Key inspection report
Care homes for adults (18-65 years)
Name: Address: Cardell House 421-423 Speedwell Road Cardell House Kingswood Bristol BS15 1ER 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: Sarah Webb
Date: 2 0 0 4 2 0 1 0 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 40 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 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): Ritzi Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 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 Care Homes for Adults (18-65 years)
Page 4 of 40 Over 65 0 12 Brief description of the care home 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 5 of 40 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: This was an unannounced visit as part of a key inspection process. This was the homes second inspection under the ownership of Ritzi Care Homes Ltd. Since the last inspection a new manager has been employed with it being her second week working in Cardell House. The visit was conducted over two days with the opportunity to review records relating to the running of Cardell House. This included looking at care records, staff recruitment and training and health and safety. We looked around the premises and also spoke with people using the service, staff and the new manager. The visit was planned using information received since the last inspection of June 2009, including surveys from people who use the service and staff. A completed annual quality assurance assessment had been received and this gave us information on how the home was meeting the National Minimum Standards, what the barriers have been Care Homes for Adults (18-65 years)
Page 6 of 40 and what improvements are intended for the forth coming year. Care Homes for Adults (18-65 years) Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Requirements not met : To keep care plans and risk assessments under review regularly to ensure the needs of the people living in the home are met. To expand on risk assessments so that they reflect the level of risk and action to take to minimize risk. For a risk assessment to be completed on all radiators where a risk has been identified and remedial action to be taken. Review staffing arrangements to ensure the social needs and aspirations of the people living in the home are met. To ensure the bathrooms and toilets are fitted with a lock that can be overridden in the event of an emergency safeguarding the people living in the home and respecting their privacy. To ensure all staff have adequate health and safety training and that they are kept up to date in first aid, food hygiene and fire. Where staff start work on a POVA First check prior to a Criminal Bureau Check (CRB) received, ensure that they are supervised at all times within a risk assessment framework. This will help to ensure the people living in the home are protected. Requirements issued through this inspection: Care planning must include more detailed instruction for staff to follow about how the needs of the individual people living in the home are to be met. This will help to ensure the individual needs in respect of the health and welfare of the people living in the home are to be met. Care Homes for Adults (18-65 years)
Page 8 of 40 Arrangements must be made 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. A record must be kept of when as required medication should be given to an individual. This will instruct staff clearly when to give as required medication and keep the individual safe. Review individual risk assessment frameworks for self medication. To monitor any changes in the needs of the people living in the home to self medicate and to ensure they are taking their medication safely. A record of all complaints made by people living in the home must be kept. This will show that the people living in the home have been listened to and their concerns and complaints have been acted on. The manager and staff working in the home must attend training in abuse. This will help to prevent the people living in the home being placed at risk of harm or abuse. A robust system must be in place to record people living in the homes expenditure, personal finances, valuables and property. This will ensure the people living in the home have their personal finances and property safeguarded. Refloor the ground floor bathroom with a suitable flooring to meet the needs of all of the people living in the home. This will help to ensure people in the home are supported safely and their independence maintained. A copy of the duty roster must be available in the home at all times. So that staff know who is on duty and for the roster to show if staff actually worked their rostered shift. Staff working in the home must receive appropriate supervision. So that staffs work performance is monitored to help ensure the needs of the people living in the home are met. The provider must send us a copy of the monthly reports required for purpose of monitoring all aspects of running the home. To ensure the service is being monitored effectively and that the people living in the home can be assured of this. Records must be maintained and kept up to date. To ensure the rights and best interests of the people living in the home are safeguarded. 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 40 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 40 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 wanting to move to the home can be confident their needs will be assessed before moving, ensuring Cardell House is suitable for them. People living in the home had been given up to date contracts providing them with current information. Evidence: The Statement of Purpose and Service User guide were seen at the last inspection and had been reviewed and amended by the new provider. Many of the people living in Cardell House have lived there for many years. Since the last inspection there have been no admissions. The home still has a vacancy. Care files included completed assessments of peoples needs carried out by staff in the home and individuals social workers. A requirement had been met for the provider to ensure individual updated contracts that reflected the change of ownership. We saw these in three peoples personal files.
