Inspection on 06/01/09 for Broadoak Park Care Home

This inspection was carried out on 6th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broadoak Park Care Home 27/01/07

Broadoak Park Care Home 14/09/05

Broadoak Park Care Home 17/03/05

Broadoak Park Care Home 29/12/04

Broadoak Park Care Home 01/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Broadoak Park Care Home Nuncargate Road Kirkby Woodhouse Kirkby-in-Ashfield Nottinghamshire NG17 9DS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Macukiewicz     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Broadoak Park Care Home Nuncargate Road Kirkby Woodhouse Kirkby-in-Ashfield Nottinghamshire NG17 9DS 01623721924 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Noel Allcock Type of registration: Number of places registered: Mr John William Nunn,Mrs Barbara Nunn care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Mr John William Nunn and Mrs Barbara Nunn are registered to provide accommodation and personal care at Broadoak Park Care Home for persons of both sexes whose primary care needs fall within the following category :- Learning Disability LD (30) The maximum number of service users to be accommodated at Broadoak Park Care Home is 30 Date of last inspection Brief description of the care home Broadoak Park is a residential complex for up to 30 people with a learning disability. Accommodation is provided in purpose built bungalow style units, each comprising of single rooms, mostly with en-suites, and with a kitchen and lounge area. The design and layout of the bungalows would be suitable for a person with physical difficulties living at Broadoak Park. There are also self-contained flats available. The entire complex has been landscaped with gardens all around. There is a central clubhouse Care Homes for Adults (18-65 years) Page 4 of 39 Over 65 0 30 Brief description of the care home with a bar area. The manager said on 6 January 2009 that the fees for the service ranged from 1308.00 GBP to 3010.00 GBP per week depending on individual needs. Prices included most activities and aromatherapy. Extra charges were made for hairdressing and toiletries. We last Inspected this service in January 2007. Copies of the last Inspection report were kept in the managers office. You can obtain copies of this, and other inspection reports by visiting www.csci.org. Care Homes for Adults (18-65 years) Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This Inspection was unannounced and lasted 7.5 hours during one day. Three preinspection questionnaires were received from people living in the home. Most had been completed with assistance. Four questionnaires were received from visiting health professionals and one from a relative. Findings from these questionnaires were used in the planning of this visit and are included in this report where appropriate. The Manager had completed a self-assessment of the home and information from this was used in the planning of this inspection. Computer held records of all contact between the Home and the Commission for Social Care Inspection since the last Inspection were also referred to in the planning of this visit. During this Inspection discussion with people who use the service, the manager and staff took place. Four peoples care files were looked at in detail and their care was Care Homes for Adults (18-65 years) Page 6 of 39 examined to see how well records reflected care practices within the home. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place, including external areas. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 39 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to choose the home and assessment procedures ensure they are not admitted inappropriately. Evidence: We looked at the information available to people who might want to use the service. This was called the Statement of Purpose. The manager told us this needed to be rewritten because it told people that there was a resource room for people to use when it was out of use. This meant that people did not have the right information about the facilities provided at the home. The manager told us that he made sure he told people about the changes when he gave the information out. In his completed pre-inspection self-assessment the manager told us that an experienced member of staff went out to do an initial assessment and that people were offered a structured introduction to the service. We saw the Homes policy on admissions and this stated that pre-admission visits should be offered if appropriate and that people should be offered a place for a trial period at first to see if they settle Care Homes for Adults (18-65 years) Page 11 of 39 Evidence: in. The policy also said that priority consideration will be given to the impact the new service user will have on those already resident in the home. We looked at the records kept by staff to see if they were following the admission policy to make sure people were being admitted appropriately. We also spoke to senior staff to ask them what they did. Staff told us that they followed procedures and had some paperwork to show that they had visited a person to assess their needs before deciding whether they should be admitted. Care files had copies of assessments done by health and social services. However, because these were not dated it was hard to tell whether staff got them before or after the person was admitted. Diary entries made by staff supported that visits had taken place. Staff were not keeping a complete record of what they did in the persons care records and there were no records to show that people already living in the home were asked for their opinions before a person was moved into their bungalow/flat. Therefore there was little evidence of a structured approach to planned admissions or consultation with people already living in the home. Care Homes for Adults (18-65 years) Page 12 of 39 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The extent to which people are supported to make informed decisions about their care is limited by inappropriate documentation and gaps in record keeping. Evidence: We looked at four peoples care files to see if they had the right information about their care needs. All had an assessment in place which was mainly based around a tick box set of paperwork, with space to record additional information. Extra sheets could be added if the information needed to be expanded upon. This was the case in two of the care files seen. Two care files contained a detailed all about me information section. This had been completed by the person and/or their relatives. This provided staff with more detailed and individualised information about the person, their routines and likes/dislikes. We also saw copies of care plans written by social services/health in files, with reviews. Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: Three care files also had a risk assessment in. Again, this was based around a standardised tick box style form, with general instructions for staff to follow in each section should a risk be identified. One person did not have a risk assessment in their care file, despite having some risks identified within the all about me section. This person had lived at the home for several months. This left the potential for them to be exposed to risks within their daily life. We found that although most care files had a lengthy assessment of the persons needs recorded, this was not followed by clear instructions for staff to follow to show how staff would support people to meet their care needs and lead a varied and individualised lifestyle. This would normally form the care plan. Staff were able to accurately describe peoples care needs, what care they needed and any risks to them, but often this did not match the needs stated in the written assessment. This meant that staff were not updating the information and that care needs could be overlooked. Often information was not signed and dated by the person so records did not provide a clear picture of what staff had been doing to support people. In his completed pre-inspection self-assessment the manager told us that service users are aware of the content of their care plan, care plans are easily accessible to staff. However, we found that the information in care files was not recorded in a way that people could understand, for example, no use was made of Makaton symbols despite one member of staff telling us that several people used this form of communication. Care files did not have easy read sections or pictures to support the information. Although one care file had been signed by the person, the only way to tell that people had any involvement in their care was because their name had been recorded by social services reviews. The manager told us that he was aware of the need to improve the paperwork and had made contact with a person in social services to help him to develop some more person centered care plans. In their completed pre-inspection survey a visiting health professional wrote from our observations the service users appear to be encouraged to make choices and be supported in their choices made about the way they live and spend their lives. When we observed how staff looked after people, they were seen to be giving people choices about their daily life such as where they sat, what they wanted to eat and where they spent their time. However, there was no formal system in place for gaining the views of people such as service user meetings or regular recorded one to one key worker sessions. Therefore there was little evidence to show the extent to which people were assisted to make decisions and choices within their daily lives. Advocacy services contact numbers were displayed in the office and the manager described situations Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: where staff have contacted independent advocates for advice and support to individuals. Care Homes for Adults (18-65 years) Page 15 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead a varied lifestyle but could be offered more facilities and choices to further enhance their daily life. Evidence: In his completed pre-inspection self-assessment the manager told us that after listening to people who use the service they set up a monthly disco and increased the amount of activities offered. He also wrote that he was planning staff training sessions on equality and diversity and that staff had supported one person to attend cultural centres within the community. One person told us they regularly attended church. When we visited, some of the people were regularly attending a local College and were undertaking vocational qualifications. They told us that they enjoyed going to College and went four days a week. They also told us that they went bowling, to the cinema Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: and spent time in the on-site club house playing music and using recording equipment. They told us that there were local pubs and clubs that they went to. One person told us that they liked to go to canoing at a local outdoor education centre. Daily records kept for each person recorded that people had spent time bowling, playing on gaming stations and shopping. People also told us they liked doing craft activities and showed us some of the things they had made. One person said they liked to help staff with the cooking and choosing the food for their bungalow, they also told us that they liked to help the staff to clean the bungalow. One person had a visitor during the day and staff told us that some people regularly went to stay with relatives for weekends. Two people told us that they had made friendships outside the home, staff told us that friends could visit the bungalows if they wanted to. There was a resource room which gave people access to the internet, an alternative therapy room and a craft/activities room. However, this needed repair work and therefore had been placed out of use. In his pre-inspection self-assessment the manager wrote that there were plans to revamp the resource centre, fit a hot tub and purchase a new music system for the club house. This would give people more opportunity for on-site activities. Staff were seen to ask permission with a knock and enter approach before entering peoples bungalows. Bedroom doors could be locked and people told us they had a key for their bedroom door. Some of the