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Inspection on 21/04/10 for Ethel Road (7)
Also see our care home review for Ethel Road (7) for more information
This inspection was carried out on 21st April 2010.
CQC found this care home to be providing an Poor service.
The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.
Other inspections for this house
Similar services:
What follows are excerpts from this inspection report. For more information read the full report on the next tab.
What the care home does well
The resident lives in a family home and benefits from a consistent approach by the registered providers. The resident is able to exercise some choice about their lifestyle and meaningful activities and relationships are promoted and maintained. The resident continues to receive personal support in a planned and consistent manner. The physical design and layout of the home currently promotes the residents independence
What has improved since the last inspection?
The Statement of Purpose and Service User Guide contain the relevant information about the services and facilities offered by the home. The home have a documented pre admission assessment procedure within the Statement of Purpose and Service User Guide in order that the home could assess the needs of any prospective resident. The residents support and personal care needs within the care plan contain basic information in order to provide support and care for the resident. Documented evidence regarding meaningful activities the resident participates in were available. The complaints procedures of the home have been revised to assist any complaints and concerns received by the home to be addressed and acted upon appropriately. Standards of cleanliness, comfort and hygiene in the home have been improved in order to ensure the safety and well being of the resident. The procedures for seeking the views and opinions of the resident and others associated with the home have improved and are recorded. Some health and safety concerns in the home have improved but further improvements have been required.
What the care home could do better:
It is strongly recommended, as best practise, that the registered providers develop the information within the Statement of Purpose and the Service User Guide in an alternative format which would assist and include the resident to have more information about their home. Arrangements must be made that detailed records are kept which determine the residents income and outgoings and receipts are kept of all expenditure. In order that records are able to be monitored and audited to safeguard and promote the residents right to involvement in their financial affairs. It is strongly recommended that the residents care plan is developed in a person centred manner, with the resident, to give them the opportunity to express themselves and be involved in the decisions regarding their daily life. It has been recommended that the risk assessment regarding the resident`s potential dehydration be documented separately due to the residents specific health care needs. Arrangements must be made for appropriate health care referrals to be arranged. In order that the residents nutritional and health care needs related to their diet are fully assessed to ensure the resident`s well being and welfare. Arrangements must be made that current documentation is sought from health care specialists relating to the residents exercises following their meals, records to evidence the residents weight, documented evidence from hospital appointments and admissions to hospital. The records must be available to support and evidence that the current health care needs of the resident are being appropriately met in order to ensure the residents well being and welfare. Arrangements must be made that the registered manager and provider undertake accredited medication training. In order to ensure that the resident is protected by the homes policies and procedures for dealing with medicines. It has been recommended that the fluid measurements be recorded in the same measures for example either metric or imperial in order to ensure that the residents well being and health are promoted. Arrangements must be made that the registered provider undertakes safeguarding vulnerable adults training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. Arrangements must be made that documented protocols are developed to provide evidence that the residents vehicle is at their disposal when they require it. In order to ensure that the use of the vehicle is for the residents purposes to improve their quality of life and social engagement. Arrangements must be made that a risk assessment is developed to assess the hazards and measures in place regarding the resident being left on their own and documented evidence to detail that safe vetting procedures have been undertaken to ensure the safety and protection of the resident when they are being supported alone by persons other that the registered providers. In order to promote the resident rights to safety and protection. Arrangements must be made that the the registered manager must undertake a Criminal Records Bureaus check and retain the documented evidence to support that the check has been undertaken. In order to promote the resident rights to safety and protection. It is recommended that the resident is provided with the current safeguarding vulnerable adults DVD as they enjoy watching the TV and this medium may support the resident to have a better understanding of abuse and what actions to take if they were unhappy. It has been recommended that the registered manager undertakes safeguarding vulnerable adults refresher training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. It is strongly recommended, that as part of best practise, the home develop a code of practise which details the services provided by any volunteers and safe vetting procedures are undertaken by the home to ensure the safety and protection of the resident. It has been recommended, as best practise, that the registered manager undertake Moving and Handling and Fire Safety training to ensure the safety and welfare of the resident. Arrangements must be made that documented records are to be developed to indicate when the resident has a bath. In order to ensure the wellbeing and welfare of the resident. It is recommended that in order to improve the management of records that the registered manager considers filing the residents care plan and associated documents within one file and file all other documents related to the home in other files in order to improve the standard of paper management within the home. Arrangements must be made that the registered providers must forward to the commission, upon receipt of the final report, an improvement plan detailing how the home intends to improve the service provided. In the home to ensure the safety and well being of the resident in the home.