Care Homes for Adults (18-65 years) Page 11 of 40 Evidence: Completed surveys received from the people living in the home told us that they liked the home and were happy living there. Care Homes for Adults (18-65 years) Page 12 of 40 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 people living in the home would benefit from better care planning and risk assessment processes. This will evidence the care and support given, that peoples needs are being reviewed and monitored and that people are being supported consistently. Some of the people living in the home make decisions about their lives. Those people who need more support do not have the same decision making opportunities. Evidence: To help determine the quality of care provided to the people living in Cardell House, we looked at five peoples care plans. A recommendation was made at the previous inspection to review the care planning format, to ensure that it was appropriate for the people living in the home and based on good practice in supporting individuals with a learning disablity. Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: We saw that although only one format was now being used, there had been no change in the care planning process. The same care planning format was being used as previously and were dated 2008. These did not detail how people should be supported and lacked information for them to be monitored fully. The information was not detailed for staff to follow and although the majority of the current staff team have worked at the home for several years, and know about peoples needs, we have been told two new staff had been recruited. Agency staff are also being used currently to cover vacant hours. We did not see any systems in place to show how agency staff were inducted in how people were supported. A member of staff told us they would need to see care plans and would be told verbally. Both agency staff and new staff need to be provided with up to date detailed information about peoples needs so that they will be supported safely. The Annual Quality Assurance Assessment told us there were plans to develop new person centred care planning. We saw no evidence of the involvement of the people living in the home in this or of any new documenation to be used. Staff spoken to confirmed care planning needed to be changed and improved. They said they were waiting for a new format. A requirement had not been met for the information recorded in risk assessments to be expanded on. We saw the same risk assessments as at previous inspections with lack of information to support the people living in the home safely. We did not see a risk assessment for people with epilepsy and how staff should be supporting them. We spoke to a member of staff who although had knowledge about their needs, was unsure what action to take if they had a seizure. They confirmed there needed to be more information for staff in care plans and risk assessments. A requirement for care plans and risk assessments to be reviewed on a regular basis, at least six monthly, had not been met. We saw care files that had not been reviewed since 2008. We saw one care file that had recorded a review had taken place in 2010. However this did not highlight any changes over the two years to the individuals care. It was evident that there had been changes as we were told they no longer were able to get their own drinks. Cardell House has a small team of staff supporting the people living there, who have worked in the home for several years. The staff are knowledgeable about the personalities and the care needs of the people living in the home. Better care planning processes will help new staff and evidence the care and support is being given to the people living there. Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: We saw a house meeting had been attended by people in April 2009. There were no recent records of meetings taking place evidencing peoples involvement in the running of the home and decisions they had made. However we did see records that showed people made daily choices about food offered. All the surveys, except one, that we received from the people living in the home told us that people make decisions about what they do each day. One person said they usually can but added a comment that day trips would be an improvement. We saw an individual who had returned from a visit to Bristol town centre independently. It was evident those people living in the home who were independent in leaving the home on their own, were making daily decisions about their lifestyle. For those people who were dependent on staff we did not see that they had the same opportunities to make decisions, or had the same quality of life. It was evident that more staff were needed to be on duty to support them on a daily basis. We saw personal items such as shampoo were bought in bulk and supplied by staff when required. We were told people paid a pound towards the cost. This does not evidence equatability or choice. The new manager has started the practice of daily written communication for staff to help ensure they are kept informed of any changes. We saw daily records were being kept of the general welfare of the people living in the home. Care Homes for Adults (18-65 years) Page 15 of 40 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. Some people living in the home benefit from a structured activity plan through external providers. Minimal staffing during the week means some people are not going out very often with staff from the home. People living in the home are supported to keep in contact with their families. People living in the home are treated in a respectful way with their rights recognised and are offered a choice of nutritious meals. People would benefit from being involved in the menu planning. Evidence: The majority of the people living in the home attend day services, work placements and college placements. One person is supported through a buddy scheme in accessing the local community. When we arrived there were five people in the home, during the morning two other
Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: people returned from different activities. We saw there were four people who did not have a structured week and spent the week in the home. One person spoken to said they didnt go out and that more staff were needed to take them out. We saw that they spent most of the day looking out of the window. We were told by staff three people needed 1:1 support in accessing the community as they needed to use a wheelchair outside of the home. We saw one member of staff on duty from nine in the morning till three in the afternoon. They were expected to help prepare the main evening meal, ongoing daily housework tasks, and ensure the people in the home had their needs met. The new manager was also on duty but was not able to support people with their personal care or be left on her own with any of the people living in the home as some of her recruitment checks had not been received. The Annual Quality Assurance Assessment told us plans were being developed to organise more trips out during the evenings. We have been told that improvements had been made in the last twelve months with increased activities within the home and day trips for people not able to access the community independently. However there was no evidence to show that this had been implemented. People living in the home did not go on holiday during 2009 but we were told had gone out on trips. We saw an outings record that had been started in November 2009, and showed people had been offered between one to two outings per month. These included activities such as walk, local outing, drive and visits to a main shopping venue. We saw some day trips had been recorded. We did not see evidence of trips out in the evenings or increased activities happening on a regular basis. A requirement was made at the last Key Inspection in June 2009 to review staffing arrangements so that peoples individual social needs and aspirations were met. There was no evidence of this requirement being met. The rota showed the two new staff in the process of being recruited were not additional staff but replacing staff who had left. Staff told us people were supported to keep in contact with their families. An individual living in the home told us they were taken out by their family and that they enjoyed their visits. This was confirmed through the record of activites. We observed staff during the lunchtime period helping people with their individual needs. They were respectful in their actions and the way they spoke. All surveys received from the people living in the home told us that staff treat them well. Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: There were no written menus. Staff spoken to agreed menus were needed for the planning of food offered and in involving people in making individual choices and decisions. Care planning showed the food preferences of the people living in the home but this information was from 2008 and had not been reviewed. People had been offered a choice every day from the food stock. It was evident people have a choice of nutritious food offered and we saw individual records of what people had been offered. People sat at dining tables at lunchtime to have their packed lunch that had been prepared previously. It was evident this is a system that supports the lack of staffing as at the previous inspection sandwiches had been made during the lunchtime period and involved people with the preparation. Some people were able to get their drinks independently. We were told food shopping was done through the internet and we did not see any evidence of people being involved in this process. Care Homes for Adults (18-65 years) Page 18 of 40 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. The personal care needs of the people living at the home are met. The people living in the home would benefit from better health care planning, monitoring and review to help evidence that peoples health care needs are being met. The practices in the home relating to the administration of medication do not always protect people. Evidence: A recommendation has not been met to develop Health Action Plans for the people living in the home. At the inspection of July 2008 and the last inspection of June 2009 it was noted that health care planning was not accessible and that health and personal care information was going to be put into a Health Action Plan format. The Annual Quality Assurance Assessment confirmed health action plans are needed. A recommendation has been met to review the recording of health care appointments. We saw recent health care records dating from November 2009 showing when people had attended appointments with chiropody, dentist, and local doctors surgery. We did not see records to show how peoples healthcare needs were being monitored and reviewed. We were told by a member of staff that although an individuals health care
Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: needs had changed over the last few years slowly, there were no records to show how they had changed and how they should be supported with their changing needs. A requirement has previously been made through Standard 6 for care planning to include more detailed information about the needs of the people living in the home. This includes peoples health care needs. Daily records provided evidence of when people had been supported with their personal care and daily routines of how people wanted to be supported were seen in care files. We were shown the systems in place for the administration of medication to the people living in the home. A requirement had been met for the medication policy to include instruction for staff in the event of an error or an omission. We saw this had been included in the medication policy and a copy for staff in the medication file. Records were being maintained of medication administration. Medication entering the home weekly was being checked generally but no individual record was being kept. We were told the current pharmacy did not always send the medication administration record (MAR) with the medication to ensure good practice measures. We were told a new pharmacy will be supplying medication to the home next month with better recording systems in place. We saw medication training by the new pharmacy had been booked for all