Inspection on 11/05/10 for Courtwick Park

This inspection was carried out on 11th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Courtwick Park 18/03/09

Courtwick Park 29/11/07

Courtwick Park 16/10/06

Courtwick Park 11/10/05

Courtwick Park 23/06/05

Courtwick Park 17/01/05

Courtwick Park 07/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Courtwick Park Courtwick Lane Littlehampton West Sussex BN17 7PD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elaine Green     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Courtwick Park Courtwick Lane Littlehampton West Sussex BN17 7PD 01903730563 01903730563 courtwick@consensussupprt.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Corich Community Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Courtwick Park is a large detached property owned by Corich Community Care Ltd. The Responsible Individual is Julie Bendelow. Courtwick Park is registered to provide a service to twelve people with severe and profound learning disabilities and associated challenging behaviour. The people who live here are supported to take part in activities within the home and access a range of facilities at the day centre at Strawberry Field also owned by Corich Community Care Ltd and on the same site, as well as local community facilities. Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 12 1 8 0 3 2 0 0 9 Brief description of the care home Fees range from £1370.55 to £2369.00 per week. A Statement of Purpose and Service Users Guide is available to reference in the home. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This home has been without a Registered Manager since April 2006. The appointed manager of the home is not currently working so the Registered Manager of another care home that is located within the same grounds as Courtwick Park is in day to day charge of the home on a temporary basis, and this is who facilitated this inspection. This unannounced site visit was undertaken on the 11th May 2010 over 7 hours. Due to the level of concerns raised with us from other professionals through Safeguarding Adults procedures the site visit was undertaken by two people, a Regulation Inspector and a CQC Pharmacist Inspector. Evidence obtained at this site visit, previous information regarding this service and information that we have received since the last inspection forms this key inspection report. Information has been shared with us through Safeguarding Adults procedures to assist us in this inspection. Due to the level of concerns raised within the service, all residents Care Homes for Adults (18-65 years) Page 6 of 35 care plans are being reviewed by their care managers and other professionals to ensure their immediate safety, some of these reviews took place prior to our visit. There are eight people living at Courtwick Park. Four of these people were on holiday on the day we visited and four people were at home. We saw into the communal areas of the home and spoke to the person in day to day charge of the home and the staff on duty. Interaction between staff and the people who live in the home were observed throughout the day. The procedures in place for handling individual monies were viewed. We also looked at care records, medication and associated administration records, staff recruitment, staff training and staff personnel files. We will be undertaking management review meetings regarding this service to decide what further action we will need to take to ensure residents are safeguarded. The outcomes for the people who live in this home are poor for all but one area which is adequate. The overall quality rating of this home is Zero, no stars. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Issues of serious concern that affect the safety of the people who live in this home have been identified at this inspection. The CQC have written to the registered person in relation to these concerns outside of this inspection process. In addition to this Management Review Meetings have taken place within CQC to establish what action if any shall be taken by the CQC. The final decision in respect of this is yet to be made. The local authority are investigating allegations of institutional abuse, poor care, neglect and financial abuse and the police are investigating an allegation of physical abuse. The CQC, local authority, care managers and the registered person have attended a series of strategy meetings that have been held in relation to these investigations, the outcome of which are not yet known. When we visited the home we were told that staff choose when they work and change their scheduled shifts without consulting the management. Information received states that staff have been heard to refer to the people who live there in a derogative manner leave them with nothing to do. Additionally, despite having training in safeguarding vulnerable adults, management and staff failed to raise an alert to the local authorities when they had concerns about the conduct of some staff members. This is indicative of a culture where staff no longer see that they are acting in an abusive way and that the home is staff lead and not run in the interests of the people who live there. At this inspection we found that one person had been admitted to live at the home without a preadmission assessment been carried out. The registered person must ensure that no one is admitted to live there prior to a full assessment of need being completed by a person qualified to do so. The care plans were saw were not holistic or person centred were not up to date and did not accurately reflect the lifestyle of the person. The registered person must ensure that care plans are based on risk assessments are written in consultation with the individual and that they cover all aspects of personal and social support and health care needs. These must