Inspection on 10/08/10 for Cardell House

This inspection was carried out on 10th August 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cardell House 19/04/10

Cardell House 30/06/09

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Random inspection report Care homes for adults (18-65 years) Name: Address: Cardell House 421-423 Speedwell Road Cardell House Kingswood Bristol BS15 1ER zero star poor service 20/04/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Webb Date: 1 0 0 8 2 0 1 0 Information about the care home Name of care home: Address: Cardell House 421-423 Speedwell Road Cardell House Kingswood Bristol BS15 1ER 01179674647 01179674647 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Diane Hull Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ritzi Care Homes Limited care home 12 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 12 The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Cardell House is a registered care home, operated by Ritzi Care Homes Ltd with the day to day management cascaded to a recently employed new manager. The property consists of two domestic dwellings converted and adjoined to provide accommodation and personal care for up to twelve people. Accommodation is offered to both female Care Homes for Adults (18-65 years) Page 2 of 16 2 0 0 4 2 0 1 0 Brief description of the care home and males. There are nine single bedrooms and one double. The home is close to shops and bus routes, with other amenities within walking distance. The home aims to provide a high standard of accommodation and care in one group living unit and to enable all of the individuals to lead an ordinary life as possible. The range of fees is from £357.66 to £749.23 at the time of publishing this report. Care Homes for Adults (18-65 years) Page 3 of 16 What we found: This was an unannounced Random Inspection that was carried out on 10th August 2010 over a period of seven hours. The manager was present and helped with the inspection process. We looked at a range of different evidence. This included information provided by the manager, and provider, speaking to people living in the home, and staff who work in the home, reviewing peoples individual care records, an examination of some of the homes records, and observation of staff interaction with the people living in the home. The purpose of the visit was to follow up the requirements from the previous Key Inspection of 19th & 20th April 2010 of which the outcome was poor. Seven statutory requirements had not been met from a previous Key Inspection and a further thirteen were issued. We invited the provider to a Service of Concern meeting on 20th May 2010. The provider and manager attended the meeting and submitted an improvement plan with details of how and when the requirements were to be met. We were assured by both the provider and manager that they were taking the outcome of the Key Inspection seriously and wanted to make improvements. At this visit we looked at the care files of four people living in the home. These had been developed since the last inspection and included information about individuals medication, personal information with a profile about peoples past history, an assessment of individualsneeds, care plan, and risk assessments. There were records of when people had gone out on activities, and other monitoring records of daily routines. Generally improvements had been made and a care planning system was now established for all the people living in the home. Peoples needs had been reviewed through the new system in place and written risk assessments had been completed. An outstanding requirement ( from June 2009 Key Inspection) for care plans and risk assessments to be reviewed had been met. A requirement made at the last Key inspection of April 2010 had been met as care plans were now in place and had included more information about people than previously. A member of staff spoken with confirmed there was better information now in care plans about the people living in the home. However some people living in the home would benefit from more detailed individual information about their needs for staff to follow so that these are met and any changes identified. Examples of this were discussed with the manager relating to how staff should be supporting people with their behaviours, including agreed strategies, how individuals accessed their finances, and how people should be supported with their health needs. It was evident that the care plan format was based on those used in a nursing service with some areas that were not applicable or appropriate to most of the people currently living in the home. A recommendation for care planning to be more individual and person centred has been partially met in that some people had been asked to sign that they agreed to their care Care Homes for Adults (18-65 years) Page 4 of 16 plan. We discussed with the manager how the further development of care planning could improve outcomes for the people living in Cardell House. For accessible formats to be used such with symbols, pictures and photographs for those unable to read the written word that would help people in understanding and being further involved in their care planning processes. Peoples preferences, choices and decisons making processes also to be included in their care planning would further evidence individuals involvement. A recommendation is made to review the care plan format and look at ways of making the process more person centred and individual and include more detailed information about peoples needs. We looked at the written risk assessments for four people. Although a requirement had been met for these to be expanded so that they reflected the level of risk and action to take to minimize risk, there were some that were confusing to read. We discussed with the manager how the use of a more robust risk assessment framework with clearer instruction would be benefical for staff in following how people should be supported safely in taking risks. A recommendation is made to review the current risk assessment process to ensure there are clearly recorded instructions for staff to follow. A recommendation had been met to review the arrangements in providing people living in the home with their personal care items and to take into consideration the equatability and individual choice. There was now