this. Care Homes for Adults (18-65 years) Page 18 of 42 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. Whilst peoples health care support is improving this is as a response to shortfalls identified by external professionals. The home are not demonstrating that they have the understanding of some of the complexity of peoples needs or that they are referring and planning appropriately. Medication is given as prescribed but further checks are required on receipt of and storage of medicines needs to be improved so that people can be assured that medication is effective. Evidence: People living in the home do not always get the personal support they need and wish. (Please see Standards 6-10) During the inspection days we saw people who did not have their personal hygiene needs met in a timely way. On the mornings of both inspection days call bells are heard ringing for a long time without being responded to which indicates that there are not enough staff to attend to peoples needs at high activity points during the day. A person was seen who had not had attention to hygiene needs following a meal. A person was seen in Care Homes for Adults (18-65 years) Page 19 of 42 Evidence: inappropriate clothes for both the weather and due to the poor state of repair. We looked at the management of peoples health care on the day of the inspection and also received information about peoples health care from health professionals involved in the care of people in the home. This has told us that there are concerns about the homes ability to manage consistently good care for the people living there. We were given information that showed there were shortfalls in identifying health needs and care planning and risk management so that needs are met safely. There are no specific health action plans for people. This means that there is not coordinated plan for meeting the routine health checks and plans to ensure that people stay as well as possible. We found little detail on care plans for conditions such as epilepsy and diabetes. General information on epilepsy was lengthy but not all of it was relevant to the person. Review of the condition did not indicate whether the person had remained well or had seizures since the last review. The plan did not indicate whether the person had warning signs of a seizure or the date of the last seizure if this was a long time ago. For diabetes care whilst we saw recorded symptoms that staff may see that would indicate that a person was having a hypoglycaemic attack there was nothing about nail and foot care or about falls. There is no monitoring of peoples weights except for one person that attends a clinic for this purpose and this means that the home cannot adjust the type and quantity of food to keep people well or determine whether slings and hoists remain suitable. We looked at daily and confidential records found a number of issues that needed to be clarified or required further action. A person admitted to hospital did not have clearly identified the health concerns and the sequence of events that led up to the admission. We found notes of injuries that were not recorded in the accident record. The homes action plan targets dates for improvement to the medication management was to take place by May 2009 and self administration of medication practices by July 2009. Medication was stored in a room with no ventilation. The temperature of the medication room was recorded to be above the recommended storage temperature for medicines on the day of the inspection and on the day before. No action was taken to reduce the temperature. Medicines that needed to be in a fridge were placed there but the home was not recording the maximum and minimum temperatures the fridge gets to in a day. Medicines can be affected if stored wrongly that is not in accordance with instructions and product licence. Most medications are correctly accounted for when Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: they come into the home but not enough checks were made for controlled drugs and we identified a delay in controlled drugs being entered on the register. We looked at the Medication Administration Records (MAR) and found for a persons insulin it stated as directed. This is not sufficient to ensure the person receives the correct amount. The GP script says as directed. There was no information in the confidential folder contents or the care plan about the dosage required. The care plan did not refer to a home made form which was kept with the insulin which stated not only the dosage but also the site where the injections have been given to ensure that these are rotated. There is a photograph of the person next to their MAR and this is good as it helps to ensure the right person gets the right medication. Generally medications were given as prescribed, opening dates for liquid medication would help with the checking that such medicines have been given as prescribed. There was a good supply of sun cream in the home and this helps to ensure that people do not get burned by exposure to the sun. The sharps bins in the home were almost full and it couldnt be confirmed that the contents were less than 28 days old. Care Homes for Adults (18-65 years) Page 21 of 42 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 poor 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 cannot be assured that the complaints they make about the quality of the service they receive will be acted upon. The management of the home are not always making plans to improve the service based on what people tell them. The poor attention to risk management and monitoring of parts of the service means that people are not always safe from injury or abuse. Evidence: We found that the management of this home did not have an open and enabling attitude to concerns and complaints. The service user guide referred to a complaints procedure this was not attached to the copy given to us at the inspection. When given the new procedure we found that it met the requirements but the home was not following it. We found complaints and compliments in various records that the home had, such as a visit by a representative of the provider, a staff file and notes belonging to a person living in the home that were not