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: Ethel Road (7) 7 Ethel Road Ashford Middlesex TW15 3RB 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: Suzanne Magnier
Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years)
Page 2 of 46 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 46 Information about the care home
Name of care home: Address: Ethel Road (7) 7 Ethel Road Ashford Middlesex TW15 3RB 07854509273 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Vaughan Charlton,Mrs Victoria Charlton Name of registered manager (if applicable) Mrs Victoria Charlton Type of registration: Number of places registered: care home 1 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 1 The registered person may provide the following category 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 category : Learning disability ( LD) Date of last inspection Brief description of the care home The home is privately owned and is registered as a care home which currently supports one adult with a learning disability. The resident has their own single bedroom and has sole use of a bathroom and toilet situated in close proximity to their bedroom. Care and support is provided by the registered providers. Care Homes for Adults (18-65 years)
Page 4 of 46 Over 65 0 1 2 8 1 0 2 0 0 9 Brief description of the care home The resident has a choice to share the communal lounge, dining room, conservatory and part of an enclosed garden and domestic style kitchen with members of the family. Care Homes for Adults (18-65 years) Page 5 of 46 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: The quality rating for this service is 0 zero stars. This means the people who use this service experience poor quality outcomes. This inspection of the care home was an unannounced Key Inspection carried out by Ms S Magnier CQC Regulation Inspector and Mrs Rosemarie James CQC Local Area Manager. The registered manager represented the service throughout the inspection. The resident lives in a family home and it is acknowledged that the expectations of the regulation of the national Minimum Standards may differ marginally from that of a larger residential care establishment. This has been taken into account during the inspection process yet where standards in the home need to be improved for the safety and well being of the resident these have been addressed within the report. For the purpose of the report the individual using the service is referred to as the resident. The inspectors arrived at the service at 08.00 and completed the inspection at 17.30. Care Homes for Adults (18-65 years)
Page 6 of 46 The inspection was a thorough look at how well the home is doing and took into account information provided by the home and any information that the commission had received about the service since the last inspection on the 28th October 2009. The inspectors looked at how well the service was meeting the Key National Minimum Standards for Younger Adults and some additional standards have been assessed during the inspection. Judgements about the standard of the service have been documented within the report. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection and it was noted that the registered manager had made improvements regarding the quality of the completed document following the previous inspection. Some shortfalls have been identified within the (AQAA ) and are included within the report. The registered providers are reminded that the document is a self assessment tool and should be completed accurately to detail the care, support and facilities offered at the home in order that the commission can ascertain the robustness of the service. The commission requested written comments, in the form of surveys, from people associated with the service yet none were received prior to the inspection. The inspectors spent time talking to the resident and observing the homes routine. The residents views and opinions about the service were sought and have been documented within the report. The communal areas and the residents bedroom and bathroom were viewed. Documents sampled during and after the inspection included the homes Annual Quality Assurance Assessment (AQAA,) the Statement of Purpose and Service User Guide, the residents care plan and risk assessments, the medication policy and procedure, the health and safety policies and procedures, the homes complaints and safeguarding procedure and the registered persons training records. No complainant has contacted the Commission directly with information concerning a complaint made to the service. One safeguarding referral has been made since the last inspection which has yet to be concluded. Care Homes for Adults (18-65 years) Page 7 of 46 What the care home does well: What has improved since the last inspection? What they could do better: It is strongly recommended, as best practise, that the registered providers develop the information within the Statement of Purpose and the Service User Guide in an alternative format which would assist and include the resident to have more information about their home. Arrangements must be made that detailed records are kept which determine the residents income and outgoings and receipts are kept of all expenditure. In order that records are able to be monitored and audited to safeguard and promote the residents Care Homes for Adults (18-65 years)
Page 8 of 46 right to involvement in their financial affairs. It is strongly recommended that the residents care plan is developed in a person centred manner, with the resident, to give them the opportunity to express themselves and be involved in the decisions regarding their daily life. It has been recommended that the risk assessment regarding the residents potential dehydration be documented separately due to the residents specific health care needs. Arrangements must be made for appropriate health care referrals to be arranged. In order that the residents nutritional and health care needs related to their diet are fully assessed to ensure the residents well being and welfare. Arrangements must be made that current documentation is sought from health care specialists relating to the residents exercises following their meals, records to evidence the residents weight, documented evidence from hospital appointments and admissions to hospital. The records must be available to support and evidence that the current health care needs of the resident are being appropriately met in order to ensure the residents well being and welfare. Arrangements must be made that the registered manager and provider undertake accredited medication training. In order to ensure that the resident is protected by the homes policies and procedures for dealing with medicines. It has been recommended that the fluid measurements be recorded in the same measures for example either metric or imperial in order to ensure that the residents well being and health are promoted. Arrangements must be made that the registered provider undertakes safeguarding vulnerable adults training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. Arrangements must be made that documented protocols are developed to provide evidence that the residents vehicle is at their disposal when they require it. In order to ensure that the use of the vehicle is for the residents purposes to improve their quality of life and social engagement. Arrangements must be made that a risk assessment is developed to assess the hazards and measures in place regarding the resident being left on their own and documented evidence to detail that safe vetting procedures have been undertaken to ensure the safety and protection of the resident when they are being supported alone by persons other that the registered providers. In order to promote the resident rights to safety and protection. Arrangements must be made that the the registered manager must undertake a Criminal Records Bureaus check and retain the documented evidence to support that the check has been undertaken. In order to promote the resident rights to safety and protection. It is recommended that the resident is provided with the current safeguarding vulnerable adults DVD as they enjoy watching the TV and this medium may support Care Homes for Adults (18-65 years)
