Inspection on 29/07/09 for Charles House

This inspection was carried out on 29th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charles House 14/08/08

Charles House 04/09/07

Charles House 03/11/06

Charles House 27/10/05

Charles House 21/04/05

Charles House 18/11/04

Charles House 21/04/04

Similar services:

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

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

Key inspection report CARE HOME ADULTS 18-65 Charles House 257 Birchfield Road Perry Barr Birmingham West Midlands B20 3DG Lead Inspector Kerry Coulter Key Unannounced Inspection 29th July 2009 09:30 Charles House DS0000016722.V377046.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. Charles House DS0000016722.V377046.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 Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charles House Address 257 Birchfield Road Perry Barr Birmingham West Midlands B20 3DG 0121 331 4972 0121 331 4972 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) Not known Alphonsus Services Limited Manager post vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Charles House DS0000016722.V377046.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 the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 10 The maximum number of service users who can be accommodated is: 10 14th August 2008 Date of last inspection Brief Description of the Service: Charles House provides accommodation, personal care and support for up to ten people with learning disabilities. The house is a large, well-maintained, three-storey period style property situated in the Perry Barr area of Birmingham. It is set back from the main A34 route into the city centre. At the front of the house is a small, neat garden and limited off-road parking. To the rear of the property is an enclosed private garden with flowerbeds and lawn and patio areas. Each person has a single bedroom, and these are situated on all three floors of the Home. One bedroom on the ground floor has en-suite facilities. All other bedrooms have wash hand basins and there are either bathroom or shower and toilet facilities on all floors. There is no passenger lift facility in the Home, so most people living there must have good general mobility and be able to manage stairs. On the ground floor is a large lounge, which leads directly into the conservatory. There is also a full-sized dining room, giving access to the kitchen. The house is well served by public transport and close to a range of community facilities and amenities, including shops, pubs and restaurants, parks, places of worship and medical centres. Visitors to the home can see a copy of CSCI reports, these are located in the home’s office. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 5 The range of fees as stated in the service user guide are £1000 to £1400 per week. However the reader is advised to contact the home for the most up to date fee information. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out by one inspector over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by three people living there. This involved establishing individual’s experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records were looked at. The people living there, the manager and staff were spoken with. What the service does well: There are systems in place to ensure that individual’s needs would be assessed before they move into the home, so that they could be assured the home could meet their needs. People who live at the home all have their own bedrooms that are individual in style and contain their personal things. Staff support the people living there to be as independent as possible in their own home, encouraging and supporting them to do the cleaning, cooking and their washing. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 7 People have regular check ups with the dentist and optician where necessary to ensure they keep healthy and action can be taken if a person’s health is deteriorating. Some staff have been employed by the home for a long time. This ensures that people know the staff who will be helping them in meeting their needs. 90 of staff are either working towards or have a National Vocational Qualification in care so they should have the skills and knowledge they need to meet the needs of the people living there. Checks of the premises and equipment are undertaken regularly to make sure that the health and safety of people living there is maintained What has improved since the last inspection? What they could do better: People’s care plans and risk assessments need further development to make sure people get the care they need in the way they prefer. The opportunities for people to take part in activities need to be reviewed so they can do the things they enjoy in the evenings and weekends. Records of food provided to people at the home need to be kept in more detail to enable staff to track that people are having a healthy diet. Monitoring and recording of people’s health conditions needs to improve so that people get the care they need to stay healthy. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 8 Medication procedures need to improve to make sure people get the medication they need safely. A record of all complaints received should be kept in the home to show that complaints are taken seriously and appropriately investigated. Procedures to keep people safe from the risk of abuse need to be improved so that people can feel safe from abuse. The entrance to the home and bathing facilities should be assessed by a qualified person to make sure they meet individual’s mobility needs. The recruitment procedure needs to be improved so that people are safeguarded from having unsuitable staff working with them. Review the training schedule for staff to make sure all staff get the training they need to meet people’s needs. An application for registration must be made from the manager of the home. So that people can be sure they have the right skills and experience to manage the home. 