recorded in the homes complaints log. The homes action plan identified that there would be a new filing and indexing system for accidents and complaints by June 2009 we found this had not been done. We found complaints that had not been followed through including no written responses to the complainants and statements without dates. We discussed the failures with the management of the home and were not assured that they see complaints as a positive way of improving the service given to people. Care Homes for Adults (18-65 years) Page 22 of 42 Evidence: We have received comments from a number of differing sources including professionals, carers and people living in the home who do not want to be identified and we are concerned that people do not feel safe to make these comments without affecting relationships in the home. We were informed before the inspection of a number of safeguarding issues that have arisen in the home. The lack of responsiveness and due process to complaints raised means that people cannot be assured that their safety is of the utmost priority. (See Management and Administration section.) During the inspection we raised with the management of the home the lack of attention to security. On one day we were able to walk into the home at 6am without being challenged. People generally do not have keys to their rooms or where this is difficult for them other ways of having private time have not been devised. On one day of the inspection we noted the doors to a persons room were open even though they were in hospital and this does not safeguard their belongings. Care Homes for Adults (18-65 years) Page 23 of 42 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 poor 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 do not have an environment that is clean or respects that equipment used on daily basis forms part of the persons view of being well groomed and having their hygiene needs met. There is poor recognition of the overall infection control matters in the home and this puts people at risk of infection. There is poor monitoring of cleanliness, repair and infection control so the capacity of the home to maintain improvement in this area is in doubt. Evidence: On the first day of this inspection we found the home to be unclean in key areas and these were pointed out to the management of the home. We found that the food storage areas including fridges and the kitchen were not clean. This included fridges that dirty hand marks on the outside, spilled dried milk, dried liquid food and mould inside and food debris in the rubber seals. A storage room had an unsealed floor and the kitchen walls and cooker were grease stained. There were urgent legal requirements made that food was kept in a clean place. When we returned a week later we found that the home had had the kitchen cleaned, the store Care Homes for Adults (18-65 years) Page 24 of 42 Evidence: room had been refurbished with new floor and new fridges. However food was still stored in the old, unclean fridges, these fridges and the other food had moved from the store to an unclean room with other equipment and this posed a health risk to people. We are taking further legal action on this. Equipment used to transfer people from place to place was unclean with dried food spillages including peoples wheelchairs and attached assistive technology equipment. We found this to be the same on the second day of the inspection. We found some moving equipment unfit for its purpose and poorly stored which was also unclean with dried body fluids. We found that the home had bought new equipment but this was not stored well and it was difficult to determine what was in use and what wasnt. We told the management about that some peoples bedrooms were not clean, some bedrooms had staining to carpets, carpets that had not been vacuumed and one bedroom had walls with drink spillages, hand marks and due to the lack of a head board staining on the wall. The communal areas were not clean with poor attention to day to day build up of debris on table pedestals and so on. We found on the second inspection day the one identified persons bedroom had been decorated. We found in bedrooms that some of the furniture needed repair or replacement and that in some cases this posed risks to people. However, bedrooms were personalised and we could see as well as electronic media equipment such as computers, televisions and sound systems people were able to display posters and so on of their interests. There was a lack of deep cleaning in key areas such as shower rooms, toilets and the sluice room. The shower rooms had been cleaned by the second day of the inspection. However the sluice area remained unclean, there was poor storage of mops, and a bowl of laundry left in soak on the sluice room floor. Toilets remained unclean with faeces and urine stained pans. We looked at the storage of clinical waste and found that the storage of the clinical waste was insecure and was not bagged appropriately. On the second day of the inspection this had not been put right leaving risks of vermin and infection. All of above lead us to determine that there are poor infection control measures in place in the home and we are taking further legal action on this. On the first day of the inspection we found a shower that had the ability to deliver water at a temperature that could scald. The management immediately put notices up Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: to say the shower was not to be used. On the second day of the inspection this was still in place. We found that the only bathroom in the home was being used for storage of equipment and this meant for people who liked a bath this was not available to them. We looked at the garden area which had a pond and a nice paved area but limited garden furniture. This was being well used on the first day of the inspection. On the second day of the inspection the outside of the home was having some work done with the garden borders. There is now a staff office in the home and this was a good area and a snack bar area in the dining room. Care Homes for Adults (18-65 years) Page 26 of 42 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels, skills and training are not sufficient to