Inspection on 30/06/09 for Cardell House

This inspection was carried out on 30th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cardell House 10/08/10

Cardell House 19/04/10

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 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Cardell House Cardell House 421-423 Speedwell Road Kingswood Bristol BS15 1ER Lead Inspector Paula Cordell Key Unannounced Inspection 30th June 2009 09:15 Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cardell House Address Cardell House 421-423 Speedwell Road Kingswood Bristol BS15 1ER 0117 9674647 0117 9674647 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ritzi Care Homes Limited Ms Katherine Hicks Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 12. Date of last inspection Brief Description of the Service: Cardell House is a registered care home, operated by Ritzi Care Homes Ltd with the day to day management cascaded to Ms Katherine Hicks. 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 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. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an announced visit as part of a key inspection process. This was the home’s first inspection under the new ownership of Ritzi Care Homes Ltd. The home was sold in January 2009 with the new owner being registered with the Care Quality Commission. In addition a new manager was registered in June 2009. Many of the staff continue to work for the new owner. The visit was conducted over one day with structured feedback being given to the newly appointed registered manager. An opportunity was taken to review records relating to running a care home including 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 manager. The visit was planned using information received since January 2009 when the home was re-registered under the new ownership, including surveys from people who use the service and staff. A completed annual quality assurance assessment was received during the visit. This gave us information on how the home was meeting the National Minimum Standards, what the barriers have been and what improvements are intended for the forth coming year. What the service does well: What has improved since the last inspection? This is not applicable as the home has changed ownership since the last visit and there is a new manager in post. However, the last report and requirements will be mentioned in this report as a bench mark on how the service has progressed. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 6 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 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. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have sufficient information about Cardell House to enable them to make a decision on whether to live in the home. However, the new provider must ensure that individuals have a new contract. Individuals can be confident that their care needs will be assessed prior to moving to the home ensuring Cardell House is suitable for them. EVIDENCE: The home has a statement of purpose and a service user guide. These clearly describe the service that can be provided including key policies. They give detailed information to enable prospective people moving to the home to make a decision on whether Cardell House is suitable. This has been reviewed and amended by the new provider and now includes the complaints procedure. There are some minor amendments to ensure that the details relating to the Care Quality Commission is consistently used throughout the document. The Annual Quality Assurance Assessment provided evidence that the home was exploring how the service use guide could be made more accessible. However, this was written in plain English and used symbols. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 9 Some of the individuals have lived in the home since it opened 25 years ago. There have been no admissions in the last four years. The manager said that individuals have only moved from the home for a more independent lifestyle and not because the placement has broken down. There is presently one vacancy and it was evident from talking with the manager that prospective individuals would be assessed prior to moving to the home. The home has an admissions policy which is included in the statement of purpose. Care files included assessments completed by the care home and that of the placing authority. Completed surveys from people using the service confirmed that they had sufficient information about the service and that they had visited prior to making a decision to move to Cardell House. Other comments include “I like living here” and one person said “I visited other homes before deciding on Cardell House”. Contracts held on file were that completed by the previous provider and must be amended to include the change of ownership. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are being supported by a team of staff that have known them for years and the individuals spoken with said they were happy with the care provided. However, the care planning processes are a mix of different formats and do not capture the care that is being provided. Information could be misleading which could mean an inconsistent service is being provided and not meeting the current and changing needs of the individuals. EVIDENCE: Three persons care was looked at as a means to determine the quality of the care provided to the individuals living at Cardell House. The Annual Quality Assurance Assessment identified care planning as an area where the home could improve ensuring that the information was more Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 11 accessible to the individuals living in Cardell House. This had been noted during the last visit in June 2008 under the previous owner. Care plans seen were a combination of two different formats. The new manager said that the previous manager was in the process of introducing a new format and this was still work in progress. Some