toilets had broken locks which meant that people did not have the option of privacy when using these. People living together appeared to get on well and described each other as friends, one told me they gave each other presents and when we saw them together they were openly affectionate to each other. Where seen, staff spoke to people with respect and there were shows of affection between them and people living in the bungalows. All bungalows had space to enable people to have some private time should they wish, and a choice of two main sitting areas. There was plenty of food seen in the main kitchen and individual bungalows. People had been given individually prepared menus, each person had been able to choose their own menu for that day. Daily records recorded what people had to eat and this showed that people were receiving a balanced diet. People had access to snacks and drinks at all times. There was the option for staff to eat with people if they wanted them to. Peoples care records showed a general assessment of what they liked to do and what transport they needed to support this. However, we did not see any individualised Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: plans of care that directed staff as to what they needed to do to support peoples individual daily routines. We did not see any alternative communication tools in use to engage people into making choices about their daily activity, particularly for those people who relied more upon non verbal communication. Staff told us that once or twice a week staffing levels had been too low to enable them to take people out on activities and that this was an area that could be improved. The planning of staffing resources would be made easier if people had activity plans in place to enable forward planning of resources and transport. Care Homes for Adults (18-65 years) Page 18 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gaps in documentation means their is potential for health care needs to be overlooked. Evidence: One visiting professional who completed a pre-inspection survey told us everyone I have had involvement with have had their health care needs met and conditions improved in certain cases - the interaction I have witnessed, individuality and dignity has always been respected. We saw staff assisting people with their personal appearance and providing them with help to get to College on time. Care records showed that people were receiving support from outside professionals such as specialist nurses and mental health teams. Staff told us that they take people to see their GP if needed and give those who have the capability a choice as to whether or not they see their Doctor in private. We saw that care files did not always record what support staff had given to the person to maintain their health care needs. There was very little recording of optical and dental checks and we saw no health care plans in place. Females did not have a Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: support care plan in place covering issues such as birth control and menstruation. Sexual health needs were not well documented. The manager showed us a health care plan that he intended to put in place in each file. This was in easy read format which would help people to become involved in planning their own health care. Each persons medicine is kept in their own flat/bungalow so it is close by. We observed staff giving out medicine. Staff told us they had to be trained in medicines before they could do this. We saw training records that showed the type of training staff had received. A local pharmacist was regularly auditing the storage of medicines for the home and the manager said that he found this useful, and that the pharmacist gave them good advice. We saw that staff were correctly recording the medicines they gave. We observed that a staff member had difficulty locating the key for a controlled medicine box because there were a lot of keys on the same bunch. This may cause problems should emergency access to a medication, particularly for epilepsy, be required. Smaller bunches of keys with better labeling would ensure quicker access. Care Homes for Adults (18-65 years) Page 20 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to complain are not fully supported. Gaps in documentation means there is potential for inappropriate practices when dealing with challenging behaviour. Evidence: We checked the complaints register, this showed that staff responded quickly to the one complaint that had been raised. In their completed pre-inspection survey one visiting professional wrote this is the area I feel the service do very well as they take any queries seriously and welcome criticism both positive and negative. When I have raised concern the matters have been responded to immediately. We saw that there was no record of any informal concerns. When we looked at this area with the manager and staff we found that there were no systems in place to assist and support people in expressing their day to day concerns, or for raising any complaints formally. We saw a copy of the complaints procedure on display in the Club house but this was written in a format that most people living there would not be able to understand. There were no records of individual or small group key worker sessions to support people to raise worries and concerns. The manager told us that most feedback would be through the persons social worker or family. However, some people did not see them on a regular basis. Because of this we concluded that there were inadequate systems in place for people to express their views on a daily basis. Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: There had been no safeguarding issues reported to us since the last Inspection. Staff had access to local safeguarding procedures. All staff we asked gave safe responses when asked about safeguarding procedures and all told us they had received safeguarding training. Staff training records showed that reporting abuse procedures were part of the staff induction training, and records showed that they had received this. The procedures in place for staff to support people to manage their money were safe. Records were kept of all transactions and receipts held. We noticed that some people needed physical intervention by staff to kept them and other people safe. Staff told us they were trained in non-interventive techniques using NAPPI training to levels one and two. Training records showed that all staff had this training. Staff told us they felt safe and confident in dealing with aggressive behaviours and said they felt supported by senior staff. We saw that staff kept records of all physical interventions that had taken place, but we saw that these were not always signed off by the Manager to show that he was monitoring staff practice to keep people safe. Although people had risk assessments in place to cover known and possible behaviours, because care records were not kept up to date and care plans did not provide clear instructions for staff, there was the potential for variances or inappropriate practices to occur. Care Homes for Adults (18-65 years) Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment compromises peoples dignity and lack of repairs leaves people exposed to potential risks within their environment. Evidence: We undertook a tour of the premises. In his completed pre-inspection self-assessment the manager told us that they had recently refitted a kitchen and bathroom and a relative told us the flat (x) has been given is excellent in their completed survey. People showed us their bedrooms which they had been able to personalise with their own belongings and told us they liked their bedroom. We noticed that several areas within the environment required improvements. The gardens were untidy and not well maintained. The windows were dirty and some glass was cracked. A piece of wiring had come loose around one of the buildings creating a trip hazard. In one Bungalow a boiler cupboard door was broken exposing people to a naked flame. A toilet door in the clubhouse female toilets was broken, as was the lid to the freezer. In the Bungalows some carpets needed replacing, locks had broken off toilet and bathroom doors which compromised peoples dignity. Many walls and paintwork needed redecorating. Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: One of the bungalows felt cold and people were seen to be wearing their outdoor coats when sitting inside. The resource room and the respite bungalow needed refurbishment. One of the bathrooms contained a low level urine odour and some of the curtains were hanging off the rails. The resource room was unlocked and therefore access by people living nearby could be gained. This area had inadequate heating and was being used to store various types of building material and unwanted items awaiting disposal. This area needed to be locked to keep people safe. The manager showed us a list of ongoing repairs that were needed and told us that requests for essential maintenance works had been made, but not yet acted upon. There was an advert out for a full time handyman and there had been five applicants at the time of this visit, as the manager had recognised that a dedicated on-site maintenance service was needed. Care Homes for Adults (18-65 years) Page 24 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be placed at risk through staffing arrangements and gaps in staff knowledge. Evidence: When we spoke to staff they told us that they had lots of training including fire safety, food hygiene, epilepsy and first aid. Staff told us they were due to attend courses on infection control and had undertaken National Vocational Qualifications. They had all attended a NAPPI (non-interventive behaviour management) course which was run by the manager, who was a qualified instructor. Staff training records showed that about half of the staff had acquired National Vocational Qualifications to level two or above. However, records also showed that the majority of staff had not completed some mandatory training in areas of basic food hygiene, fire safety and health and safety. Fire safety training was not planned for six monthly intervals as recommended by the Fire service for staff working night shifts. Gaps in staff training means that people may be placed at risk through lack of staff knowledge. Planned staffing rotas were seen, along with the actual staffing rota which recorded what staff actually worked, taking into account short notice absences and holiday cover. We found the actual rota hard to read as it did not accurately reflect what staff Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: told us they had worked. The two senior staff on duty, including the manager, were not stated on the staffing rota so the amount of contact people had with management was not defined. Staff were unclear about how many staff there should be to cover each shift, one told us there should be a minimum of seven, another told us there should be eleven in the daytime. The actual staffing rota showed that between seven and nine staff usually worked each day shift and that at night, staffing was reduced to four or five. The sleep in arrangements were not clearly stated. The allocation of staff per bungalow or to each person living in the home was not clearly stated, even though we were told that some people needed one to one or two to one support at times. Staffing rotas showed that there would be times at night when one Bungalow did not have a member of staff in. The manager told us that at these times contact with a staff member would be achieved by staff wandering between two bungalows. In the absence of a working staff call system this meant that anyone needing emergency assistance in the night had to rely on the member of staff returning to their Bungalow. In a completed pre-inspection survey, one relative wrote concern is that frequent staff shortages cause problems in that they cannot provide the level of service paid for. We looked at staff recruitment files, these showed that both Police checks and references were being obtained before people were being employed. The manager was not aware of the need to check former employment where the person had worked with vulnerable adults or children so was not fully complying with safe recruitment practices, but was ensuring compliance in all other areas of