ensure that peoples needs are met and that the home is pleasant and comfortable place to live. The homes recruitment processes need to be improved to assure people that their interests are being safeguarded. Evidence: We looked at the rota of staffing for the home and spoke to the deputy manager during the inspection. We were told that the home usually had available on the morning shift seven care staff of which at least one would be a senior care. These care staff start at 7am and all except the senior care would work until 2.30pm. There was also a manager available in the home from 9am. The home has no domestic, laundry or housekeeping staff and a cook works from 10am to 6pm. There is an activity coordinator for some hours each day through the week. At the weekend this changed as there was no manager and the cook works from 7-3. The findings in Individual Needs and Choices, Personal and Health Care Support and Environment sections of the report would indicate that this not enough staff in the right roles to ensure that people have all their needs met. In an afternoon the number of carers lessens to 4 care staff and over night to 2 care staff. The findings in the Lifestyle section gives evidence that there are not enough staff to ensure that people have the opportunities to be involved Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: in activities in evening. The home has currently 14 people who need assistance with hoisting and staffing of two staff at night is not sufficient to ensure that people can be responded to if they call the alarm. We made a previous recommendation that this was increased to 3 but this was not happening at the time of this inspection. The findings in the environment would suggest that cleaning tasks that are supposed to be completed at night are not being done and there are not enough staff to undertake these tasks. We looked at the employment records of six staff and found the following. Checks done by the Criminal Records Bureau were not always on file and this meant for some there was no information about when this check was received or whether it was clear. There was little checking of any gaps in employment and references in some cases were not confirmed as being from a previous employer. One person started work with the home with a passport that stated that they could not work. This was later updated with a newer passport. The system of recruitment is not robust enough to ensure that people living in the home are safeguarded. We found a number of incidences where staffs performance had raised concerns and some of these were as the result of complaints and some had safeguarding considerations in them. These were not logged in the complaints log or referred to the appropriate agencies in the majority of cases. Supervision of staff had not been regular for a number of months and this means that staff performance is not managed well and staff are not given an opportunity to raise their concerns in a private way. We looked at the training matrix for staff in the home. This shows what training has been undertaken for the staff group. There was not one available for 2009. For 2008 the training record only went up to May 2008 and there were substantial gaps in training. There was very low attendance for moving and handling and infection control training and considering issues raised in Environment, Individual needs and Choices and Personal and Health Care Support this is very concerning. We were told that 7 staff attended basic first aid training between the two inspection days. We understand that some staff were to undertake a medication training course in July 2009. Further training to be an appointed first aider was taking place in August 2009 although the home could not supply us with evidence of this. We were told that DVD had been purchased about infection control and so far 5 staff had looked at this. There were no recent certificates of training on the staff files. Staff spoken to had not had all the required training. The homes action plan told us that the home has a large number of care staff that have completed a National Vocational Qualification level 2 in care. This means staff have beeen trained in the generic care needs of people that live in care homes. Care Homes for Adults (18-65 years) Page 28 of 42 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. People living in this home do not have the benefit of management systems that ensure a good quality of service. Management do not have systems to identify shortfalls and there iare delays in rectifying them when identified. This means that service falls below peoples expectations and shortfalls in the quality of service are repeated. People cannot be assured that their safety and wellbeing is paramount and that they can receive a service that is individual to their needs. Evidence: At the time of this inspection there was no care manager for the home. There was a new deputy manager who was not fully familiar with the running of the home. The representative of the provider the responsible individual told us the home was being supported by the care manager from Little Ashmill. We were told that a new manager would be in place in 2 weeks time. We looked at the records of meetings of staff, residents and relatives since the Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: beginning of 2009.There had been 3 staff meetings and a staff newsletter since the beginning of the year and this does not seem enough considering the concerns raised. We note the issues of wheelchair cleanliness and answering call buzzers promptly were known in January of this year. (Please see Environment and Personal and Healthcare Support Sections) There was a residents meeting following the random inspection in April 2009 where people had voiced their concerns. There were no minutes of any other meetings with people living in the home. We could not see that issues raised at that meeting had been substantially acted upon. There had a relatives meeting in May 2009 where the home outlined improvements they intended to make however there were still issues. The responsible individual had visited the home but had only reported what theyd found on two occasions and had not made plans to say what improvements