Inspection on 30/06/09 for Carr Bank House

This inspection was carried out on 30th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carr Bank House 12/01/10

Carr Bank House 08/12/09

Carr Bank House 22/10/09

Carr Bank House 17/06/08

Carr Bank House 05/07/07

Carr Bank House 11/06/06

Carr Bank House 31/10/05

Carr Bank House 03/07/05

Carr Bank House 18/08/04

Carr Bank House 01/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Carr Bank House 9-11 Heywood Street Bury Lancs BL9 7EB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lucy Burgess     Date: 3 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Carr Bank House 9-11 Heywood Street Bury Lancs BL9 7EB 01617977130 01617631747 jocarrbank@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Pauline Jones care home 14 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 14 The home is registered for a maximum of 14 service users, in the category of Adults with Mental Disorder (MD) under 65 years of age. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Carr Bank House is a privately owned care home for 14 adults with mental health needs. There has been no change in relation to the weekly fees. These are 365.00 pounds per week. However this may vary depending on the persons level of assessed need. The home is located in a residential area, close to Bury town centre, within easy reach of buses and trams, shops, cafes, and other local amenities. The house consists of 2 adjoining properties that have been adapted to form a large house. There is a small garden at the front and a large enclosed garden at the side. There are 12 single rooms and one double. Three bedrooms also have en-suite facilities. There are 2 lounges, an activities room, and a dining room. Care Homes for Adults (18-65 years) Page 4 of 36 Care Homes for Adults (18-65 years) Page 5 of 36 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: Two inspectors carried out the visit to the home, which they did not know was going to take place. The inspection was carried out over 1 day lasting 8 hours. The home was last inspected on the 17th and 23rd June 2008. During this visit inspectors briefly spent time talking with people at the home as well as the manager and deputy manager. We also spent sometime looking round the home to check that it was clean and well maintained as well as looking at records. As part of the inspection process the provider was asked to complete a self-assessment document (Annual Quality Assurance Assessment). This had not been returned as Care Homes for Adults (18-65 years) Page 6 of 36 requested prior to our visit. The manager was contacted and a reminder letter was sent. The manager again advised us that a further copy of the completed document had been sent, however this too has not yet been received. Failure to provide the information has resulted in a statutory requirement notice being sent to the provider with a timescale to comply. Failure to do so may result in further action being taken. No surveys were sent to people at the home due to the AQAA having not been provided. Following our last visit the manager was asked to provide an improvement plan detailing what action was to be taken to address the action identified. This was not provided. Discussion and feedback was held with the registered manager during our visit. Due to the concerns identified during this visit and the outstanding requirements we will be holding a management review to decide on what further action needs to be taken. What the care home does well: What has improved since the last inspection? What they could do better: As already stated requirements made at the last key inspection remain outstanding. Adequate management arrangements need to be in place so that issues within the home are addressed in a timely manner. Quality assurance systems need to be improved and clearly evidence that the service is being monitored. This is to ensure that the improvements needed are made so that a good quality service is provided and the home is run in the best interests of those who live there. We again found further evidence of unsafe recruitment practices. Due to our concerns copies of records were taken as further evidence. This has previously been discussed with the manager. Failure to follow the correct procedure potentially leaves people at risk of harm. The standard within the environment remained unchanged. Some areas were damp and further damage had been caused to the decoration, carpets required cleaning, beds/mattresses need replacing, bathrooms need attention, the external areas of the home need to be cleared of rubbish and tided and a broken window in one of the bedrooms needs replacing. This is poor. The provider must ensure that a good standard of accommodation is provided and that areas are clean and safe. Due to the concerns we contacted the environmental health officer. There has been no staff training over the last year. The manager had advised us that membership of the local training partnership had been arranged so that relevant training could be accessed for staff. This is not the case. The training group told us that no contact has been made with them by the home. Without suitable good quality training such as mental health awareness, challenging behaviour, medication, safeguarding, epilepsy in addition to the mandatory courses, there is no assurance that staff have the necessary skills needed to support people living at the home. This Care Homes for Adults (18-65 years) Page 8 of 36 