recruitment. The Manager had recognised that improvements were needed in terms of staff training, recruiting and retaining staff and showed us an appointment he had made in his diary with a workforce planning expert, for advice. Care Homes for Adults (18-65 years) Page 26 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not always run in peoples best interests. Management of health and safety means that people may be exposed to preventable risks in their environment. Evidence: The manager has worked in care since 1982, and has worked in a management capacity since 1996. He has a registered managers award and an advanced certificate in care management. He also told us that he had a management qualification and is an approved NAPPI trainer. The manager was using a system called quality tree devised by Nottinghamshire Social Services, to monitor the service. He showed us paperwork that explained how the system worked, and it included the need to regularly send out questionnaires to people using the service and their relatives. We saw that some surveys had been sent to people and that the outcomes had been looked at. The manager did not have a more regular system in place for gathering feedback from people using the service or their relatives in the form of residents meetings or similar. This would ensure that day Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: to day quality was better managed and that people had more of a say in the running of the home. There was some health and safety information in the managers office and a fire risk assessment. A senior member of staff told us that there had been a full health and safety audit undertaken but could not locate this on the day we visited. This means that staff may not have access to all information about hazards in the environment. We saw that most service records for equipment were up to date with the exception of the fire fighting equipment. This had not been tested since 2007. The manager showed us a date in January when this was due to be undertaken. However, management sytems were not robust enough to monitor when servicing was required to ensure that people were not put at risk through poorly maintained equipment. The manager also told us that there was no staff call system in the bungalows, there was a hand held battery operated call system but he said this wasnt used. This meant that people must rely on the availability of staff in the vicinity. Given the fluctuating staffing levels, particularly at night, this may pose safety hazards. Given the evidence in this report we consider that the management of the home could be better. People were not being consulted enough about the service. Record keeping did not show that the manager was monitoring daily practices and planning care in a structured and person centered way. The manager did show us evidence that he was aware of areas that needed improving, but we are concerned about the speed at which improvements were being made. In particular, maintenance issues which posed safety issues to people (see environment section). Also the implementation of paperwork such as easy read formats for health care plans, that were available but not yet put into practice. Because the managers hours were not stated on the staffing rotas we are unable to tell how much time he had available to spend on making improvements to the service. Care Homes for Adults (18-65 years) Page 28 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 39 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 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 2 14 Records kept in each 28/02/2009 persons care file must be able to show all the preadmission assessment, planning and visits that have taken place. All records, including assessments by social services or health must be dated and signed to show when they were done and who carried out the assessment. There must be records kept to show that people already living in the home have been properly consulted and that staff have fully assessed the impact of the new admission on them, before a new admission is made into their flat/bungalow. This is to ensure the home can demonstrate through records, that people have been properly assessed as to their suitability for admission Care Homes for Adults (18-65 years) Page 30 of 39 to the home. Also, to show that the rights of people already living in the home have been upheld and their views considered. 2 6 15 Any care plans developed must be written in a format that is accessible to the individual, taking into account their level of ability and individual communication style. Care plans must be available to them and completed with their input and/ or that of their advocate. This is to ensure that any care and support provided is user-focused and that peoples rights make choices about their life are upheld. 3 6 15 Care records must be 28/02/2009 reviewed and updated as the persons care needs change. So staff have the right information about the persons care needs so care needs are not overlooked. 4 6 15 All people living in the home must have detailed instructions for staff in the form of a care plan, to show how they will meet the persons identified care needs. These must show what staff need to do to support the person both in the present, and also how they can support them in the future to achieve their aims and ambitions. 28/02/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 31 of 39 This is to ensure staff know what they must do to support people and to prevent care needs being overlooked. 5 7 12 2) and 3) Records kept at 31/03/2009 the home and in care files must demonstrate that people are being consulted about their care and that they are being enabled to make decisions about their life. To assist in this, care plans and information about the home must be written in a way that people can understand and which is accessible to them. This is to support that peoples rights to make choices about their lives is upheld. 