be reviewed and updated when changes occur. Peoples behaviour must not be managed through the use of locked doors and restricting peoples access to the home and grounds. The registered person must ensure that people are supported to make their own decisions and manage their own finances. Where this is not possible an independent advocate or agent must be found. The registered person must ensure that people are supported to set, monitor and achieve both their long and short term goals and aspirations and that this is recorded. Care Homes for Adults (18-65 years) Page 8 of 35 This must include community participation and be reflected in plans of care. The registered person must ensure that peoples rights are respected, that people are treated with respect and that staff interact with the people who live there and not exclusively with each other. The registered person must ensure that the people who live at the home are involved with the planning and preparation of meals. People must be given a choice in relation to where, when and with whom they eat. The registered person must ensure that peoples health care needs are assessed and monitored and that clear procedures are put in place to address them. This must be clearly documented. There must be a clear support plan on the use of anti-convulsant medicines and MAR charts must reflect the dosage directions that the doctor intended. The registered person must ensure that the local protocol in relation to safeguarding vulnerable adults are followed at all times. Information must be passed to the relevant authority without delay so decisions are not taken in isolation. The registered person must ensure that the premises are well maintained. A maintenance and renewal plan must be implemented and the premises must be clean and free from offencive odours. The registered person must ensure that all staff receive the induction and training they require they need to carry out their role and that there is an effective staff team in place at the home at all times. The registered person must ensure that recruitment practises are robust and that 2 appropriate references are obtained prior to a person being offered employment. Staff performance must be monitored and all staff including the appointed manager must receive documented supervision a minimum of 6 times a year. The registered person must ensure that effective quality monitoring of the performance of this home and its staff team. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into this home do not benefit from an admission process that ensures their individual needs are appropriately assessed prior to moving into the home this and places them at risk. Evidence: The appointed manager of the home completed the homes Annual Quality Assurance Assessment (AQAA) on the 17th November 2009. In relation to what this home does well for this outcome area it states Individual Risk Assessment based on their needs and individual backgrounds will be completed prior to admission. A transition period based on the specific needs and wishes of the individual will be developed and implemented prior to admission. We looked at the care plan and support plan for a person who had been admitted to the home within the last 12 months and could see no evidence that any pre admission assessments or risk assessments had been completed for this person prior to them moving into the home. Additionally the plans related to this persons previous home. Care Homes for Adults (18-65 years) Page 11 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. That people are not supported to make choices in respect of how they spend their time or how they receive their care. Independence and participation in the running the home is not encouraged. People are not protected from financial abuse. Peoples behaviours are managed by restricting their movement through the use of locked doors. Evidence: Under what we do well for this outcome area the homes AQAA states We ensure that the people living here fully participate in the running of the home, using creative means to support their involvement. Individuals are supported to make informed choices about what they like to do, using digital photography to further support effective communication. Individual rights are respected for all of the service users. Support plans are monitored and reviewed on a monthly basis to ensure that they are current and up to date. We looked at the care plans and support plans for the people who live in the home Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: and records show that care plans and support plans are not reviewed on a regular basis and do not document peoples preferences. There was some evidence of the use of photographs for some people however, this was limited. There was no evidence that people were consulted in relation to the writing of these plans that peoples preferences were taken into consideration or that they are are offered the opportunity to participate in the day to day running of the home. The people that were in the home on the day we visited were seen to be wandering around the home or sitting in the lounge doing nothing and at no point during the day were people seen to be engaged in any meaningful activities. When we arrived staff were discussing one of the people who live there and were discussing the fact that a member of staff should take one of the people who live there out with them and take them to MacDonalds. There was no discussion about whether this person should be asked what they would like to do or what they would like to eat. Later in the day in the dining room three members of staff openly discussed a person who has communication difficulties whilst they were sitting at the table with them and talked about them not to them and did not include them in the conversation. Care plans seen did include reports