potentially leaves people at risk. The manager must ensure that where it is identified in the care plan that additional monitoring of a persons weight/diet should be carried that this is complied with so that appropriate support and intervention can be provided should the concerns continue. Information recorded on the care plan should reflect the current and changing needs of people. Risk assessments need to be reviewed and updated ensuring information is accurate. Where additional needs have been identified these too should be included and provide staff with information about the level of support required so that people are kept safe. Records in relation to the administration of medication (MARs) need to be completed in full and where codes have been used these should be explored so that the health and well being of people can be monitored. Where there are handwritten entries on the MARs, it is advised that these are checked and countersigned by a second member of staff to ensure that the information recorded is correct. Incidents which may affect the well being of people must be reported to us evidencing all necessary action has been taken to ensure their safety. Water temperatures were found to be very low. These should be regulated as close to 43 degrees C as possible for the safety and comfort of people. An annual service check must be carried out in relation to the gas ensuring it is safe. Evidence must be provided to show that the work identified on the electric certificate has been addressed ensuring the system is safe and in good working order. The manager is to review the staff rotas so that staff are available to support people, encouraging them to take part in activities in and away from the home. This will enable people to increase their independence and skills. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 36 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 36 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. Sufficient information had been provided to enable the home to make a decision about the suitability of placement. Evidence: Since our last visit to the home there have been two new admissions. One person has moved in on a permanent basis and the second receives regular respite. Information was examined for the person receiving respite. Records had been provided by the funding authority including an up to date CPA (care programme plan) with regards to their support needs. This included details about their emotional, social and health care needs. A placement agreement and client specification were also included. These detailed the responsibilities of the home. Information provided had been used to develop a care plan and risk assessments. Care Homes for Adults (18-65 years) Page 11 of 36 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. Information about people does not accurately reflect their current and changing needs. This potentially leaves people at risk of not being supported in a way they would wish or need. Evidence: Individual records are held for each person. This includes a care plan, risk assessment, personal information, professional visits, CPA minutes and daily diaries. We looked at the files for 2 people where there had been recent changes in their physical health. The first file we looked at was in relation to a person identified during our last visit. This was because of changes in their health and weight loss. A referral had been made to the GP and the dietician was involved. Supplements had been prescribed. Short falls were previously found in relation to the monitoring of the persons weight as directed Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: in the care plan. We again looked at the plan to see what this stated. Information remained unchanged instructing staff to weigh the person on a weekly basis as well as record their daily food intake. We looked at the diary records to see if this had been done. Records showed that since January 2009 the person had only been weighed on 5 occasions. There were no food diaries. Some of the language used in the plan also needed amending. Comments were subjective and the opinion of the person writing the plan. Other information in the care plan included details about a budget plan along with a consent agreement, this was dated in 2005 agreeing for staff to assist. This information did not correspond with what we were told whilst carrying out a money check. Records in relation to professional visits were also not up to date. Information for one person showed that their last contact with a health care professional had been in March 2009. However other records showed in June 2009 a GP had been called to the home for them and they had also been admitted to hospital via A&E after being taken ill at home. We had also not been advised of this in line with Regulation 37. On the second file there was a care plan, this was not dated however and made reference to staff who no longer work at the home but had moved to the sister home. The risk assessment covered a number of areas in relation to health, medication, personal hygiene, fire and socialising. However this was dated the 30 January 2007 and made reference to the person as having schizophrenia. Information provided by a care health professional stated that the persons diagnosis was Bi-polar disorder. The manager must again ensure that information recorded on plans is accurate and up to date, reflecting the current and changing needs of people so that staff are clearly directed