6 9 13 4 c) All people living in the home must have a detailed and individualised risk assessment in place. This must then provide instructions on what measures staff must take to ensure any risks are reduced, and be subject to regular review. To ensure people are kept safe. 7 14 16 2)m) Care records must show that people have been properly consulted about what activities they want to do, and a plan of care must be in place as to how staff 31/03/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 32 of 39 will support the person to achieve this. To ensure activities are person centered and to show that people are fully consulted about how they live their lives. 8 16 12 4a)All bathrooms and toilets 31/03/2009 must have a working privacy lock. People who are assessed as unsafe using these areas with locks must have this clearly stated in their care plan and the toilet provided without a lock must be allocated solely for their use. To ensure peoples rights to privacy and dignity are upheld. 9 19 13 1b) People must have a health care plan in place that identifies all health needs and gives directions to staff on how to support peoples health care. To ensure that peoples health care needs are not overlooked and that preventative health measures are in place. 10 20 13 2) The medicine cupboard keys must be clearly labeled so that staff have quick access to emergency medication. To ensure peoples health and welfare is safely maintained. 28/02/2009 31/03/2009 Care Homes for Adults (18-65 years) Page 33 of 39 11 22 22 2) There must be a system 31/03/2009 in place for listening to people and to allow them to raise concerns in the most appropriate way for them. All systems put into place must be fully documented to evidence that people are being listened to and supported to raise complaints. This is to ensure peoples rights are upheld and to keep people safe. 12 23 13 7) Those people who exhibit 31/03/2009 challenging behaviours must have a clear behaviour management plan in place that provides staff with clear directions as to how they manage this behaviour. This is to ensure that people are being kept safe. 13 24 16 2c) The respite bungalow must be upgraded with better fixtures and curtains re-instated at windows before being used. This is to ensure peoples well being is not adversely affected through exposure to an inadequate environment. 31/03/2009 14 24 23 2)b)d)o)p) There must be arrangements in place for daily maintenance so that repairs are quickly made, windows are clean and gardens kept tidy. 31/03/2009 Care Homes for Adults (18-65 years) Page 34 of 39 This is to enhance peoples quality of life and to ensure people live in a safe environment. 15 28 13 4a) The resource room must 28/02/2009 be kept locked until it is fully refurbished and made safe. This is to prevent people accessing this area and being exposed to unnecessary risks. 16 33 18 1a) There must be sufficient 31/03/2009 numbers of staff on each shift to supervise people living in the home. There must be records to show the exact staffing requirements for each shift and for allocation of night staff duties. This is to ensure that people are not placed at risk through poor workforce planning and inadequate staff numbers. 17 33 18 1a) Staffing rotas must accurately record the numbers of staff provided for each shift, their designation, the delegation of duties, sleep in cover and the management cover for the home. This is to show that people are being supported by sufficient numbers of staff at all times. 18 34 19 b)i) The reasons why people ceased to work in a position 31/03/2009 31/03/2009 Care Homes for Adults (18-65 years) Page 35 of 39 with vulnerable adults or children must be established for each former employment before a member of staff works at the home. This is to ensure people are not exposed to potentially unsuitable workers. 19 35 18 c) All staff must receive the required mandatory training in areas of basic food hygiene, fire safety and health and safety. This is to ensure that people are not placed at risk through lack of staff knowledge. 20 37 12 1)2)3) There must be management time allocated for the development of the service and for the undertaking of quality assurance. This must be shown on staffing rotas and through a written plan of improvement for the home, with timescales and who is responsible for carrying out such actions. This is to ensure the neccessary improvements to the service take place in a timely way, for the benefit of people living there. 21 42 13 4)c) The written risk assessment of the environment must be located, accessible for staff at all times and kept up to date. 28/02/2009 31/03/2009 30/04/2009 Care Homes for Adults (18-65 years) Page 36 of 39 This is to ensure people are not exposed to unnecessary hazards in their environment. 22 42 23 2)c) People must have 28/02/2009 access to a working staff call system at all times. To ensure people have the means to call staff in case of emergency. 23 42 23 4)iv) All fire fighting equipment must be serviced and maintained at appropriate intervals. This is to ensure the safety of people living in the home. 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of purpose should be reviewed so it provides accurate information about the facilities provided by the home, and so people can make an informed choice about whether they want to live there. Care records should be dated and signed upon each entry to provide a complete picture of what support has been offered to people and to enable staff to accurately identify review timescales. Staffing levels should allow for people to participate in their chosen activities, to enable them to lead a fulfilling and varied lifestyle. Health care support plans should be written in a way that is accessible to people such as easy read, or Makaton, so they can be fully involved in the decisions made about their health care needs. The manager should ensure that he signs off all incident forms to support that he is monitoring practice and keeping people safe. 2 6 3 14 4 19 5 23 Care Homes for Adults (18-65 years) Page 37 of 39 6 39 The manager should actively seek to engage people and their relatives/advocates to find out their views about the service and to enable them to have a say in the running of the home. This should be recorded. Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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. 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