no such an arrangement in place and we saw the original stock of personal items had not been replaced for people to use. We spoke to two people living in the home. One person said they had been out and about since the last inspection, that they had enjoyed the experience and wanted to go out more. We saw in some peoples files a record of when they had been out to do shopping. A requirement for arrangements to be made for the people living in the home to have access to the local community and leisure activities has not been fully met. We spoke to people living in the home, staff, and looked at activity records that monitored when people went out. Although there has been some activity and we were told by people that they had been out to do personal shopping this was not happening on a regular basis. There have been no day trips during the summer months. We saw that that although five staff had been recruited since the last Key inspection, two of those staff have left . This has had an impact on the outcomes for the people living in the home and in not being able to access the local community regularly. A member of staff told us that with just one care staff on duty from 9.00am to 3.00pm it was not possible to take any of the people out on a regular basis. That most of the people left in the home during the day needed 1:1 support and use of a wheelchair. We spoke to the provider and were told that a new car is in the process of being bought for the home and would be available for people to use in September. However although this is a positive move in helping people to access the local community and further afield we have concerns as to whether there will be enough staff on duty to carry out these activities. Although an outstanding requirement had been met since the last inspection to review Care Homes for Adults (18-65 years) Page 5 of 16 the staffing to ensure individuals social needs and aspirations are met individually and collectively, it is evident that staffing is now still an issue and continues to impact on outcomes for people. We saw the care plans for four people living in the home had included their physical support needs. Assessments had been completed about peoples individual needs and information had been developed from these to instruct staff how to support people with their personal care needs. Daily records provided evidence of when people had been supported with their personal care and daily routines. There was better information that showed when people had been supported to see dentist, optician, chiropody, doctor or attended hospital appointments. However some of the information had not been dated, or showed the outcome of appointments so that peoples health needs could be tracked and monitored. A recommendation for Health Action Plans to be developed for the people living in the home had not been met. We discussed the value in developing these with the manager and involving people in how they wanted to be supported with their health care needs. A further recommendation is made. We looked at how the medication was being given to people living in the home. A requirement had been met for a record to be kept of when as required medication should be given to an individual instructing staff clearly. A requirement had been met to review an individuals risk assessment framework when self medicating. There were currently no people living in the home that self medicated. Since the last Key Inspection the home has changed to Boots pharmacy to supply the medication for people. The majority of medication was now being administered through blister packs and kept secure in a medication trolley. A record of individuals medication needs was seen in their care plans. We looked at a random sample of blister packs and at the corresponding MAR sheet (medication administration record) for those people who had medication administered. We saw for one individual on one day when they attended a day service, that although their medication had been removed from the blister pack, and had been signed for by staff the medication had not been sent to the day service. We could not be assured that the individual had taken their medication at the right time. We were told by the manager that the pharmacy had been instructed to send an separate blister pack for the individual to take to their day service. It was evident that this had not happened and had not been followed up. We saw tablets had been administered to an individual from the wrong week in the blister pack and had not been signed on two occassions. We saw an individuals medication had no directions on the MAR sheet or on the box and instruction was written as directed. We saw one tablet was missing from an individuals blister pack for the evening dose on the day of our visit. From the evidence we saw from the medication errors, we are concerned that the impact of current medication administration practiced by staff could put the people living in the Care Homes for Adults (18-65 years) Page 6 of 16 home at potential risk. We are concerned the outcome for people is that they are not being supported safely. The manager and provider told us that medication training had been arranged for staff through Boots pharmacy when the new blister pack system started. We were told Boots had not been able to carry out the training due to their staff not being available. We advised the manager to carry out immediate instruction for the staff until the pharmacy was able to reorganise training, to help prevent further medication errors and keep people safe. The manager was unaware of the medication errors we saw and advised her that we must be informed through a written notification. We saw through written records that medication not in use had been returned to the pharmacy. A requirement had been met for a record to be kept of all complaints made by the people living in the home. We saw the complaints log and this showed four complaints had been recorded with the action and outcome. We saw through training records of when staff had attended training in recognising abuse while we saw the manager was due to attend safeguarding training for managers in September 2010. We saw an outstanding requirement had been met for new staff when starting work through a ISA check, before their CRB (Criminal Records Bureau) has been received, that they had been supervised at all