in how people wish to be supported. Further evidence should be made to show that people have actively been involved in developing their plans. A key worker system is in place. Information is recorded of any discussions held. Information varied depending on the person. Some people preferred not to engage whilst others appeared to have a good relationship with their key worker and talked openly about issues they may have. Care Homes for Adults (18-65 years) Page 13 of 36 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. Suitable arrangements are in place with regards to daily routines however this could be enhanced further by providing a more flexible approach, which caters for people with varying needs. Evidence: Little had changed with regards to peoples daily routines. Rising and retiring times were flexible dependent on each person allowing them to follow a lifestyle of their own choosing. People spend some of the time watching television, reading papers and relaxing, as well as more planned activities away from the home accessing the local and wider community. Others activities may include going to the pub or betting shop, bus rides to places of interest and shopping. During our visit we were told that two people had Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: gone into Manchester to the Cathedral, whilst another was out with their outreach worker who provides additional support as part of their placement agreement. An activity book is in place. This showed that over the last 2 months there had been 4 entries. These were with the same member of staff and involved 4 residents taking part in different activities. These included, dominoes and cards, jigsaws and shopping in the local town centre and on the market. We were told by the manager during our last visit that she was going to review the staff rota so that more staff were available at the times when support is required. In doing this more opportunities would be made available during the day to encourage people to be more active in and away from the home. On examination of the rotas this had not been done. Relationships with family and friends continue to be encouraged both in and away from the home. Visitors are welcome to visit Carr Bank at any time. Individuals were able to see visitors in private using the communal rooms or their bedrooms. One person regularly spends time away staying with their partner. The new permanent resident had been a regular visitor to the home spending alot of time with another resident. They said they were happy to have moved into the home and the support they receive and had settled very well. Meals vary depending on individual preferences. Special diets are also considered including kosher, halal and vegetarian. There is a main kitchen and a small kitchen which is for residents use. They were able to make snacks and drinks at any time. One resident now takes on the responsibility of doing the weekly shop for the home. The shopping list is drawn up by the resident and a staff member based on what was needed from the menu. As previously identified, people continue to be encouraged to develop and maintain their independent living skills. Some of the residents were involved with household tasks, including cooking, cleaning and laundry. Support was provided where required. Care Homes for Adults (18-65 years) Page 15 of 36 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. Systems are in place to monitor the mental health of people however where additional concerns have been identified records fail to evidence these are being addressed, which may affect the health and well being of people. Evidence: Each of the people living at the home were able to manage their own personal care needs only requiring prompts or encouragement when necessary. Records are on file for health appointments and meetings. Review notes in line with the care programme were also held on file. These include reviewing the needs of people as well as their current medication. The home continues to have good links with local mental health professionals who will offer advice and support where needed. One person continues to receive outreach support, which involves 1-2-1 support to assist in developing life skills. Following our last visit we found that one person had issues with regards to their Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: weight loss. Staff had liaised with the GP and supplements had been prescribed. Information in the care plan, which had been signed by the manager stated that this person was to be weighed on a weekly basis and that food intake charts were to be completed. However on examination of the record we could only find 5 entries of weight from February 2009 to June 2009. There were no intake charts. Weight records dated February and March showed that the persons weight was 8 stone 7 pounds. In June their weight was recorded as 9 stone however 2 weeks later when the GP was called out the person was weighed again and recorded as being 8 stone 2 pounds, therefore showing a weight loss of 12 pounds in 2 weeks. There was no weight records for April and May and no food intake charts in place, therefore their diet was not being monitored. Again records were inadequate and do not appear to be accurate. More attention was needed to ensure information was accurate and reflects the current and changing needs of people so that appropriate support and intervention can be provided if concerns continue. The and and and medication system was