need to be made. On the latest of these people living in the home and staff were said to be fine and that several bathrooms had been refurbished and the home was clean and tidy. We noted in the complaints and protection section of this report that an anonymous complaint was mentioned but not recorded in the complaints log. We were informed in the homes action plan that audits would be in place in July 2009. We did not find in the key areas of accidents, complaints, cleanliness of the building and equipment, safety of equipment, training of staff, risk assessments, and the involvement of people living in the home that were sufficient checks in place. The home supplied the action plan in May 2009 and could not demonstrate that they were meeting their own targets. This means that the home could not show that it was being run in the best interests of people living there. The management of this home has a reactive attitude to issues raised with them. There are few systems in place for the home to identify areas of poor outcomes for people living in the home. Concerns have been raised about the quality of the service since the beginning of the year and the home has not demonstrated capacity to effect change quickly. We found that accident records were not sufficiently well recorded with no number on some forms and no overview of accidents. We looked at the results of an accident earlier this year and found that there had been no review of the persons moving and handling risk assessment as a result. This means that the person could be at risk of having a similar accident. Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: We looked at some of the health and safety maintenance and inspection records. The home had a fire risk in place but needed to ensure that it met the latest fire regulations and included personal evacuation plans for people living in the home. A fire drill was due. However fire alarms and fire fighting equipment were being checked. Lifting equipment had recently been checked however documents suggested that these needed to be checked sooner than they had been and this did not include hoist slings. We will be asking the home to provide us with an improvement plan to advise us how they intend to secure the improvements needed and how they can assure us that they can sustain these improvements. Care Homes for Adults (18-65 years) Page 31 of 42 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 16 The registered provider must 25/05/2009 ensure that all parts of the home is kept clean and hygiene at all times. This is to ensure that people live in a clean and hygienic environment. Care Homes for Adults (18-65 years) Page 32 of 42 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 (4)(c) 23(2)(c) You must 10/07/2009 devise a risk assessment that ensures that bed rails are fitted only when assessed as necessary, and a procedure to ensure that these are fitted correctly and monitored for their continued safety and records should be kept of this. This is to ensure that people living in the home are not injured by the use of bedrails. 2 9 13 (4)(c) You must risk assess 26/06/2009 all other bed rails in use to determine their safety and take remedial action if necessary and keep a record of this assessment. This is to ensure the safety all people using bed rails. 3 30 23 (2)(d) 13(3) You must ensure that all areas of the home are clean and develop procedures that ensure that this remains the case. This is to ensure that people have a clean and pleasant place to live. 28/06/2009 4 30 13 (3) You must ensure that all areas where food is stored and prepared are clean and that a monitored procedure is in place to maintain this. This is to ensure that people 26/06/2009 Care Homes for Adults (18-65 years) Page 33 of 42 Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action are not likely to get infections from poorly stored food. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 23 (2)(c)You must ensure there 17/08/2009 is a recorded system of monitoring the condition of hoist slings in use. This is to ensure that they are clean, odour free, and undamaged before they are used to move people from place to place. 2 9 13 (4)(c)You must devise a 31/08/2009 method to ensure that the type of hoist and the size and identification of sling is recorded for each person requiring these for transfers. This is to ensure that people are only moved with equipment that is appropriate and lessen risks of injury to the person. 3 10 12 (4)(a)You must devise a confidential records procedure that looks at all documents relating to the assessment, planning, 31/08/2009 Care Homes for Adults (18-65 years) Page 34 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action monitoring and recording of peoples care and information given in confidence which determines where they are to be kept, and who has access. This procedure must be then implemented. This is to ensure that the privacy and dignity of people is maintained. 4 18 12 (1)(a)You must ensure that 17/08/2009 people living in the home are assisted to access health services and the outcomes of those consultations result in the necessary changes to care plans and risk management plans. This is to ensure the health and well being of people using the service. 5 20 13 (2) Medications must be stored as required by their product licence. This is to ensure that medicines remain effective and promotes well being of the person they are prescribed for. 6 20 13 (2) A record of controlled drugs must be entered into the controlled drugs register as they are received by the 17/08/2009 17/08/2009 Care Homes for Adults (18-65 years) Page 35 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action home. A copy of receipt of controlled drugs must be stored in a secure way so drugs received can be checked against the entry in the controlled drug register. This is to ensure that controlled drugs are fully auditable. 7 20 13 (2) Where medicinal creams are prescribed these should indicate what they are and where they are to be used. This is to ensure that people have creams applied appropriately. 