times. We sopke with a newer member of staff who confirmed this. We saw a risk assessment had been completed stating that they should be supervised at all times until a CRB had been received. We looked at the records of peoples cash being held for safekeeping and the arrangements for people to access their monies. At the last Key Inspection we had concerns about the recording, auditing and accountability of the finances of the people living in the home and that the practices did not protect their interests. A requirement was made to keep records in these areas. At this Random Inspection we saw there were improvements in some of the recording of peoples financial transactions by the manager, and this showed a requirement was met to follow polices and procedures for the management of residents monies and financial affairs. A more robust system was in place and we saw two staff signatures were obtained for cash transactions with receipts kept that corresponded. At the last Key Inspection we saw there were no receipts, for furniture that had been bought by some of the people living in the home, and for some day trips people had gone on. These had amounted to large amounts of peoples monies. We were told by the provider that she had contacted the furniture suppliers for copies of receipts. The provider had continued to invoice people for different services they had received and which she had paid for, such as chiropody. Although we saw individual cash sheets that could be cross referenced with monetary transactions made on behalf of people, individual bank reconciliations, there were still some areas relating to the invoices that had no receipts and that could not be tracked. Care Homes for Adults (18-65 years) Page 7 of 16 We had discussed with the provoider and manager, at a Service of Concern meeting in May 2010, the arrangements in place for people to access their finances, and had advised the provider to carry out an external audit. The provider told us at this visit that she intended to carry this out when she had been sent copies of missing receipts. We saw in peoples care files arrangements to record the valuables and property of the people living in the home. However none of the information had been recorded and it was evident this was an unmet requirement. Information in financial risk assessments needed more detail to instruct staff how people were to be supported with their finances. There was no information about individuals capacity to consent. Based on the evidence seen a further requirement is made for a record to be kept of the property and valuables of the people living in the home. A recommendation is made to review the arrangements for the recording of peoples finances and expenditure and how some people could access their finances more independently. We were shown the ground floor bathroom and saw a requirement had been met for the floor tiles to be replaced with more suitable flooring. The new flooring was of a non slip material to ensure peoples safety and help prevent slips and falls. We saw the bathrooms and toilets had new locks installed and that they could be over ridden in the event of an emergency. This practice promoted peoples privacy and dignity whilst arranging to ensure peoples safety. We had received information about staffing levels shortly after the last Key Inspection but had been assured by the provider that appropriate staffing was in place. We had been sent a rota to show staff cover was being managed through an agency and extra hours by existing staff. We were also told at the Service of Concern meeting in May 2010 that four new staff were in the process of being employed. However since this recruitment drive, two of the new staff had left the home leaving vacancies. A requirement had been met for a copy of the staffing roster to be available at all times. We saw this displayed in the home. Staffing rotas confirmed agency staff are still being used, however the manager told us recruitment is underway to fill the staff vacancies. An issue from the last Key Inspection was some staff were working excessive hours. We saw this was still occurring for some staff whom we saw from the rota had worked on one occassion over 68 hours during one week. There was no opt out agreement in their staff file to agree to work longer hours complying with the European Working Time Directive. A recommendation is unmet for this to be actioned. We looked at three staff files. All three contained contract of employment, two references, CRB(Criminal Records Bureau) or POVA First check. One newer staff file had no copy of their application or information relating to their visa allowing them to work in the United Kingdom for a two year period. Another file had no photograph. A member of staff confirmed they had completed an application, been interviewed, and had both a POVA first and CRB check completed before they could support people with their personal care. Care Homes for Adults (18-65 years) Page 8 of 16 An outstanding requirement to ensure that staff have had adequate training in health and safety and keeping this up to date and current including first aid, fire and food hygeine had not been met. We saw that four staff had attended food hygeine since last inspection. The manager is the only staff employed who is up to date with first aid training and there should always be someone on duty at all times who is trained in first aid. The manager has since the visit informed us that two dates have been booked for staff to attend first aid training in August and September. Fire training has also been booked for all staff to attend at the end of August 2010. A requirement for staff to be supervised has been partly met. We saw through some staff files that the manager has started the supervision process but has yet to complete supervison of all staff. We advised she plan ahead and book all staff supervision in advance. It was evident that the manager is available and approachable for informal advice. Although there had been improvement in some areas of recording, a requirement is unmet for records to be maintained. There were still some records that must be further maintained to ensure the rights and best interests of the people living in the home are safeguarded. These included records of valuables and property, some areas of financial management, medication and Health Action Plans. A