of when people had presented with behaviours that had been challenging but there was no evidence that this had resulted in any review of the care plan or support guidelines and the action taken as a result of the incidents had not been always been recorded. We saw that the doors to most rooms in the house were locked including the dining room and basement where the staff base is located. Staff told us that some people have keys to their own rooms. They explained that rooms were locked to prevent people entering other peoples rooms Guidance for staff to follow when supporting people with their health care needs was not always present for example one person has epilepsy but the guidance for staff to follow for how to recognise this person is about to have a fit or how to support them following a fit, was on the homes computer and not in the care plan. The people who live in this home do not have independent appointees and all benefits are paid into individual bank accounts managed by the provider. These accounts and associated financial records are not currently independently audited or monitored and there are ongoing safeguarding investigations into the alleged abuse of peoples finances. Care Homes for Adults (18-65 years) Page 13 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are not supported to lead the life they choose. People are not involved in the planning of meals or given a choice of food at meal times. Evidence: The AQAA states The home encourages each individual to work towards their identified goals, continuously developing their skills and experiences. there was no evidence that this happens for people. One persons support plan talks about how they like to walk to a local market however this is completely out of date as it relates to where they used to live. Some people are attending a local college and the day centre which is within the grounds, but there was no records to illustrate how the decision had been made for people to participate in these activities and there was little evidence that progress in meeting goals was being monitored. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: As previously stated within this report on the day we visited the home people were seen to be wandering around the home and not engaged in meaningful activities. Peoples care plans and support plans are not written in consultation with people and peoples preferences were not recorded. At one persons clinical review a health care professional stated that people needed to have structured days with activities and the lack of this could impact on their behaviour. There is little evidence to support the fact that people are involved in the planning of their activities or that they participate in the activities that planners state. One persons care plan updated in January 2010 does not include a section for activities however they did have a weekly activity plan. There was no documentation to support this plan so it was impossible to assess whether the activities stated ones that the person had chosen. There are also activities shown on a board however staff told us that these activities rarely take place as planned. On the day we visited the home, four of the people who live there were present whilst four were on holiday together. Records did not show that people had been consulted about their preferences about where they went on holiday or that they had specified that they wanted to go together. Staff told us that people paid for their own holidays. The homes AQAA states People living at Courtwick Park are offered a choice of suitable healthy menus, the choice of when they want their meals. Meal times are relaxed, unrushed, and flexible to suit individuals activities and schedules. People are encouraged to help plan, prepare and serve the meals. We were told on the day we visited the home that food would be served at 12.30. When we went into the dining from at 12.45 everyone had eaten their meals and left the room. Staff said this is because people rush their food and that mealtime is over very quickly. We saw a copy of the menu on the wall in the kitchen. This was typed and which is not a format that is accessible to the people who live here. The menu did not specify a choice of main meal but did show that people could have a baked potato or a sandwich if they did not want the food that was on offer. When we asked staff how people would know what the meals would be for the day they told us that they would not know unless they came into the kitchen. Other than the menu in the kitchen, menus are not made available to people. We asked staff how the people who live here are involved in choosing the meals on the menu and they told us that staff write the menu based on their knowledge of what people like. There was no evidence of records being kept in respect of what people ate or what they preferred to eat. Peoples preferences in relation to food are not recorded. Records show that people are supported to have contact with their family. One Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: persons contact sheets shows that staff regularly telephone this persons family to update them on what this person has been doing. Care Homes for Adults (18-65 years) Page 16 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. That peoples personal and health care needs are not met. People are not treated with dignity and respect. People do not always receive their medicines safely. Evidence: The homes AQAA states Each person has an individual plan which states their preferences in the way that they are supported. We looked at support plans and care plans and found that peoples preferences had not been documented and there was no evidence that the care plans seen were based on assessments or that the person had been consulted. People do have named key workers however there was no