staff. However we did not see a record of previous medication training staff had received. We saw from the MAR that medication was being given to an individual when required. However there was no detail or instruction on either the MAR or the medication about when this should be given to the individual. We advised that the individuals GP be approached to clarify when the medication should be given, and for a record to be kept of this to instruct staff. We saw a requirement had been met for the disposal record of medication to include two staff signatures. However we were concerned that a requirement had not been met to ensure medication was stored securely and in accordance with the instructions of the pharmacist. Creams and eye drops were seen to be stored still in a metal filing cabinet in the small conservatory. The member of staff on duty moved the medications to the appropriate medication cabinet during this inspection. However we noted that some eye drops had been left out after use and not stored securely. We saw those people who took their own medication had an individual risk assessment framework for self medication. However this was dated 2007 and their was no evidence that these had been reviewed or if people were still taking their medication safely. We were informed that those people who took their own medication had been Care Homes for Adults (18-65 years) Page 20 of 40 Evidence: given a lockable unit to keep medication safe. Care Homes for Adults (18-65 years) Page 21 of 40 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. Although people living in the home know how to make a complaint, we cannot be assured a record of complaints is being maintained. The people living in the home are not being protected from risk of harm. The manager and some of the staff have not received up to date training in abuse. Policies and procedures are not being followed to help ensure robust record keeping and practices to safeguard the financial interests of the people living in the home. Evidence: All surveys received from the people living in the home told us they knew how to make a complaint and that staff listened and acted on what they said. Although we are aware there is a complaints policy and procedure,and that this had been seen at previous inspections, we saw the complaints log had no documentation in it and cannot be assured a record of complaints is being maintained. The new manager has been working in the home for two weeks. We asked the manager about her understanding of safeguarding protocol and what action she would take in the event of an allegation of abuse. We are concerned that the manager has not updated her knowledge in current safeguarding practice and did not know know the local protocol followed or contact details to report a safeguarding issue. The manager must attend training in this area as soon as possible so she is up to date with current practice and that we can be assured she knows appropriate action to take
Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: in the event a disclosure is made. We advised that she would also benefit from attending investigatory training for managers to further her knowledge and practice. Staffing records showed two staff had attended safeguarding training in 2007. Three other staff records did not show they have attended any training in safeguarding vulnerable adults. As part of this inspection we asked to see the records of peoples cash held for safe keeping, and the arrangements for people to access their finances. The AQQA told us there was a clear audit trail of financial transactions. We saw no evidence of this. We saw there was a policy on the management of residents money and financial affairs. This detailed the philosophy of enabling the people living in the home to have control over their finances. It stated peoples ability to manage their finances should be assessed and any concerns discussed fully with their relative or social worker, that this should be documented in their care plan and reviewed. It was evident this policy has not been followed regarding three people who have control of their finances. There was no documentation in their care plans about how they managed or should be supported with managing their finances. Although the policy stated that staff should ensure safeguards are in place to protect the financial interests of people, we saw the arrangements in place did not follow this practice. There was no evidence to show robust systems were in place to protect peoples finances. We were concerned that the recording, auditing and accountablity in this area was not robust and did not protect peoples financial interests. We did not see individual cash sheets that could be cross referenced with other monetary transactions made on behalf of people. For example when money had been taken/entered into bank accounts and purchases made by people. However there was a record of people receiving their weekly personal allowance. Most of this was put into individual envelopes for people to use during the week. We did not see any evidence of robust measures in place to monitor financial systems. We were informed that some people had made purchases for items such as digital televisions and we saw from peoples cheque books they had bought items of furniture. There were no records of the property and items of value belonging to the people living in the home. We saw from previous receipts dating back to several years that staff had used their debit cards for making purchases on behalf of people. Some of these receipts showed Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: that items had been bought for more than one person but only one receipt had been kept. We saw that people borrowed money from the provider to pay for chiropody, rent, trips, personal allowance and any major purchase made. The provider invoiced people monthly. We saw monthly invoices and bank statements confirming monies paid that could be tracked to individual invoices. However there were no individual financial records tracking expenditure, savings, and monies going into individuals accounts. Although people had been charged and invoiced for trips we did not see receipts that