8 20 13 (2)Medications that are 17/08/2009 prescribed as directed should be clarified with the prescriber (or where this has been changed by a specialist or consultant) and details of the dosage placed on the medication administration record and care plan. This is to ensure that people receive the medication as prescribed to keep them well. 9 22 22 (8) All Complaints and concerns must be logged in a way that shows the detail of the concern or complaint, the investigation and or the 17/08/2009 17/08/2009 Care Homes for Adults (18-65 years) Page 36 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action referral to other agencies, the proposed action, and a copy of the written response to the complainant. This is to ensure that complaints can be tracked and lessons learned and this improves the lives for people living in the home. 10 23 13 (6) You must have robust procedures and training to ensure that all complaints raised that have a safeguarding element are referred to us and social services. This is to ensure that peoples safety and well being is maintained. 11 24 23 (2)(c) 13(4)(a)Furniture in peoples rooms must be maintained in a good state of repair. This is to ensure that there is a good standard of furnishings and to prevent accidents due to exposed edges screws and so on. 12 27 23 (2)(c)The assisted shower that is not in use must be repaired so that the temperature it can attain is within safe limits. 24/08/2009 31/08/2009 18/09/2009 Care Homes for Adults (18-65 years) Page 37 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that people whose rooms are in that area of the building do not have to travel too far to use an assisted shower. 13 27 23 (2)(j)The assisted bathroom must be made safe and available to people. This is so people who as part of their care plan have requested baths have this facility available to them. 14 27 23 (2) (l) You must ensure there are appropriate and adequate storage facilities for equipment. This is to ensure that equipment remains in a good state and other parts of the home are accessible. 15 33 18 (1)(a) 23(2)(d) 12(1) (a) 17/08/2009 You must ensure at all times there are enough suitably qualified, trained, experienced and competent staff to ensure that people have the benefit of clean environment and their health and welfare needs are met. This is to ensure that people are safe and receive care as planned. 31/08/2009 24/08/2009 Care Homes for Adults (18-65 years) Page 38 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 16 35 13 (6) You must ensure that all 31/08/2009 care staff in the home have appropriate moving and handling training specifically for all the ways people living in the home should be transferred. This is to ensure that all people living in the home are transferred in a way safe for them and for staff. 17 37 24A You must provide us with an 30/09/2009 improvement plan following the receipt of your final report. This is to assure us that the home has a timetable of improvements to secure the wellbeing of people living at the home. 18 42 13 4(a)(c) All accidents that occur in the home must be recorded on an accident form. Relevant risk assessments should be reviewed following accidents. This is to ensure that accidents are prevented as much as possible for the individual and all people living in the home. 17/08/2009 Care Homes for Adults (18-65 years) Page 39 of 42 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 service user guide should be reviewed to ensure it contains required information and reflects the true fees for provision of the service. People should receive a reassessment should their needs change following admission to hospital Reviews of peoples care should take place no less often than 6 monthly and when a persons need has change or when the home is not providing the service identified in the plan of care. Hoist slings should be stored appropriately and consideration should be given to people having their own slings to improve the infection control in the building. People should have a plan that encompasses their work, leisure and activity plan and this should be reviewed with them routinely to ensure it meets their goals and aspirations. People who need liquidised food should have this liquidised in individual food tastes this is to ensure that all food tastes are preserved for the individual. The home should have some appropriate method of weighing people so that changes in their health or well being can be determined and acted upon. Where people have known health conditions consideration needs to be given about how this condition is affecting the individual, signs that the condition is getting worse and measures to keep the person as well as possible. Consideration should be given to the provision of health action plans to assist in monitoring routine health checks and checks on long term conditions. It is recommended that the sharps bin is disposed of in a timely way to improve the homes infection control. The home should consider some long term solution to the ventilation in the medication room so that the temperature remains under 25 degrees centigrade. The home should record the maximum, minimum temperature of fridges used for the storage of medication to ensure medicines are subject to temperatures outside their product licence. 2 3 2 6 4 9 5 14 6 17 7 18 8 19 9 19 10 11 20 20 12 20 Care Homes for Adults (18-65 years) Page 40 of 42 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 13 14 23 34 Consideration should be given as to how security in the home is improved so that peoples belongings remain safe. All visas should be current at the point of employment and measures put in place to monitor the dates of staff who have limited leave to remain. All references should be validated to ensure that they are authentic All care staff regular supervision amounting to no less than six times per year. The home should develop monitoring systems and these should be evaluated regularly to secure improvement to standards of the service provided. The home should ensure that they have personal evacuation plans for people and contact their fire services to ensure they have all the required documentation and comply with the frequency of drills. 15 16 17 34 36 39 18 42 Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: 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. 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