examined. Generally this was found to be in good order items were stored safely. Records were made of all items brought into the home returned to the supplying pharmacist. Administration records were also up to date had been signed by staff where necessary. As a new cycle had just started we looked at the administration records for the previous months. We found that there were gaps particularly over the weekend period and codes used did not identify the reason why medication had not been administered. Records for the person receiving respite were handwritten. The assistant manager was advised that entries should be checked and countersigned by 2 staff to ensure information reflects that on the prescription. Care Homes for Adults (18-65 years) Page 17 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices within the home does not ensure the safety and protection of people living there. Evidence: Information in relation to concerns and allegations is requested as part of the AQAA. However a completed document had yet to be provided by the service. We asked during our visit if any issues had been brought to their attention and were advised that there had not. No concerns or allegation have been made directly to us. People living at the home were aware of the complaints procedure and who to speak with if they had any issues or concerns. As detailed further in the report, practice in relation to recruitment and staff training and development are poor and potentially place people at risk. The manager advised us that membership to the Bury Training Partnership Group had now been completed, which would enable her to access relevant safegaurding training for the team. However we have been advised by the Partnership group that they had not been approached by the manager for either this home or the sister home. Training in this area again remains outstanding. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: A random check was carried out in relation to personal finances held at the home. We were advised that the provider is the appointee for certain people and that alternative arrangements are made for the remaining residents. A random check was carried out and found to be in order. Care Homes for Adults (18-65 years) Page 19 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The condition of the environment is poor and in need of attention so that people living at the home are provided with good standard accommodation which is both safe and comfortable. Evidence: Time was spent looking round the environment due to the issues identified following our previous visit. We found that little or no action had been taken to address areas which had previously been agreed and there was further evidence of deterioration. The manager told us she had agreed with the owner for a monthly budget to be put in place so that a programme of work could be completed. This would not include the 3 bathrooms as these would be refurbished in addition to the money agreed. This would commence once finances outstanding from care fees had been paid. The general appearance of the home was poor. Areas required redecoration and some items of furniture and carpeting needed replacing. Issues included: a) The back yard was storing rubbish and needed weeding, this needs to be cleared b) The garden was over grown and unkempt with rubbish lying around, this too needed attention c) Upstairs bathrooms remain in a poor condition d) In the front smoking lounge there Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: was damp to the chimney breast and wall which had caused some damage and needed attention e) Water was overflowing from the drain pipe outside the smoking lounge f) One of the bedrooms still had a lot of damage to the walls due to damp on the gable wall g) A further bedroom was also damp with wall paper coming off the wall. This had been identified in the maintenance book in June 2008 and had still not been addressed h) The flooring in the downstairs shower room had dropped i) There was considerable damp in a downstairs bedroom, which was adjoining the shower room. Electric sockets were also sited on the damp wall j) One person was sleeping on a broken bed, another had a bed frame which was bent k) A number of mattresses where in poor condition and in need of replacing l) The laundry cupboard has yet to be fitted with a lock although a sign on the door states the door must be kept locked m) The broken window to another bedroom needs to be replaced Due to some of our concerns we contacted the environmental health officer and requested a visit. The manager advised us that she has now spoken with the provider and that plans have been made so that money is made available on a monthly basis. This will allow necessary work to be completed over a period of time. The manager must provide us with a plan of work along with timescales for completion so that we can monitor the completion of the work. During our visit to the sister home, Laburnum House, we were advised by the providers husband that plans have been submitted to the planning office in relation to an extension to Carr Bank House, increasing the bed numbers by 10. Plans had yet to be approved. We have some concerns about further work being started at the home whilst the existing property is in a poor condition. This must be addressed in the first instance so that the current residents are provided with a good standard of accommodation in which to live. In relation to hygiene standards these had