could be tracked to the individual charge. We saw a few people living in the home were independent in handling their money and for one person their care plan stated that they needed support to access their money. This did not instruct staff how they should be supported. There were no financial risk assessments or information about peoples individual capacity regarding consent. Care Homes for Adults (18-65 years) Page 24 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although Cardell House provides clean and homely accomodation, the people living in the home are not benefiting from a safe environment. Requirements have not been met to ensure peoples safety and that their privacy is maintained. Evidence: Cardell House is a large property that consists of two houses that have been converted into one. The home is close to local shops and bus routes with other amenities within walking distance. We saw the home was clean and free from odour. This was confirmed by all but one of the completed surveys received from the people living in the home. Staff support people who need help to clean their rooms with the majority of the housekeeping tasks completed by staff. This was confirmed through cleaning rotas in place. The AQQA told us five staff had received training in the prevention and control of infection and was confirmed through staff training records. The large open plan living area on the ground floor had been redecorated and recarpeted since the last inspection. There was an industrial style kitchen that was used by both the staff and some of the
Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: people living in the home. Tea and coffee making facilities were available in the dining area and we saw people making their own drinks when they wanted. The previous stainless steel units had been replaced with domestic units to give a more homely feel. A recommendation had been met for staff to maintain a record of daily fridge /freezer temperatures. There were sufficient toilet and bathing areas. One bathroom had an assisted bath to help people with their mobility. We were told the flooring in this bathroom continues to be a problem due the floor tiles retaining water and odour. Although on the day of the inspection there was no odour, we noted there was water on the floor. It was evident this could result in some of the ageing people living in the home with poor mobility slipping. A requirement was made at a previous inspection for flooring in this bathroom to be replaced with a more suitable flooring and we had been told the flooring had been purchased. We saw no evidence of this. Although the home had been redecorated and recarpeted in some areas, we were concerned that several requirements relating to keeping people safe had not been met. A requirement had not been met for bathrooms and toilets to have a lock fitted that can be overridden in the event of an emergency, safeguarding the people living in the home and ensuring their privacy is maintained. A requirement had not been met for a risk assessment to be completed on all radiators where a risk as been identified and for appropriate action to be taken, again safeguarding people from harm. A recommendation had also not been met for a review of the star locks on the bedrooms of the people living in the home to be carried out, and to remove if no longer required, installing a lock where people request a key. We saw a requirement had been met for an attic window to be replaced. Care Homes for Adults (18-65 years) Page 26 of 40 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people living in the home benefit from the minimum staffing arrangements and are not always supported with sufficient numbers of staff to meet their needs. People living in the home are not protected by recruitment processes, or through a trained staff team. Evidence: There is still a small team of staff working in the home with the majority having worked there for several years. The results of the surveys received from the people living in the home conveyed that they were very happy with the staff and felt well supported. We asked for a copy of the duty roster to see if this confirmed the staff working. There was no roster in place but the manager offered a copy of hers that had been given to her by the provider. During the day the manager printed off copies of previous rosters that were emailed to her by the provider. The roster showed the home was staffed with two staff when all the people living there were at home. This was reduced to one care staff and the manager during the week. Two staff slept in at night. Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: It has been previously recorded in Standard 12, 13 and 14, that people were not going out on a regular basis, and that the reduction in staffing during the day had impacted on the outcomes for the people that stayed at home during the day. We have been told three staff have up to now worked long shifts of between 42 to 52 hours a week. Three other staff cover various lesser hours. Staff working the longer hours have complained to the provider and asked for their hours to be cut. One staff spoken told us the provider has agreed for them to work shorter hours. We saw in staffing files an opt out agreement for one member of staff to work longer hours complying with the european working time directive. However there was no record of such an agreement for the two other staff. Three completed staff surveys received told us that there are always enough staff to meet the individual needs of the people living in the home while another three surveys said usually. We have concerns about the current staffing arrangements as currently there are three staff not working due to sickness, with one new staff only just recruited and with another in the process. The manager is also new and is waiting for her Criminal Records Bureau(CRB) to come through so can only be with the people living in the home when there are other staff around. We have also been told since this inspection that another member of the care staff has resigned. We asked the provider to inform us of the staffing arrangements over a bank holiday weekend. The provider has responded telling