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. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 9 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 Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 10 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. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. Before people move in their needs are assessed so they know that their needs can be met there. EVIDENCE: People have access to a service user guide that tells them about the home. Since our last visit to the home the guide has been updated to include pictures making it easier for people to understand. Information about fees has also been included so that people know how much it costs to live there. The home’s Annual Quality Assurance Assessment told us that in the next twelve months it is intended to also provide the guide in an audio format. A new manager has recently started at the home and the guide needs updating to reflect this. The manager told us that he intended to update the guide but had not been able to do it yet as the homes computer had broken and a replacement had not been made available. There have been no admissions for a couple of years and there is currently one vacancy. As reported at previous inspections there are systems in place to Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 11 ensure that individual’s needs would be assessed before they moved into the home. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 12 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. Staff do not have all the information they need to be able to support people to meet their needs which could impact on their safety and well being. EVIDENCE: Care records for three people who live at the home were looked at. Each person had a care plan but these did not include pictures or photographs, which would make them easier for people to understand. However the home’s Annual Quality Assurance Assessment told us that the home does intend to develop pictorial care plans in the next twelve months. Most of the care plans were detailed on how staff are to support the individual to meet their needs and achieve their goals. They included how staff are to support the person with their daily living skills, during the night, their activities, occupation, personal care, behaviour, social skills, communication, Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 13 and health needs. Plans were up to date and cross referenced to people’s risk assessments. However for some people’s care plans improvements were needed. Records for one person indicated they often have unexplained bruising. The manager told us this person was prone to bruising due to one of the medications they were on. This was not recorded in their care plan. For one person there was conflicting information in their care plan and health action plan about their epilepsy. One persons care records indicated they had previously had a pressure sore but there was no risk assessment or care plan in place for this. It was also not clear that all staff were aware of the content of some people’s plans. One persons plan said that they needed the assistance of two staff to get in and out of the bath however a member of staff told us that they help this person on their own as they only need one staff. One persons care plan said that they needed to use an adapted spoon to eat with but we saw that staff gave them a normal spoon to eat their meal with. Care plans include people’s goals for the future, this is generally person centred and progress sheets are completed to check actions are being worked towards. Annual review meetings are also held for each person where their care is discussed. Where appropriate relatives, health professionals and social workers are invited to attend. We observed members of staff supporting people to make choices about what they wanted to do and where they wanted to go. Records sampled included individual risk assessments. These stated how staff are to support the person to minimize risks such as being scalded, using the kitchen, accessing the community, shaving, falls, using stairs and steps, and the risk from behaviours of people who live at the home. Risk assessments were signed as being regularly reviewed but very few amendments had been made to assessments when they had been reviewed. One person’s assessment regarding using the steps to the front door recorded they were to be referred to a health professional for an assessment of their needs. The risk assessment had been signed as reviewed several times since being completed but there was no update regarding any referral being made or completed. There were also some areas of risk where a risk assessment was not available. As stated earlier one person did not have an assessment regarding the risk of pressure sores. One persons records showed there had been occasions where they had fallen out of bed at night, there was no assessment re this. Earlier this year one person suffered a fractured ankle and slept downstairs in the lounge for a short time as they could not manage the stairs. The home had completed an assessment of their mobility needs but had made no assessment of how the person’s privacy and dignity would be maintained when sleeping in the lounge. There was also no assessment made of the impact this may have on other people living at the home. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 14 Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 15 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. Arrangements do not always ensure that people experience a meaningful lifestyle, which could impact on their well being. EVIDENCE: During the day most of the people who live at the home attend local daycentres or colleges. We looked at the activities on offer for people when they are not attending the daycentre or college. At our last visit we found that people had limited opportunities for community activities. This has now improved and people who want to have been out on more activities, for example to the cinema and for meals. One person who was not attending their daycentre during our visit went out with staff to a local shopping centre and for lunch. Before the evening meal we saw staff playing dominoes and board Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 16 games with people. A member of staff assisted one person to choose Jenga blocks from the activity cupboard. Members of staff were directly observed encouraging people to take an active part in jobs around the house, so as to develop their personal independence. One person was being supported by staff to help out in the kitchen during our visit. Where people have chosen not to go out this is usually recorded. Sometimes records showed that planned community activities did not happen but did not say why. Records of activities showed that often activities at the weekends involved watching the television. People had individual activity plans in place but these seemed to be for the benefit of staff as they were not in a format that people would understand. Records show that people are supported to keep in touch with their family. Some stay with families for weekend visits and also receive visits at the home. Care plans stated who the persons relatives were but did not have any information about how staff are to support people to make new friends or keep in contact with friends from their past. It was identified at the last inspection that one person has a listening monitor in their room so that staff can hear if they have a seizure but it was not clear if the persons right to privacy had been discussed. Their care plan did not record that consent for the use of the monitor had been obtained. At this visit we found the use of the monitor had been discussed and agreed with the person’s relative as the person themselves was unable to give consent. Food stocks were examined and supplies were ample, including fresh fruit. Menus sampled indicated that people have access to a balanced diet that is sufficiently nutritious. However food records sampled for people would not enable staff to properly track if individuals were having a healthy diet. Records do not record how much people eat and usually do not record the type of fruit or vegetables that people had and the menu sometimes did not record this. This would also mean that staff cooking meals might give people the same type of vegetables they had the previous day which people may find repetitive. The home’s Annual Quality Assurance Assessment told us that the home intends to develop pictorial menus in the next twelve months. This will help people to be more involved in planning menus. One person who lives at the home told us ‘food is good here, we get a choice’. We saw that people had a choice of pudding during our visit but people all had chicken curry for the main meal. People were offered cordial to drink with their meal but no alternative was offered. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 17 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. Arrangements do not always ensure that individual’s personal care and health needs are met so ensuring their well being. EVIDENCE: Care plans sampled detailed how staff need to support each person with their personal care. People were generally well dressed and this was appropriate to their age, gender, their cultural background and the activities they were doing. However we did see that one person returned from the day centre with food stains on their clothing. Staff did not assist them to change and then at the evening meal proceeded to put an apron on the person to protect clothing that was already stained. Interactions between members of staff and people who live at the home were seen to be informal and relaxed, and support was given respectfully and in a warm and friendly manner. Records sampled showed and staff said that a range of health professionals are involved with individuals to help meet people’s health care needs. One healthcare professional who returned a survey to us said that people’s Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 18 healthcare needs are always met and that the home usually seeks and act on advice. Records sampled included an individual Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. These plans generally detail the frequency that people need to attend appointments such as the dentist or optician. Records sampled showed that people have regular check ups with the dentist and optician where necessary to ensure they keep healthy and action can be taken if a person’s health is deteriorating. Records for one person showed that they were weighed regularly but it was not clear from their care records if they were actually at a healthy weight. For two other people records repeatedly showed they refused to be weighed. There was no evidence that consideration had been given to using a different type of scales or a different method to try and establish if people were at a healthy weight. Significant loss or gain of weight can be an indicator of an underlying health need so it is necessary to monitor individual’s weight regularly where possible. Records show that one person at the home has a health condition that needs an operation. Medical professionals have not arranged for this to happen as the person is unable to give their consent. Discussion with the manager indicates that a best interests meeting will be arranged for the person to consider if the operation should take place, it is advised the manager ensures any decisions are inline with