of the care plans were dated August 2006 and the review process was unclear. One care plan did not fully capture how the staff were supporting the individual until you read the review where staff then fully detailed how they were supporting an individual with smoking. Some of the care plans lacked information to enable them to be fully monitored for example to keep in touch with family and accessing the community. The plan failed to state who would support, how and the frequency. Another person’s care plan was about isolation and community participation but again it failed to state how and who would support the individual and the frequency to assist with meeting the individual’s needs. A formal review would have been difficult to complete due to the lack of information. From talking with staff and the manager it has been difficult to assist this person in the community due to the person’s changing needs. This will be discussed under the lifestyle section of this report. Risk assessments were in place. Again the manager said they were in the process of updating these. Two different formats were in place and the information did not fully describe the risk for example one said personal care but not what the risks for the person were and another contradicted the plan of care as the risk stated one to one support when out in the community but the care plan said two staff to support. Risk assessments would benefit from being expanded to ensure that the level of risk is detailed and the action the staff are taken to support the person. The home operates a key worker system. Individuals are supported by their key workers to clean their bedrooms and plan opportunities to go out shopping on a weekly basis. Individuals are supported to make choices on how to spend their time, when they wish to get up and go to bed and have choices on what to wear. From talking with the manager and staff it was evident that the weekly key worker time was a place for individuals to make decisions on what they would like to do or discuss any concerns if they have them. Individuals have an opportunity to attend a monthly meeting where people can express their views and make further decisions. It was evident that individuals are making plans for the summer holidays and a barbeque. There is a small team of staff supporting the individuals and many of them have worked in the home for a number of years. Whilst it is evident that the staff are knowledgeable about the personalities and the care needs of the Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 12 individuals, better care planning processes will assist both new staff and better evidence the care that is being delivered. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some individuals benefit from a structured activity plan provided by external providers. Minimal staffing during the week means that some individuals are not going out very often with the staff working at Cardell House. Individuals are supported to maintain contact with friends and family. A healthy menu is available to the people living in Cardell House. EVIDENCE: Individuals confirmed in conversations that they were supported to go out with staff locally to the shops and the pub. One person could not recall when they last went out but said they had a “system” they were happy with. It was evident from the conversation they were happy to potter around the home and if they needed to go out staff would support him. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 14 Four of the individuals were at home during the visit. All said they were happy with the care that was being provided. Whilst many of the individuals attend day centres, college courses or work placements four of the individuals are retired and have no structured activities in place. The manager said that the staffing is reduced Monday to Friday when the majority of the individuals are out with only one care member of staff being on duty and the manager. It was noted that one of the individuals needs two staff to support them when going out further afield. The manager said that additional staff would be employed to assist the individual and the last time this occurred it was in May 2009. The manager stated that the person receiving a care service contributed to the cost of the additional staff member. This must be discussed with the placing authority as this would be deemed as part of the fees that are already paid by the local council and the individual. Where the needs of the individual has significantly changed then again this must be discussed with the placing authority to enable them to complete a reassessment of the person’s needs. Comments from the completed surveys stated “I can always do what I want during the day, in the evenings and at weekends”. Staff said that individuals assist with the cleaning, food preparation and in addition board games and crafts are organised when requested. Individuals have access to a communal lounge and it was noted there was a big box of games. One individual said that they spend some time in their bedroom watching television. Daily records did not evidence that individuals were going out on a regular basis. Individuals could not remember when they last went out in the evening. One member of staff said we use to go to the pub in the evening but that was last year and people enjoyed this. The manager said that individuals have not been given as many opportunities as she would have liked and that this was planning to change with trips being planned for the summer. The manager said that this is to do with a shortage of staff with the previous manager leaving and another member of staff retiring. However additional staff have been employed. The manager feels confident that this will change and discussions have taken place both with the individuals and the staff on how this can be addressed. One person said they have lived in the home for a number of years and liked both the people who live in the home and the staff team. Another put their thumb up when asked whether they were happy living in Cardell House. Individuals have chosen not to have a holiday this year and are going out in small groups for day trips to places of interest. At the time of the visit this had not been formally organised. One person has said they would like to go on holiday and discussions were taking place in respect of the funding of the holiday as the person is reluctant to pay. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 15 People are supported in keeping touch with families and friends. The Annual Quality Assurance Assessment stated that nearly all have contact with family. It was evident from talking with individuals that they could have people to visit the home or the staff would support them to visit family or friends. The manager said that the staff and the individuals are planning a barbeque and all relatives and friends will be invited. From evidence provided during the last visit it was evident that where individuals required support from an advocacy service this would be supported. However it was noted that individuals had signed a letter which enabled the previous manager or the staff to consent for treatment on behalf of the individuals. This was discussed with the new manager, as the care staff do not have legal capacity to sign for consent on behalf of the individuals. It is advisable that the manager attends training on the Mental Capacity Act. An opportunity was taken to view how individuals were supported during the lunch time period. Staff were courteous and respectful. All individuals were supported to make choices on what they wanted to eat and drink and the atmosphere was relaxed and unrushed. Individuals were observed making drinks and one person said they can help themselves to snacks whenever they choose. The menu was varied and provided evidence that individuals have available to them a healthy eating plan. There is a choice of two main meals and it is evident that staff support a person with a special diet. Food shopping is done on a weekly basis with smaller purchases made locally. The kitchen was well stocked with both convenience food and fresh vegetables. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It was difficult to ascertain how individual’s health care needs were being met from records maintained. Individual’s personal care needs were being met. Individuals could be put at risk due to the lack of recording of medication entering the home and the lack of guidance for staff in respect of an error. EVIDENCE: It was noted at the last visit in July 2008 that the care plans were not accessible and the health and personal care information was going to be put into a Health Action Plan format. This has not been completed. The manager said that there has been a change of provider and manager and this continues to be an area that could be improved. It was difficult to track whether individuals had regular appointments with the dentist and opticians as all health care appointments were recorded with the day to day activities. There was no overview available for staff to quickly find out the information. The manager said that this information could be Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 17 ascertained from the home’s dairy however a review should be taken to improve the recording so it is more accessible. Advice is evidently being sought from other professionals in supporting the people at Cardell House including the local community learning disability team, speech and language therapist and district nurses. The manager and the staff confirmed that routine appointments are made with the GP, dentist and opticians. An optician visits the home on an annual basis and the dentist is organised through the practice clinic as it is on the same site as the doctors. Daily records provided evidence where individuals were supported with their personal care. One person said “I can have a bath or shower whenever I want”. Daily routines are included in the plan of care in relation to preferences for getting up and bathing routines. One individual said they can get up and go to bed whenever they want. An opportunity was taken to review the medication system. Records were being maintained of medication administration but less apparent was a record of medication entering the home. The disposal record had only one signature where there should have been two members of staff and the pharmacist and the reason for the disposal. It was noted that a number of prescribed topical medicines and some eye drops were not held securely and left on the top of a filing cabinet in the office. It was advised that the eye drops were stored at temperatures not exceeding 20 degrees and not in sun light. The office was a conservatory and was very warm on the day of the visit. Medication was stored in a locked filing cabinet. It would be advisable for the home to purchase a suitable medication cupboard. Some of the individuals are able to look after their medication within a risk assessment framework. These were looked at during the last visit to the home. The home has a medication policy which would benefit from staff having information on what to do in the event of an error, omission or any other discrepancy in relation to medication. Evidence was provided during the last visit that staff had completed accredited training on the safe administration of medication. Staff are also in the process of completing a distance learning pack on medication. The manager said that she has yet to check how far staff have got with this. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that the staff working in the home will listen to their concerns and good safeguards are in place. EVIDENCE: The home has a complaints procedure which is now included in the statement of purpose. Individuals in completed surveys said they knew how to complain and would tell the staff if they were unhappy. All returned surveys said “they felt listened too and staff act upon what is being said”. The complaint procedure is available in an accessible format which includes symbols and clearly sets out how the home will respond to concerns and the timescales. The home maintains a record of complaints. There have been no complaints since the last visit. The majority of staff have attended training in safeguarding. The manager has identified that the two staff recently employed will be attending this with Bristol City Council. Staff spoken with during the course of the visit confirmed the procedures in respect of safeguarding and all were clear that abuse would not be tolerated and reported appropriately. The manager has attended the basic training on safeguarding with Bristol City Council. However, it has been identified through the fit person process with the Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 19 Care Quality Commission that she may benefit from attending the investigatory training for managers. She confirmed that she was in the process of organising this. This will be followed up at the next visit to the home. It was noted during the last visit that the statement of purpose makes reference to restraint being used. This has now been removed. Two staff and the manager stated that restraint is never used in the home. From conversations with both staff and three of the individuals it was evident that people get on well and it was rare for individuals to quarrel. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cardell House provides suitable accommodation for the people that live there. It was clean and homely. Individuals are benefiting from the programme of redecoration. Individuals could potentially be at risk of scalds due to radiators not being guarded. EVIDENCE: Cardell House is a large property and consists of two domestic dwellings that have been converted and adjoined. The home is close to shops and bus routes, with other amenities within walking distance. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 21 The home was clean and free from odour. Staff and the individuals are complete the cleaning tasks in the home. It was confirmed in the completed surveys from people who live in the home that it was always clean and fresh. Cleaning rotas are in place. There is a large open plan living area on the ground floor. This was in the process of being decorated. The manager stated that new furniture and carpets have been purchased to complete the refurbishment. It was evident that the new provider was intending to redecorate all communal areas including the hallways, again the manager confirmed new carpets had been purchased. Staff in a completed survey said “the only improvement that could be made is decoration of the home”. It was evident that the provider and the manager were addressing this. The home has an industrial style kitchen which can be accessed both by staff and the individuals living in the home. Tea making facilities are sited in the dining area and from talking with staff and the manager it was evident that this area was being replaced with domestic kitchen units to make it feel more homely rather than the present stainless steel units. The home has recently been visited by an Environmental Health Officer and has been awarded a four star rating. It was noted that the kitchen was in good order, clean and provided a safe place to prepare and serve food. Records were maintained to demonstrate that food hygiene principles were being adopted. However, the staff were only recording fridge temperatures on a weekly basis rather than the recommended daily record. There are four toilets and three bathrooms. One bathroom has an assisted bath to help people who may need support with their mobility. New flooring has been purchased which has assisted in combating the odour that was noted during the last visit. It was noted that all the bathrooms and toilets were fitted with conventional locks which cannot be overridden in the event of an emergency. This should be addressed as many of the individuals are getting older and could be prone to falls or health related matters which may require staff to assistance. Bedrooms seen were personalised by the individual and were comfortably furnished. One individual said they had recently been supported to choose a colour scheme and new furniture. The manager said that it is the provider’s responsibility to furnish the bedrooms. It was noted that bedroom doors were fitted with star key locks. The manager said these are not used. It would be recommended that these are removed as part of the decoration process. The manager said that all the individuals have been offered a key to their bedroom door. It was noted that none of the bedrooms seen had a lockable devise other than the star key lock. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 22 During the tour of the home it was noted that windows have been fitted with restrictors. There was a crack on the attic hallway window which was made safe during the visit and the intention was to get a glazier out as a matter of urgency. Whilst the home was a safe place to live with water temperatures being controlled it was noted that none of the radiators throughout the home were guarded. The manager said that the radiators are regulated and none are set high thus preventing scalds. This should be risk assessed and where a high risk area is identified then remedial action must be taken for example bathrooms and toilets where space maybe confined. The individuals have access to a large rear garden which has raised flower beds and a water feature as an added attraction. The garage has been converted to an office and storage area for fridge/freezers and food storage. Cardell House is a non smoking building and individuals smoke in the garden. One person has a shed that they have made their own with comfortable chairs and a music centre. From talking with the individual it was evident that they liked to spend time there. Cardell House has a room specific for laundry which is sited separate from the kitchen. Individuals assist with their laundry. Cleaning products are stored there in a locked cupboard. Guidance was available in accordance with Care of Substances Hazardous to Health including data sheets in respect of the chemicals used. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a small team of staff where there is good communication. However, the minimum staffing could be restricting individuals from fully accessing the community. Due to the change of management and ownership training has slipped in respect of their statutory training this could put individuals at risk. Individuals are not protected by the home’s recruitment processes. EVIDENCE: There is a small team of staff working in the home with the majority having been there for many years. The home is staffed with two staff when all the individuals are at home and this is reduced to one care staff and the manager during the week. There are two staff sleeping in at night. There is good communication between the staff with daily handovers and monthly staff meetings. The records for the latter could not be found. Two staff Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 24 spoken with during the visit said that there are regular meetings. This was echoed in completed surveys from staff. As already mentioned the reduction in staffing during the day could be having an impact on the individuals that stay at home with activities being restricted to the house if only one member of staff is on duty. The manager did say that additional staff could be rostered for trips but this has not happened recently. Staff are involved in the household chores and the cleaning of the home. That means that when staff are involved in catering there would only be one member of staff supporting the individuals with their personal care and activities. The home maintains a rota of staff and the hours worked. Job descriptions were seen at a previous visit to the home. Recruitment information was seen for two new members of staff. Information was in place demonstrating that a robust recruitment had taken place to protect the individuals working in the home for one of the staff members. Whilst one person had two references for the second person there was only one. The manager said that she has repeatedly asked for the second reference with no response or acknowledgement. The manager should find out the reason why they are declining. Good practice would be to obtain a second reference from another source. This same person had commenced working in the home a month prior to the manager receiving a full criminal record bureau disclosure. Where staff start prior to receipt of a full CRB then a risk assessment should be in place with the member of staff being supervised at all times. Both the new staff have started their induction and well within the timescales for completion. The manager said that it has been difficult for one of the members of staff as they work mainly nights. Good practice would be for staff to complete the Learning Disability Qualification as part of their induction as recommended in the National Minimum Standards. Training records provided evidence that staff need updating in all areas of health and safety training including first aid, food hygiene, fire training and health and safety. All staff have attended training in manual handling within the last twelve months. The manager said that there has been an interim period where the home did not have a manager and a list has been drawn up on what each member of staff requires and this is being sourced with Bristol City Council. This will be followed up at the next visit to the home. The manager said that three out of the seven staff have a National Vocational Qualification at either level 2 or 3 and one person is in the process of completing a level 3. The home is working towards the target of 50 of the workforce having a National Vocational Qualification. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 25 Records provided evidence that in the past staff have attended training in Makaton (a sign language for people with Learning Disabilities), continence, assertiveness training, mental health and learning disabilities and loss and bereavement. From talking with the manager it was evident that where staff expressed an interest in a training course and it was relevant to the needs of the individuals living in Cardell House this would be supported. The manager said that all staff would be completing a course in infection control. Five of the seven staff have attended a course in safeguarding and the manager has identified for the two new staff to complete a course and was in the process of organising a date. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager has a good awareness of the areas for improvement in the home. It is evident that some of the documentation has slipped during the changeover period in ownership and management. Improvements are required in relation to health and safety to ensure that individuals are safe and free from harm. EVIDENCE: Since the last visit Cardell House has been sold to a new provider. The new provider registered with the Care Quality Commission in January 2009. A new manager was appointed in March 2009 and registered with the Care Quality Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 27 Commission in June 2009. The new manager is Ms Hicks, she was previously the deputy manager. From talking with the staff team it is evident that Ms Hicks has an open door management style. Good systems of communication are in place, with Ms Hicks assisting with the day to day care of the individuals and working as part of the team. Although she said now she has to concentrate on the management side more in respect of care planning and record management. Ms Hicks has completed a National Vocational Award at Level 4 and is planning to complete the Leadership and Management Qualification formally the Registered Manager’s