evidence that people were involved in choosing their key worker or that regular key worker meetings take place. The AQAA states All individuals have a Health Action Plan, which is presented in an accessible format. The health action plans we saw were blank documents that were yet to be completed. Daily records were being kept for one person in respect of their bowel movements however there was no indication why this was being monitored or what action staff should take or when. The medication profile for this same person was Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: not up to date and did not include all their prescribed medication. Not all staff have had the training needed to safely administer medication to people and information received states that the guidelines in place for administering specialist medication for some people were dangerous. These guidelines have now been amended but the support guidelines and treatment plans for people who have epilepsy were still incomplete and not are not signed and dated. The CQC recently received a notification in relation to one person having an epileptic fit. The incident describes how staff supported this person before during and after their fit and it is clear the action they took was not safe and had put the person at risk. There are on going safeguarding investigations into allegations that a staff member was aggressive and used physical force against this person whilst they were recovering from an epileptic fit and at other times. There are ongoing investigations into an allegation that a member of staff did not support someone with their personal care when they had been incontinent and that they left them in wet clothing in their room. The Pharmacist inspector from CQC inspected the medicine management in the home. The service has adequate storage facilities and the system used to give medicines to people followed safe practises and accurate records are kept. Records are kept of all medicine that come into the home or are returned back to the pharmacy for disposal. This means an audit is possible for reconciliation. We saw guidelines for medicine to be given only when needed and the outcome is recorded. This means that there is consistency in the use of these medicines. There were support plans in place for medicine to be given in case of an epileptic fit. These were recently prepared and were not signed by a medical officer. These contained information relating to the stages of an epileptic fit and action to be taken at that particular stage. The reference sheet for what different stages look like was not readily available to staff. Looking at previous medicine administration records [MAR] and Care plan for one resident we saw that the medication profile in the care plan was not current information. For this same resident for a constipation medicine which was prescribed to be taken daily the staff had written PRN on the instruction which means to be given only when needed. This adding of PRN to instructions on MAR chart was seen again for another resident. There was no supporting information as to why this was Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: made PRN and who authorised this change in dosage directions. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are not protected from harm or the risk of abuse. There is a complaints procedure in place but people are not supported to use this. Evidence: Currently there are ongoing investigations into serious allegations of abuse at this home. These include financial abuse, physical abuse, institutional abuse and neglect. Investigations are being conducted by both the police and the local authority. Throughout investigations it has come to light that some information was known to the then registered person and that they failed to refer this to the local authority as local protocol states and started to conduct their own investigations. Additionally staff have told us that they had raised concerns in the past to management but that nothing was done about it. Records show some evidence to support this. We looked at the records relating to the management of peoples finances and records show that one member of staff was charging people £10 to cut their hair even though they are not a hairdresser and were already paid to be on shift at the home. Records show that people have paid for their own meals and for staff meals when they have been out for the day. People paid for staff parking and snacks when staff visited them in hospital. In addition to this when money was stolen from peoples tins this was reported to the police but the CQC and placing authorities were not informed. To date this money has not been replaced. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: Whilst the home does have a complaints policy and procedure that states the timescale that they will respond to the complainant at no time were people supported to make a complaint or was a complaint raised on behalf of the people who live here when money was stolen from them and not returned. Care Homes for Adults (18-65 years) Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is not clean or hygienic. Evidence: On the day we visited the home we found there was an offencive odour in both the hallway and the lounge area. The carpets in the lounge and hallways were dirty, wallpaper was torn and paintwork was chipped. There was black mould in the wet room and incontinence pads were left out of their packaging on the back of the toilet, staff told us that this was because there was no storage in the wet room. The majority of the doors were locked and on the day we visited only the staff were seen to be able to open them. People had the freedom to walk into the lounge as this was not locked however the door, which was a fire door was wedged open. The laundry is located in the basement so soiled