the Mental Capacity Act and Deprivation of Liberty Safeguards. The care records for one person whose care we looked at said they had a pressure sore a few months ago. There was no detail in the records about the severity of the sore and from the records there was no evidence of when it had got better. Staff we spoke with were not aware the person had a pressure sore. Monitoring and recording of people’s health conditions needs to improve so that people get the care they need to stay healthy. Medication is stored securely within a locked cupboard in the office. Medication Administration Records (MAR) sampled included a photograph of the person at the front so if unfamiliar staff were giving medication they would know who to give it to. MAR’s had been signed appropriately indicating that medication had been given as prescribed. One person’s care plan recorded that they were allergic to penicillin, however their medication administration record did not record this. This information needs adding to reduce the risk of people being given medication they are allergic to. One person at the home has medication that staff need to have received extra training from a suitably qualified person to administer. It was unclear from Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 19 records held in the home which staff were trained to do this. The manager told us that as the home had several new staff who had not had the original training then he would be arranging more training for this. We saw that medication was stored in one cabinet. One of the medications needs to be stored more securely and staff should do a daily stock check to make sure the amount of medication held matches the records of what has been administered. Some people had written guidelines in place for ‘as required’ medication but some of these were a couple of years old. It is recommended that these are reviewed to make sure the information is still current. Since our last visit to the home they have obtained a copy of the Royal Pharmaceutical Society guidelines for administration of medication so that staff have more information of what is good practice when administering medication. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems do not always ensure that people can be sure their views are listened to and people are protected from abuse. EVIDENCE: People have access to the home’s complaint procedure, a copy of the complaints procedure has been put on the notice board in the hallway. It is good that the procedure is in a pictorial format. Unfortunately the procedure is not up to date and includes a photograph of the old manager of the home. This should be updated with the new manager so that people know who to complain to and are not confused by the information on display. Most people who live at the home were unable to tell us if they knew how to make a complaint due to their communication needs / level of learning disability. Two people who were able to fill in our survey told us they knew how to make a complaint. Last years Annual Quality Assurance Assessment (AQAA) told us that it was intended to produce the complaints procedure in an audio format so that it was easier to understand. This has not been done and this years AQAA again told us this would be done in the next twelve months. At our last visit to the home we looked at the complaint log, however this was not available at this visit as the manager could not find it. The manager told us that the home had not received any complaints in the last twelve months. The Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 21 home does have a new ‘grumbles’ book and this is where people can record minor concerns where they do not wish to make a formal complaint. The book did not yet contain any ‘grumbles’ but has only been in use for a short time. We have not received any complaints about the home in the last twelve months but have been made aware by the local authority that they are currently investigating a potential safeguarding matter in relation to the home. Most staff have completed training in the protection of vulnerable adults and policies and procedures to include whistle blowing are readily available to them. Some new staff need to attend training and the manager said he was trying to arrange this. Minutes of a staff meeting showed that signs of abuse and the procedure had been discussed with staff. We spoke with three staff about what they would do to keep people safe if they had suspicions of abuse occurring. All staff confirmed they would report it to their manager or someone higher in the organisation, however one staff was unsure of who could be informed if it was not taken seriously. The records of one person showed that it is very common for them to have unexplained bruises. The manager told us that this person bruised easily due to the medication they were on. This was not recorded in their care plan and there was no specific guidance for this person when bruises needed to be reported under safeguarding procedures. Records indicated that the cause of bruising was looked at in an ad hoc way with no real tracking taking place of how they could have occurred. One person at the home had a fracture to their ankle earlier this year, their records recorded that the cause was unknown. There was no evidence of any formal investigation taking place about how this could have occurred and it was not reported to the local authority under safeguarding procedures. Training records sampled and discussions with the manager indicate that staff at the home have not yet had training about the Mental Capacity Act and the new Deprivation of Liberty Safeguarding legislation. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. We looked at the financial records for three people. Records showed that people had recently bought new beds and furniture and paid for these themselves. Beds and furniture are usually something the home should provide. The manager told us that people paid for their own as there was nothing wrong with their previous furniture but that it was thought people might like some new furniture and that they had the money to pay for this. There was no evidence in people’s care files that this had been discussed and Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 22 agreed with them or their representative. This should have been available to show that people’s money is being looked after and they are not expected to pay for things that the home should provide. We looked at the home’s recruitment procedure and found that for one new staff the procedure followed had not been robust and may have put people at risk of having unsuitable staff working with them. This is further detailed in the staffing section of this report. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 23 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. People live in a homely, comfortable, safe environment that meets most of their individual needs. EVIDENCE: Charles House is an old property that has character and is generally maintained to a good standard. We looked at all communal areas and some bedrooms at this visit. People’s bedrooms are individual in style according to gender, age and culture, and personal effects and possessions are in evidence. These include personal televisions, video / DVD players, music systems and computer games, so that people can enjoy private time on their own if they so choose. Communal areas were homely in style and generally in good decorative order. There were some areas of décor that needed some minor attention and these were included in the homes schedule for redecoration. At the time of our visit the home was Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 24 undergoing a programme of having new windows fitted to the rear of the home. The décor of the lounge and dining room was of a satisfactory standard. Since we last visited new dining chairs and settees have been provided making these rooms more comfortable to spend time in. The home benefits from having a conservatory. As identified at the last inspection one side of the conservatory external windows were dirty but staff have no access to be able to clean this area. Net curtains have now been fitted so that this area looks nicer for people to spend time in. The homes Annual Quality Assurance Assessment told us that it is intended to provide new blinds for the conservatory in the next twelve months. This will give people more privacy when using this room and help to keep it at a comfortable temperature in the summer. Some people who live at the home need assistance with their mobility. It is not clear that the design of the home best meets their needs. There are several steps to the front of the home meaning that one person needs support from two staff to get in and out of the home. The homes most recent quality report recorded that one relative had said they felt that a ramp to the front of the home may be needed. One person has an en-suite shower but has to step in to the shower tray when a level access shower would be easier to access. The manager told us that it was intended to refurbish bathrooms in the near future and the provision of level access showers would be looked at. The home does not have an adapted bath and one person is assisted by two staff to get in and out. Staff spoken with felt that people were safe but that things could perhaps be made easier for people. Due to people’s mobility needs and the current design of the home assessment that the building and bathing facilities meet people’s needs should be undertaken by a competent and qualified person. This was something we recommended at our last inspection. We found that infection control procedures had improved. Bathrooms, toilets and the kitchen had satisfactory hand wash facilities. The floor to the bathroom is carpeted and is not an ideal floor covering for this type of area as it is not easy to keep clean. Discussion with the manager indicates the carpet will be replaced when the bathroom is refurbished. Part of the first floor hallway carpet had been replaced with a more hardwearing covering that had reduced the unpleasant odour in this area of the home. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 25 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. The arrangements for staffing, their recruitment, support and development is variable and does not always ensure that people’s needs will be met. EVIDENCE: Direct observations of staff interactions with people who live at the home show they have a good relationship with people in their care and a good general understanding of their needs. New staff are given the opportunity to complete the Learning Disability Qualification (LDQ). 90 of staff are either working towards or have a National Vocational Qualification in care. This helps staff to have the skills and knowledge they need to meet the needs of the people living there. One health professional who returned a survey told us that staff had the right skills to meet people’s needs. We spoke with staff, observed them working and discussed staffing levels with the manager which indicated that sufficient skilled care staff were on duty to meet the needs of people currently living at home. Due to the behaviour of one person at the home there has been increased pressure on staffing levels Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 26 as staff have to maintain close supervision to make sure other people are safe. In the last few months the home has recruited specific staff to work with this person. This has increased the numbers of staff on duty and also meant that a consistent group of staff work with this person who know their needs well. Some staff have been employed by the home for