improved. However there were still odours within the bathrooms, no hand washing facilities and a soiled towel within one of the bathrooms. The carpet to the stairs and landing also needed intensive cleaning. Care Homes for Adults (18-65 years) Page 21 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Failure to follow safe recruitment practices along with the lack of good quality training does not ensure the safety and protection of people living at the home. Evidence: In the absence of the registered manager at the sister home the registered manager for Carr Bank had been overseeing the management of both homes, which included responsibility for recruitment. Since we last visited two new staff had joined the team. Information was requested with regards to their recruitment however one file could not be provided. Records were seen for the second member of staff and another worker who had been working at the home but recently moved to the sister home Laburnum House. One new member of staff had been recruited through an agency who had initially carried out their own criminal record and POVA check however on commencement at Carr Bank the manager did not carry out her own checks. The second file examined was also incomplete as this too does not hold any references or criminal record or POVA check. Without such information there is no assurance that people living at the home are protected. As this is an outstanding requirement information was copied and taken under a Code B as further evidence that this area had not been complied with. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: The staff rotas were looked at. This remains unchanged. Staff rotad for the day of our visit included the manager working 8 till 1, the assistant manager 12 till 5, a carer working 8 till 5 with additional responsibilities for cooking meals, an evening worker from 5 till 10 and a night staff member. There was also a domestic who works part time. Whilst there were two staff on duty during the afternoon, the deputy manager has additional responsibilities in relation to office tasks and was therefore not always providing support. It was also noted that the manager splits her time working either at Carr Bank or working from home. During our last visit the manager explained consideration was being given to the staffing rotas so that staff could be utilised at times which would allow for more effective support during the day for activities and appointments. This had not been done. Rotas must be kept under review ensuring that sufficient staffing is provided to meet the needs of the service. We looked at what staff training had been provided over the last year. Copies of certificates are held along with a matrix. The manager was asked to update the matrix to show recent training as no evidence could be found of any recent training other than that some staff having undertaken fire safety training. This again is concerning as we have previously discussed with the manager the need for effective staff training particularly in areas specific to the needs of people living at the home, i.e. mental health issues, challenging behaviour, safeguarding, medication and epilepsy for example in addition to mandatory courses. Certificates seen on one file examined showed that training previously undertaken had expired in November 2008. We were advised during our last visit that staff would be completing a work book in relation to mental health, which would then be assessed by a Community Psychiatric Nurse who works closely with the home. The was no evidence to show that this had been done. Without good quality training there is no assurance that staff have the knowledge, competence or skills needed to support people in way which fully meets their needs. The manager advised us again that an application and information required to join the Bury Training Partnership Group had recently been submitted and she and the assistant manager had been put forward so that they could attend the monthly meetings. However we were advised by the partnership that no contact has been made with them by the service. This too is concerning as the manager has told us on two occasions that this has been carried out. As the training matrix was incomplete it was unclear which staff had completed their Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: NVQ. As identified further within the report this too remains outstanding in relation to the manager. Care Homes for Adults (18-65 years) Page 24 of 36 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. Due to the lack of progress and poor practices there was little evidence to show that the home was being effectively managed ensuring people received a good quality service. Evidence: Over the last year the manager had been supporting both Carr Bank and the sister home Laburnum House due to the registered manager there being on maternity leave. The provider advised us of the arrangements in writing which included additional support from her. It was apparent due to the lack of progress made following our last visit that these arrangements had been inadequate. Following our last visit the manager was asked to provide an improvment plan detailing what action was to be taken to address the action identified. This was not provided. As already stated rotas show that the managers hours were split between Carr Bank Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: and working from home. This had clearly not been effective and had done little to effect