laundry does not have to be carried through the area of the home where food is prepared. Care Homes for Adults (18-65 years) Page 22 of 35 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. Ineffective training and the lack of staff induction and supervision place the people who live here at risk. Evidence: As a result of ongoing investigations and allegations of abuse at the home currently 3 members of staff have been suspended. In addition to this on the day we visited the home staff told us that one staff member had left the previous week, a senior staff member was leaving the following week and a other senior member of staff was off sick. This has left the home without any of the regular management and a significant reduction in the number of seniors. We looked at the staff rota and found that during the week that until very recently there were significantly less staff on duty at the weekends than there were during the week. The person currently managing the home assured us that this had now been addressed and rotas seen confirmed this. The person in charge of the day to day management of the home is not always specified on the rota for example the rota starting the week of the 3rd May only shows a management presence for one day of the week. Staff told us that the registered person had been based at the home that week. However it is unclear in what capacity they were working as information received from the registered person states that other people would be managing the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: home that week and yet their names did not appear on the rota. We were told that some people will refuse to work certain shifts and if they are on the rota to do a shift they do not like they will change the rota themselves or they will go sick. The person currently managing the home stated that this issue was being addressed and that new rotas that were in the process of being drawn up would ensure that there would be a mix of skills and abilities on duty at all times so that peoples needs could be met. The homes AQAA completed on the 17th November 2009 states A training matrix is in place which is flexible to accommodate training needs. The training on offer is frequent and opportunities are available to ensure compliance with mandatory training. Other training is identified according to the specific needs of the people living in the house to ensure that staff skills, knowledge and attitudes are kept up to date. We looked at the training that staff had completed and found that the majority of staff had not had all their mandatory training and updates within the timescales that are required. As already stated within this report staff have not all had specialist training to support people with epilepsy or been assessed as safe to administer medication. We looked at the recruitment of staff currently employed and found that the identity and security checks had been completed prior to people starting to work in the home. In all cases two references had been obtained however some had been obtained from friends of the person employed rather than from previous employers. We asked to see the induction that the most recently employed members of staff had completed and no evidence could be found that these had been completed. The homes AQAA completed on the 17th November 2009 states There is a robust supervision process in place, and all staff receive regular supervision. It also tells us that at that time the manager had been in post for 6 months. We looked at supervision and found that staff have not been receiving supervision on a regular basis and that the appointed manager had not had their first supervision until January of this year. Care Homes for Adults (18-65 years) Page 24 of 35 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. This home is badly managed. Poor practise has been allowed to continue unchecked due to the lack of effective monitoring and this has placed the people who live here are at risk of harm from abuse. Evidence: This home has not had a registered manager since April 2006. The CQCs predecessor wrote to the registered person several times about this issue and the CQC has wrote to both the registered person and the appointed manager again in September 2009 and April 2010. To date no application has been submitted for someone to become registered to manage this home. The appointed manager is not currently working at the home and the person in day to day charge is the registered manager of another home that is located within the same grounds. This is a temporary arrangement. The registered person has informed us that they plan to recruit a manager from an agency to manage the home until a permanent manager can be recruited. Following the site visit to the home the registered person has since confirmed that an interim manager has now been Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: appointed. When we visited the home we were told that staff choose when they work and change their scheduled shifts without consulting the management. Information received states that staff have been heard to refer to the people who live there in a derogative manner at handover and that they have been observed lounging on sofas whilst the people who live there were left with nothing to do. Additionally, despite having training in safeguarding vulnerable adults, management and staff failed to raise an alert to the local authorities when they had concerns about the conduct of some staff members. The homes own quality assurance failed to identify the shortfalls that have been highlighted throughout this report or the incidents that are being investigated by the local authority and the police. Requirements have been made throughout the report in respect of these issues however the outcome of the ongoing police and local authority investigations have not yet been established. The CQC has had Management Review Meetings about this home to establish what action they may or may not take and a decision is yet to be made. We have also written to the registered person in relation to the serious concerns identified. Care Homes for Adults (18-65 years) Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 27 of 35 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 2 14 The registered provider must ensure that no service users are admitted to the home prior to a full assessment of need being completed by a person qualified to do so. To protect service users from harm and to ensure that the home can meet their needs. 