requirement was issued for the provider to send us a copy of monthly reports required for the monitoring of all aspects of the running of the home. We saw these during the visit and have received a copy of the May 2010 monitoring visit. The provider has told us she has sent copies to us for June, July and August 2010 and this will be followed up. A requirement had been met for risk assessments to be completed on all radiators where a risk has been identified and remedial action to be taken. We saw a risk assessment had identified that a radiator in a bathroom was a risk and appropriate action had been taken. This was seen in a bathroom where a large radiator had been covered to help ensure peopls safety. The manager has been invited to attend an interview with us in August 2010 for the registered manager of Cardell House. It was evident that the manager has improved some areas of the management of the home. There are still some requirements that have not been met and we will expect the provider to sent us an improvement plan with more specific timescales for them to be met. What the care home does well: What they could do better: Care Homes for Adults (18-65 years) Page 9 of 16 Arrangements must be made for the people living in the home to have access to the local community and leisure activities so that they are part of the local community. The manager and all the staff must attend training in safeguarding so that the people living in the home are protected form abuse. Staff must be kept up date with mandatory training in health and safety, fire and first aid so that the people living in the home are kept safe by a competent staff team. All staff must be supervised appropriately at regular intervals to ensure their work practice is monitored. Review the care planning format to develop a more personed approach so that people are involved with their care planning. Keep a record of when people are given medication for staff to sign in the appropriate space. Ensure individuals medication is given from the appropriate time slot in the blister pack so that people are protected and supported safely in taking their medication. Keep a record on the MAR sheet and on the individuals medication of when to take the medication and the dosage. So that staff support people with their medication consistently and safely. Inform us by notification of when a medication error has occurred. Review staffing arrangements and to take into consideration the amount of hours staff work with appropriate breaks in between. Ensure all recruitment documentation is available for inspection including agreed working visas, applications and evidence of staffs identity. Keep a record of the property and belongings of the people living in the home. Develop health action plans so that people are involved in the planning of their care. 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 2. Care Homes for Adults (18-65 years) Page 10 of 16 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 13 16 Arrangements must be made 31/07/2010 for the people living in the home to have access to the local community and leisure activities. This will help people to be part of their local community and to engage in appropriate activities. 2 23 13 The manager and staff working in the home must attend training in safeguarding. This will help to prevent the people living in the home being placed at risk of harm or abuse. 30/06/2010 3 35 18 (1) (c) (i) To ensure that staff have adequate training in health and safety and keeping this up to date and current including first aid, fire and food hygiene. Ensuring individuals are supported by competent staff. 30/09/2009 4 36 18 Staff working in the home must receive appropriate supervision. 31/07/2010 Care Homes for Adults (18-65 years) Page 11 of 16 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action So that staffs work performance is monitored to help ensure the needs of the people living in the home are met. Care Homes for Adults (18-65 years) Page 12 of 16 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, 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 20 37 Notify us when the people 27/08/2010 living in the home have been subject to a medication error. So that we know what action has been taken to monitor medication errors and keep people safe. 2 20 13 Keep a record of when people are given medication and for staff to sign in the appropriate space. Ensure individuals medication is given from the appropriate time slot in the blister pack. So that people are protected and supported safely. 27/08/2010 3 20 13 Keep a record on Medication Administration Record of when an individuals medication is administered and with dosage. So that staff support people with their medication consistently and safely. 27/08/2010 Care Homes for Adults (18-65 years) Page 13 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 4 23 13 Keep a record of the 27/08/2010 valuables and property belonging to the people living in the home. So that peoples property is safeguarded. 5 33 18 Review staffing arrangements. So that the the individual and collective social and leisure needs of the people living in the home are met. So that staff are not working excessive hours without the required breaks in between. 27/08/2010 6 34 19 Ensure all recruitment 27/08/2010 documentation is available including agreed working visas for staff empolyed from overseas, applications and evidence of staffs identity. So that the people living in the home are kept safe. 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 6 Review the care plan format and look at ways of making the process more person centred and individual and include more detailed information about peoples needs and preferences Develop health action plans to help monitor peoples health care needs and involve people with their care planning. 2 19 Care Homes for Adults (18-65 years) Page 14 of 16 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 3 20 Develop controls in place to ensure the administration of medication is robust and that medication errors are picked up. Review the arrangements for the recording of peoples finances and expenditure and how some people could access their finances more independently. 4 21 Care Homes for Adults (18-65 years) Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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