any change at either home. Whilst the provider completes the monthly monitoring visits in line with Regulation 26 there was little evidence to show that there had been further assistance in overseeing the management of the service. An annual quality assurance report was seen during our last visit. The manager and provider had identified improvements they wished to make over the forthcoming year including improvements to the environment and staff training and development. This had not be done. As already stated within the report unsafe recruitment practices had been followed and staff had received no training over the last year. This does not give us confidence that people are being protected and that the service is being managed competently. The provider must ensure that the home is adequately managed at all times and that all issues identified are addressed in a timely manner ensuring the home is ran in the best interests of those who live there. In relation to training the manager is again finalising her portfolio for the relevant management training required. This was late being submitted last year and therefore further work has now been required in order for it to be assessed. This has been outstanding since 2007. The manager said that she had also attended training in relation to the mental capacity act and deprivation of liberty. We looked at records held in relation to health and safety checks. A servicing certificate was seen for the annual testing of the small appliances and we were told that the fire alarm and equipment had been checked on the 24 June 2009 however they were waiting for the certificate. There was a gas certificate which was dated 19 June 2008. A new check is now required. The 5 year electric check was not on file. Whilst this had been seen during our last visit there were a number of areas that required attention and the manager was to evidence that these had been addressed following our previous visit. However this was not provided. The manager must evidence that all these checks have been completed and are satisfactory, any action identified must be addressed without delay and confirmed with us that this has been done. Issues within the home were also logged within the maintenance book and are brought to the attention of the management team. However this is not always followed up, for example and entry made in June 2008 stated that there was damp and wall paper coming off the walls in one of the bedrooms and that the wardrobe door had broken off. We checked the room to see if the work had been completed. It remained unchanged. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: As previously identified the home had a record book for logging any accident or incidents. Information showed there had been 6 incidents with 1 of these resulting in the person attending A&E and being admitted to hospital. This incident had again not been reported to us in line with Regulation 37, which was a requirement made at the last inspection. The manager must ensure that we are advised of all incidents, which may affect the well being of people living at the home along with the action taken to ensure that they are safe and protected. Water temperature records were again also looked at as these were a requirement at the last inspection. Records showed that temperatures were low with readings ranging from 24 degrees to 29 degrees C. This is too low and water outlets should be regulated so that temperatures are around 43 degrees C ensuring the safety and comfort of people. Care Homes for Adults (18-65 years) Page 27 of 36 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 19 12(1) Accurate records must be 30/08/2008 maintained with regards to peoples dietary needs as well as accurate monitoring of their weight ensuring they are supported fully and their health and well being is maintained. 2 23 18(1)13(4) Arrangements should be 30/09/2008 made for staff complete Safeguarding training in relation to the local authority procedure so that they are aware of the procedure to follow ensuring people are kept safe. 3 33 18(1)(a) Staffing levels should be kept 30/08/2008 under review ensuring staff are provided in sufficient numbers at times which best meet the needs of people living at the home. 4 34 19schedule 2 All relevant information and 30/08/2008 checks needs to be in place before staff commence any work at the home ensuring people are not placed at risk. Care Homes for Adults (18-65 years) Page 28 of 36 5 35 18(1)(c) (i) A programme of training 30/09/2008 needs to be developed for the forthcoming year so that staff receive all necessary training relevant to their roles and responsibilities ensuring they are competent to carry out their role safely. 6 42 13(4)23(2) Action needs to be taken to 30/09/2008 ensure that water temperatures are maintained at 43 degrees C for the safety and comfort of people living at the home. 7 42 37 Any incidents, which occur that may affect the wellbeing of people, must be reported to the CSCI in line with Regulation 37. 30/09/2008 Care Homes for Adults (18-65 years) Page 29 of 36 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 7 15 Information recorded on the care plan should reflect the current and changing needs of people. Without this information there is no assurance their needs and wishes will be met. 30/09/2009 2 9 13 Comprehensive risk assessments need to be reviewed and updated ensuring information is accurate. Where additional concerns have been identified these too should be included. Providing staff with information about the level of support required so that people are kept safe. 30/09/2009 3 19 15 Adequate monitoring and recording must be made with regards to the weight and dietary needs of people where concerns are identified in the care plan 30/08/2009 Care Homes for Adults (18-65 years) Page 30 of 36 ensuring the appropriate support and intervention can be provided should concerns continue. 