15/06/2010 2 6 15 The registered person must 15/06/2010 ensure that care plans are based on risk assessments are written in consultation with the individual and that they cover all aspects of personal and social support and health care needs as specified in Standard 2. These must be reviewed and updated when changes occur. To ensue that peoples assessed and changing Care Homes for Adults (18-65 years) Page 28 of 35 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 needs and personal goals are reflected in their individual plan and that their preferences are taken into consideration. 3 6 12 The registered person must 15/06/2010 ensure that peoples bahaviour is not managed by restricting peoples access to the home and grounds through the use of locked doors. Care plans must contain guidlines for staff to follow in respect of supporting people to manage their behaviours. To ensure that peoples freedom is not restricted. 4 7 12 The registered person must 15/06/2010 ensure that people are supported to make their own decisions and manage their own finances. Where this is not possible an independent advocate or agent must be found. To ensure that peoples right to made decisions is protected and that people are protected from financial abuse. 5 12 16 The Registered Person must ensure that people are supported to set, monitor and achieve both their long 15/06/2010 Care Homes for Adults (18-65 years) Page 29 of 35 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 and short term goals and aspirations and that this is recorded. This must include community participation. To ensure that people identify their own goals and are supported to develop skills to achieve maximum independence and fulfilment. 6 16 12 The registered person must ensure that peoples rights are respected, that people are treated with respect and that staff interact with the people who live there and not exclusively with each other. To ensure that people are treated with respect. 7 17 16 The registered person must ensure that the people who live at the home are involved with the planning and preparation of meals. People must be given a choice in relation to where, when and with whom they eat. To ensure that choice is given in relation to food and people enjoy their meals and mealtimes. 8 19 13 The registered person must ensure that peoples health 15/06/2010 30/07/2010 15/06/2010 Care Homes for Adults (18-65 years) Page 30 of 35 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 care needs are assessed and monitored and that clear procedures are put in place to address them. This must be clearly documented. To ensure that people health care needs are met. 9 20 13 The registered person must ensure that MAR charts reflect the dosage directions that the doctor intended. To ensure the health and welfare of the residents is protected. 10 20 13 The registered person must ensure that there is a clear support plan on the use of anti-convulsant medicines. To give staff clear guidance on action to be taken when a resident has a fit. 11 23 13 The registered person must ensure that the local protocol in relation to safeguarding vulnerable adults are followed at all times. Information must be passed to the relevant authority without delay so decisions are not taken in isolation. 31/05/2010 30/05/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that people re protected from harm at all times. 12 24 23 The registered person must 30/08/2010 ensure that the premises are well maintained. A maintenance and renewal plan must be implemented. to ensure the health safety and welfare of the people who live and work in the home. 13 30 16 The registered person must 15/06/2010 ensure that the premises are clean and free from offencive odours. To ensure that health safety and welfare of the people who live and work in the home. 14 32 18 The registered person must ensure that all staff receive the induction, mandatory and specialist training they need to carry out their role. To ensure that staff have the skills they need to support people safely. 15 34 19 The registered person must 15/06/2010 ensure that recruitment practises are robust and that 2 appropriate references are 30/07/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 obtained prior to a person being offered employment. To ensure that people are protected from harm and the risk of abuse. 16 36 18 The registered person must ensure that staff performance is monitored and that all staff including the appointed manager receive documented supervision a minimum of 6 times a year. To ensure that staff have the skills and underpinning knowledge they need to do their job safely and that gaps in training or understanding are recognised and support provided. 17 39 24 The registered person must ensure that effective quality monitoring of the performance of this home and its staff team. To ensure that shortfalls are identified without delay and actions are put into place to rectify them. 15/06/2010 30/07/2010 Care Homes for Adults (18-65 years) Page 33 of 35 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 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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