a long time. This ensures that people know the staff who will be helping them in meeting their needs. We looked at the recruitment procedures followed for four recently recruited members of staff. For two staff the procedures followed were robust. For one staff the procedures were generally adequate but work references had been sought from colleagues rather than someone in a management position. For one person the procedure followed was not robust and did not ensure that people would be protected from having unsuitable staff working with them. The member of staff had stated working in the home before a Criminal Records Bureau (CRB) check had been applied for by the home. We saw that their application form did not declare any offences yet the returned CRB check showed they had committed an offence. There was no risk assessment in place to show it had been explored why the offence had not originally been declared, the nature and circumstances of the offence and to assess if the person was considered safe to work with vulnerable people. Staff surveys received and discussion with staff indicate that the majority of staff are satisfied with the training on offer. The training matrix for the home shows that staff get most of the training they need to meet peoples needs. However as discussed earlier in this report staff would benefit from training about the Mental Capacity Act and the new Deprivation of Liberty Safeguards. Some staff at the home have had training in meeting the specific needs of people to include epilepsy and diabetes. As under half of the staff team have had this training it is recommended it is arranged for staff who need it so they have a better understanding of peoples health needs. Staff have recently had training in manual handling, discussion with the manager indicates that this was via a DVD and written test. Consideration should be given to arranging for staff to have more practical training given that some people at the home have manual handling needs. Since we last visited the home staff have had more training on meeting behavioural needs. The Annual Quality Assurance Assessment told us that this was very specific to the needs of one person and staff supporting them and had been carried out by an external health professional. Minutes of staff meetings show these do not happen very regularly. The manager told us that often meetings have had to be cancelled due to the low turnout of staff. Some staff commented about staff meetings in surveys returned to us, one said that meetings were sometimes held at inconvenient times, another said there should be separate meetings for night staff. The home should consult with staff about the best times for meetings to be held to try and boost attendance. Staff meetings are important as they should keep Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 27 staff up to date with issues of good practice, people’s needs and the homes policies and procedures. The manager told us that staff supervisions had got behind when the previous manager had left the home and that he was trying to catch up with them. Supervision records showed that staff were not having this at least every other month. Regular supervision is important for staff as it enables them to reflect on practice and identify their training and development needs. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 28 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. Management arrangements have not always ensured that the home is well run to ensure the safety and well being of the people living there. EVIDENCE: Since our last visit to the home the registered manager has left and a new manager is in post. We have not yet received an application from them for registration. This is required so we can be sure that the new manager has the right skills and experience to manage the home. As stated earlier in this report recruitment practice has not always been robust, however discussion with the new manager indicates that these staff were recruited before he started working in the home. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 29 The new manager completed the Annual Quality Assurance Assessment and returned it when we asked for it. Staff spoken with said that the manager was very approachable. One person who lives at the home told us ‘the new manager works very hard’. Another person told us ‘the new manager is alright’. Quality assurance systems are in place. The service manager visits the home and writes a report of their visit to see if it is being well managed. The format of the reports has changed since we last visited so that it is clearer what standards have been looked at. However the new reports do not show that staff or people who live at the home have been consulted as part of the visit. This should be done so that people are as involved as possible in how the home is run. Other quality assurance systems in place include an annual quality assurance audit. Satisfaction surveys had been completed by some people who live at the home or their relatives. The previous manager had collated the results of the surveys and completed a report that detailed what action had been taken as a result of listening to people. The new manager said that the next stage was to complete an annual development plan for the home. A number of checks are undertaken regularly by the home to make sure that the health and safety of people living there is maintained. A number of these were sampled. Staff test the water temperatures to make sure they are not too hot which could put people at risk of being scalded. Records showed that these were within the correct temperatures so that people were not at risk. Staff have fire safety training so that they know what to do in the event of a fire. Staff regularly test the fire equipment to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Certificates were available to show that gas and electrical installations had been checked to make sure they were safe. The manager was unable to locate the current fire risk assessment for the home. However evidence that someone had visited the home two days prior to our visit to undertake a new assessment was available. The manager told us that they would be receiving the new assessment soon. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 30 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 3 2 X X 3 X Version 5.2 Page 31 Charles House DS0000016722.V377046.R01.S.doc No 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 YA6 Regulation 15 Requirement Care plans must detail the needs of the individual. So that staff know how to support the person and ensure their well being. Risk assessments must be completed for all areas of identified risk to people. To make sure risks to people’s safety and well being are well managed and people are as safe as possible. Controlled medication must be looked after securely in line with the appropriate controlled medication regulations. A record of all complaints received must be kept in the home to show that complaints are taken seriously and appropriately investigated. The local authority must be notified of any potential safeguarding incident to make sure that the appropriate investigations can take place. This will help to keep people safe from abuse. DS0000016722.V377046.R01.S.doc Timescale for action 29/10/09 2 YA9 13(4) 29/10/09 3 YA20 13(2) 29/09/09 4 YA22 22 29/09/09 5 YA23 13(6) 29/09/09 Charles House Version 5.2 Page 32 6 YA23 13(6) 7 YA23 13(6) 8 9 YA34 YA37 19 11 A review of the procedures where people may pay for items the home should usually pay for needs to take place. To ensure that peoples money is well looked after and is used in their best interests. Where people are identified as being at risk of bruising easily then guidelines should be available to staff specific to the individual. These should inform staff of when bruising needed to be reported under safeguarding procedures. The recruitment process must be robust so that people are safe from harm. An application for registration must be made from the manager of the home. So that people can be sure they have the right skills and experience to manage the home. 29/09/09 29/09/09 29/09/09 29/09/09 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 2 3 Refer to Standard YA1 YA6 YA9 Good Practice Recommendations The service user guide for the home should be updated to reflect the new manager arrangements. So that people have up to date information about the home. Care plans should be produced in a format that the person can understand to help them be more involved. When reviews of peoples individual risk assessments are completed a full evaluation should be completed to ensure the assessment details any changes to people’s current needs. People should be supported to help plan the things they want to do in a way that is meaningful to them. People should have more opportunities to take part in activities at times valued by others of a similar, age, DS0000016722.V377046.R01.S.doc Version 5.2 Page 33 4 5 YA12 YA12 Charles House 6 7 8 9 YA15 YA17 YA18 YA19 10 11 12 YA19 YA20 YA20 13 14 YA22 YA23 15 16 YA29 YA36 17 YA36 18 19 YA35 YA39 gender and culture to ensure they have a good lifestyle. Care plans should state how people can be encouraged to make new friends and keep in contact with friends from their past to improve their well being. Food records should be recorded in more detail so that staff can monitor peoples food intake so help them to have a healthy diet that suits their individual needs. Staff should give assistance to people who need it with their personal care to make sure their clothing is clean so upholding peoples dignity. Review the way in which peoples weight is monitored so that is done in the manner in which they prefer and information is available to show if people are at a healthy weight. Monitoring and recording of people’s health conditions needs to improve so that people get the care they need to stay healthy. Written guidelines in place for ‘as required’ medication should be reviewed to make sure the information is still current. Records of staff training for the administration of medication should be improved so that it is clear what staff have received training, if it includes special medication used during a seizure and that it was carried out by a suitably qualified person. The pictorial complaints procedure needs to be reviewed to make sure people have up to date information about how to make a complaint. Staff should received training in the Mental Capacity Act and Deprivation of Liberty Safeguards legislation. So that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The entrance to the home and bathing facilities should be assessed by a qualified person to make sure they meet individual’s mobility needs. There should be at least six staff meetings a year so that staff are updated with best practice and know how to support the people living there to meet their changing needs. Staff should have at least six formal, recorded supervision sessions a year with their line manager. This will ensure they are supported in their role to meet the needs of the people living there. Review the training schedule for staff to make sure all staff get the training they need to meet people’s needs. Audits of the home should include seeking the views of the DS0000016722.V377046.R01.S.doc Version 5.2 Page 34 Charles House people living there and staff to ensure they are involved in the running of the home. Charles House DS0000016722.V377046.R01.S.doc Version 5.2 Page 35 Care Quality Commission West Midlands 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. 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. 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