4 20 18 All staff who administer medication must receive accredited medication training ensuring they have the competence needed to administer peoples medication safely. 5 20 13 Medication administration records must be completed in full along with explanations where medication has not been given ensuring people are given their medication as prescribed and their health and well being is not affected. 6 23 13 Hand washing facilities should be provided in all bathrooms and toilets to promote good hygiene and prevent cross infection 7 23 13 The stairs and landing carpet needs a thorough cleaning providing a cleaner environment. 8 23 23 Damp identified in the bedrooms and communal areas must be resolved and then rooms redecorated 30/09/2009 30/09/2009 30/09/2009 30/08/2009 30/10/2009 Care Homes for Adults (18-65 years) Page 31 of 36 so that standard of accommodation provided for people is improved. 9 23 23 The sunken floor in the downstairs shower room need attention so that people are not placed at risk and further damage to the property is prevented. 10 23 23 The electric sockets in the ground floor bedroom need to be moved so that the resident is not placed at further risk of harm or injury 11 23 23 The condition of the beds should be reviewed and where necessary replaced so that people are provided with items which are safe to use. 12 23 23 Each of the bathrooms are in need of redecoration and refurbishment so that they provide comfortable, safe and clean facilities for people to use. 13 23 23 The broken bedroom window 30/09/2009 must be replaced for the safety of the resident. 14 23 23 A lock must be fitted to the laundry door and kept locked 30/09/2009 30/11/2009 30/08/2009 30/08/2009 30/08/2009 Care Homes for Adults (18-65 years) Page 32 of 36 ensuring the safety and protection of people. 15 23 23 The exterior of home needs to be cleared of rubbish and the garden and yard tided so that people living at the home are able to enjoy it. 16 23 18 All staff must complete Safeguarding training in line with the local authority procedure. So that they are clear of their responsibilities ensuring people are protected 17 33 18 Rotas should be kept under review ensuring that sufficient staffing are provided to meet the needs of the service. All relevant information and checks including written references, POVA checks and criminal record checks must be sourced by the manager prior to new staff commencing their employment. Without this there is no assurance that people are being kept safe. 19 35 18 All staff must be provided with good quality training specific to the needs of people living at the home. This should include areas such as mental health 30/10/2009 30/09/2009 30/10/2009 30/09/2009 18 34 19 30/08/2009 Care Homes for Adults (18-65 years) Page 33 of 36 awareness, challenging behaviour, epilepsy as well as mandatory courses. This is to ensure staff have the knowledge, skills and competences needed to support people safely. 20 37 12 The registered person must 30/08/2009 ensure that the care home is conducted in such a way as to promote and make proper provisions for the health and welfare of service users ensuring their safety and protection. 21 39 24 Quality assurance systems need to be improved and clearly evidence that the service is being monitor and reviewed ensuring the improvements needed are addressed and a quality service is proivded. 22 42 23 An up to date gas safety check must be carried out and evidenced that this has been done ensuring the system is in good working order and people are kept safe. 23 42 23 Action must be taken to ensure that the water temperatures are regulated as close to 43 degrees C for the comfort and safety of people. 30/08/2009 30/08/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 34 of 36 24 42 37 All incidents which may affect the well being of residents must be reported to us evidencing the appropriate action has been taken. 30/08/2009 25 42 23 Evidence must be provided 30/09/2009 to show that action required on the electric certificate has been addressed ensuring it is in good working order and people are kept safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Consideration should be given to the language used within the plans as this should be the needs and wishes of the person and not the opinion of staff. Consideration should be given to the staffing rotas allowing for more flexibility and opportunities for people to develop their skills and Independence both in and away from the home. Where there are handwritten entries on the medication records these should be countersigned by a second member of staff to ensure that the information recorded reflects that of the prescription. The manager must ensure that staff complete NVQ training ensuring they have the skills and competencies needed to carry out their duties Evidence that the annual fire safety check has been completed must be provided so that people are not placed at risk of harm. 2 13 3 20 4 32 5 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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