Award. As part of Ms Hicks registration there was an expectation that she would complete further training on safeguarding. Ms Hicks confirmed she was in the process of enrolling on the appropriate course. This will be followed up at the next visit to the home. Regular meetings are held both for staff and the people who use the service enabling them to air their views about the service being provided. Annual Questionnaires are sent to stakeholders including people who use the service, their relatives and professionals involved in the care of the individuals. This was confirmed in conversations with individuals living in the home, staff and the manager and in the completed annual quality assurance assessment. The staff and the manager stated that the provider regularly visits the home. However, there were no records confirming that the visits were taken place in respect of regulation 26 where the provider who has not got day to day responsibility for the home completes a monthly audit on the running of the home and the quality of the service provided. Records were viewed in respect of health and safety including food hygiene and fire. Records demonstrating food safety measures were in place were all complete except the home was under the misunderstanding that fridge temperatures only need be recorded weekly. However, it is recommended that these are maintained daily. As already mentioned the home has been inspected by Environmental Health and has been awarded four stars. As already mentioned during the tour of the home it was noted the radiators had no guards to protect individuals from scalds. A risk assessment must be completed in light that individuals are getting older and could be prone to falls and at risk of scalds if they should fall in a confined space near a radiator. Where areas have been identified as high risk remedial action must be taken to address and minimise the risk. Fire records were complete in respect of checks on the equipment and staff participating in regular fire drills. Less apparent was evidence of staff taking part in fire training in accordance with the fire officer’s recommendations which is six monthly for day staff and three monthly for night staff. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 28 Other records seen were electrical testing completed on equipment annually, gas appliance checks and external contractors testing the fire equipment. Since the new provider has purchased the home, works have been completed on the call bell system and a new boiler installed as confirmed in conversations with staff and the manager. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 3 3 X X 2 x Version 5.2 Page 30 Cardell House DS0000072694.V376134.R01.S.doc N/a Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (1) (c) Requirement For the provider to ensure that there is an updated contract that reflects the change of ownership. Ensuring individuals have current information about the home. 2. YA6 15 (1) (2) 12 Keep care plans and risk assessments under review at least six monthly. To ensure meeting the changing needs of the individuals. To expand on the information recorded in risk assessments. To ensure that it reflects the level of risk and the action taken to minimise the risk. Review staffing arrangements To ensure that individual’s social needs and aspirations can be met individually and collectively. To expand on the medication policy. So that staff know what they should do in the event of an error or an omission. Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 31 Timescale for action 30/08/09 30/12/09 3. YA9 13 (4), 15 30/12/09 4. YA33 18 (1) (a) 30/08/09 5. YA20 13 (2) 30/08/09 6. YA20 13 (2) 7. YA20 13 (2) 8. YA20 13 (2) Ensure that medication is stored 30/06/09 securely and in accordance with the instructions of the pharmacist. Safeguarding the individuals. For the disposal record of 30/06/09 medication to include two staff signatures and the reason for the disposal. For a record to be maintained of 07/07/09 all medication entering the home. Enabling the home to audit medication entering the home and protecting the individuals. 9. YA42 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. For the window to be replaced in the top attic hallway. 30/08/09 10. YA24 23 (2) (b) 07/07/09 11. YA27 23 (2) (n) Safeguarding the individuals. To ensure that bathrooms and 15/09/09 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. 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. The provider must maintain a record of the monthly visits in respect of regulation 26 with a copy held in the home. DS0000072694.V376134.R01.S.doc 12. YA35 18 (1) (c) (i) 30/09/09 13. YA39 26 30/08/09 Cardell House Version 5.2 Page 32 14. YA34 19 (7) schedule 2 So that individuals are assured that the service is being monitored. Where staff commences work 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. 30/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Where one person’s needs have increased in respect of staffing support a request must be made for a review with social services ensuring that funding is appropriate to enable them to have access to social occupation. To review the care planning format to ensure that it is appropriate for the people living in the home and based on current good practice in supporting individuals with a learning disability. To review the recording of health care appointments to ensure that these can be clearly reviewed. Consider separating from the daily care records and developing health action plans for individuals. To review the star locks on the bedroom doors and to remove if no longer required installing a lock where individuals request a key. Maintain a record of daily fridge freezer temperatures in accordance with the safe handling food practices. 2. YA6 3. YA19 4. 5. YA24 YA42 Cardell House DS0000072694.V376134.R01.S.doc Version 5.2 Page 33 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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