us that three of the five agency staff being used have worked at the home previously, and that the manager would be available at all times over the weekend. A requirement had not been met for when staff start work on a POVA First check, before a full CRB is received for a risk assessment to show they being supervised at all times offering the people living in the home protection. It was evident that the care staff had not made plans to leave the home whilst the new manager was on duty. However it was unsure what would happen in the case of an emergency such as an individual being admitted to hospital. We saw all the staffing records apart from the two new staff being appointed. Documents in place showed appropriate checks had been made, applications and proof of identity. One staff file held their POVA First check but only one reference. There was also no risk assessment for this person for when they first started working prior to their CRB. All staff files had job description, and contract of employment when there Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: had been a change in provider. We spoke with a member of staff who told us they had been given an induction that provided them with enough information before starting work about the needs of the people living in the home. We saw that three staff had a National Vocational Qualification. This was confirmed through certificates seen in staffing files. The AQQA told us staff are regularly booked onto training to update their knowledge and best practice. However the AQAA has also recognised that an area to be improved is keeping mandatory training up to date. A requirement had not been met to ensure staff have up dates in areas such as first aid and food hygiene. We saw no evidence that staff had been booked onto training on a regular basis. One staff record showed a record of food hygeine training but no other. It was evident a staff member employed a year ago had training through their previous employment but that this had not been updated. Some staff had attended training in effective communication, and recording skills in 2009. We did not see up to date supervision records. Staffing files showed supervision had taken place in 2008 and in February 2009. Three staff spoken with told us they had been supervised formally but had not been given a written record. Also that they had their work performance appraised. We saw some documentation to show some appraisals had taken place and some staff said they were due to be appraised. Four of the staff surveys we received told us the manager often gives enough support and meets to discuss working while two told us this happens regularly. We saw the record of staff meetings with the last meeting held in October 2009. Care Homes for Adults (18-65 years) Page 29 of 40 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager has only just been employed and will need to apply to be registered manager and complete further training. Policies and procedures are not always followed in ensuring the rights and best interests of the people living in the home are safeguarded. The people living in the home would benefit from improvements in effective quality monitoring, the maintaining of records, and health and safety to ensure they are protected. Evidence: As previously recorded, the new manager, has been employed for just two weeks. She told us about her previous experience in working with people with a learning disability and that she has a National Vocational Level 3 and the Registered Managers Award. We advised her that she send in an application to be the registered manager and that she will be expected to attend further training in line with a management role. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: The new manager has previous experience of running a small care home. It is evident as previously recorded in Standard 23 that she will need to complete updates in her training in key areas, such as safeguarding, The Mental Capacity Act and Deprivation of Liberty Safeguards. It was evident that she will also need to be supported by the provider as part of her induction in understanding how some of the key areas in Cardell House are managed. The new manager has started new recording systems for better communication with staff to help ensure they are being kept up to date with any changes. We saw she is in the process of building relationships with the people living in the home and the staff team. The new manager helped with the inspection process as far as she could despite she was finding it difficult to find information about the way the home is run including up to date records and documents. It was evident that the provider has not been robust in monitoring the management of the home to ensure the people living in the home are being kept safe. Although a requirement has been met for a record to be kept of the providers monthly visits, we saw through the records that key areas of the management of the home had not been commented on. Requirements had not been met since the last inspection and we did not see any reference to how these should be met. We are not assured that the quality assurance methods are providing effective monitoring of key areas as the reports do not provide evidence of this. As previously recorded in Standard 23 the policies and procedures relating to the management of finances belonging to the people living in the home are not being followed. It was evident that record keeping had not been maintained in order to safeguard the rights and best interests of the people living in the home. As previously recorded we were unable to find up to date records of supervision, staff training and financial transactions and documents. The records relating to the people living in the home such as care plans were not up to date providing sufficient information for staff to follow in meeting their individual needs. Records were seen relating to the monitoring of the health and safety of the home. A recommendation had been met in maintaining a record of the refridgerator and freezer temperatures. Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: The fire risk assessment had been reviewed in 2010 and fire records were complete in respect of checks on the equipment and staff participating in regular fire checks. There was no up to date record of fire training that staff had attended. As peviously recorded a requirement had not been met in risk assessing the need to guard hot radiators so that the people living in the home are protected from burns. It was evident that some of the people living in the home are getting older and could be prone to falls and at risk of burns if they should fall in a confined space near a radiator. Where areas have been identified as high risk then remedial action must be taken to address and minimise the risk. Care Homes for Adults (18-65 years) Page 32 of 40 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 6 15 (1) (2)12 Keep care plans and risk 30/12/2009 assessments under review at least six monthly. To ensure meeting the changing needs of the individuals. 2 9 13 (4), 15 To expand on the information 30/12/2009 recorded in risk assessments. To ensure that it reflects the level of risk and the action taken to minimise the risk. 3 27 23 (2) (n) To ensure that bathrooms and toilets are fitted with a lock that can be overridden in the event of an emergency. Safeguarding the individuals and ensuring their privacy is maintained. 15/09/2009 4 33 18 (1) (a) Review staffing arrangements To ensure that individuals social needs and aspirations can be met individually and collectively. 30/08/2009 Care Homes for Adults (18-65 years) Page 33 of 40 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 5 34 19 (7) schedule 2 Where staff commences work 30/06/2009 on a POVA first prior to a full CRB being received ensure that they are supervised at all times within a risk assessment framework. Offering the individuals protection. 6 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 7 42 13 (4) For a risk assessment to be completed on all radiators where a risk has been identified then appropriate action to be taken. Safeguarding individuals from harm. 30/08/2009 Care Homes for Adults (18-65 years) Page 34 of 40 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 6 15 Care planning must include 31/07/2010 more detailed instruction for staff to follow about how the needs of the individual people living in the home are to be met. This will help to ensure the individual needs in respect of the health and welfare of the people living in the home are to be met. 2 13 16 Arrangements must be 31/07/2010 made 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. 3 20 13 Review individual risk assessment frameworks for self medication. To monitor any changes in 21/05/2010 Care Homes for Adults (18-65 years) Page 35 of 40 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 the needs of the people living in the home to self medicate and to ensure they are taking their medication safely 4 20 13 A record must be kept of when as required medication should be given to an individual. This will instruct staff clearly when to give as required medication and keep the individual safe. 5 22 22 A record of all complaints made by people living in the home must be kept. This will show that the people living in the home have been listened to and their concerns and complaints have been acted on. 6 23 17 A robust system must be in place to record people living in the homes expenditure, personal finances, valuables and property. This will ensure the people living in the home have their personal finances and property safeguarded. 7 23 13 The manager and staff working in the home must attend training in abuse. 30/06/2010 21/05/2010 21/05/2010 21/05/2010 Care Homes for Adults (18-65 years) Page 36 of 40 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 will help to prevent the people living in the home being placed at risk of harm or abuse. 8 27 23 Refloor the ground floor bathroom with a suitable flooring to meet the needs of all of the people living in the home. This will help to ensure people in the home are supported safely and their independence maintained. 9 33 17 A copy of the duty roster must be available in the home at all times. So that staff know who is on duty and for the roster to show if staff actually worked their rostered shift. 10 36 18 Staff working in the home must receive appropriate supervision. So that staffs work performance is monitored to help ensure the needs of the people living in the home are met. 11 39 26 The provider must send us a 31/05/2010 copy of the monthly reports required for purpose of monitoring all aspects of running the home. 31/07/2010 17/05/2010 30/09/2010 Care Homes for Adults (18-65 years) Page 37 of 40 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 To ensure the service is being monitored effectively and that the people living in the home can be assured of this. 12 40 12 The policies and procedures in place must be followed. So that the rights and best interests of the people living in the home are safeguarded. 13 41 17 Records must be maintained 30/06/2010 and kept up to date. To ensure the rights and best interests of the people living in the home are safeguarded. 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 31/05/2010 1 6 Develop care plans in a more individual and person centred way to show the people living in the home are involved in the planning of their care. Review the arrangements in providing people with their personal care items to take into consideration the equatability and individual choice. Involve people living in the home in the development of a planned menu. This will help evidence decision making processes and support staff in the planning of shopping. Develop Health Action Plans for the people living in the home to help them understand and be involved in the
Page 38 of 40 2 7 3 17 4 19 Care Homes for Adults (18-65 years) 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 planning of their health care. 5 23 The manager would benefit from attending investigatory training relating to safeguarding, to further her understanding, knowledge and practice. Ensure all staff sign a record of consent if offered working hours over the working time limits. 6 34 Care Homes for Adults (18-65 years) Page 39 of 40 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!