Page 9 of 46 the resident to have a better understanding of abuse and what actions to take if they were unhappy. It has been recommended that the registered manager undertakes safeguarding vulnerable adults refresher training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. It is strongly recommended, that as part of best practise, the home develop a code of practise which details the services provided by any volunteers and safe vetting procedures are undertaken by the home to ensure the safety and protection of the resident. It has been recommended, as best practise, that the registered manager undertake Moving and Handling and Fire Safety training to ensure the safety and welfare of the resident. Arrangements must be made that documented records are to be developed to indicate when the resident has a bath. In order to ensure the wellbeing and welfare of the resident. It is recommended that in order to improve the management of records that the registered manager considers filing the residents care plan and associated documents within one file and file all other documents related to the home in other files in order to improve the standard of paper management within the home. Arrangements must be made that the registered providers must forward to the commission, upon receipt of the final report, an improvement plan detailing how the home intends to improve the service provided. In the home to ensure the safety and well being of the resident in 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. Care Homes for Adults (18-65 years) Page 10 of 46 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 11 of 46 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide contain the relevant information about the services and facilities offered by the home. The home has pre admission assessment procedures to ensure the home could meet the assessed needs of the prospective resident. Evidence: The home continues to offer a service to one resident who has resided at Ethel Road since the home was granted registration in July 2001. The section of the Choice of Home in the Annual Quality Assurance Assessment (AQAA) had not been completed by the registered providers and they are reminded that it is the expectation of the commission that the Part 1 of the AQAA as a self assessment tool is completed to demonstrate the care and support provided to the resident in the registered establishment. The registered manager confirmed during the inspection process that no admissions are planned at the registered premises. Following the requirement made during the last inspection there was evidence to support that the Statement of Purpose and the Service User Guide documents had
Care Homes for Adults (18-65 years) Page 12 of 46 Evidence: been updated to comply with the current legislation. Although previously recommended over several inspections, as best practise described in the National Minimum Standards for Younger Adults, the registered providers have not developed the Statement of Purpose or the Service Users Guide in a format using pictures and symbol representation which could be helpful for the resident in understanding and being more aware of the homes aims of objectives in their daily life. During the inspection the registered manager confirmed that they had been unable to download a copy of the current Care Homes Regulations updated 2006 and the inspector showed the registered manager how to access the documents on the computer in order to ensure that the registered service is compliant with the Care Home Regulations. Whilst sampling the Service User Guide and Statement of Purpose it was noted that reference had been made to the importance of pre admission assessments in order that the home could assess the needs of any prospective resident however the registered manager confirmed it was not the intention of the registered care home to offer any further placements at the home. Care Homes for Adults (18-65 years) Page 13 of 46 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. The residents support and personal care needs within the care plan contain basic information. The care plan is not developed in a person centred approach. The management of risk assessments and the residents protection regarding their finances is poor and does not promote the residents rights to safety, protection and well being. Evidence: On arrival at the home at 08.00 it was observed that the resident was up and in their pyjamas, looked well groomed and was animated and happy to talk with the inspectors about their recent trip to London. The registered manager advised that the resident was up early as a family member needed to attend an appointment and the resident would be going with the registered manager to the appointment. During the inspection the registered manager was able to demonstrate, as the previous inspection, her understanding of the residents needs and reinforced that the home is run as a family home with the resident being very much part of the family. It
Care Homes for Adults (18-65 years) Page 14 of 46 Evidence: was observed that the resident had some control over their life and moved freely around the downstairs part of their home which included their bathroom, the communal kitchen, lounge and dining room. The resident confirmed that the registered manager chooses their clothes for them to wear which was OK and enjoyed watching a film in the lounge on the large screen TV during part of the inspection. The care plan sampled was similar to the care plan evidenced during the last inspection in October 2009 and consisted of the daily routine of the resident which is centred around when they were or were not at college and included information necessary to deliver the residents basic care. The care plan included how the resident is supported to get up by prompting and encouraging the resident in promoting a level of independence with personal care and dressing. The registered manager advised that the resident had a copy of their care plan in their bedroom and that the resident had been involved in developing their care plan. There was no indication on the documented care plan sampled that the resident had been involved or included in developing their care plan and during the inspection the resident confirmed to the inspectors, when asked, that they did not know they had a care plan. The registered manager advised that a copy of the care plan was not in the residents room at the time of the inspection as she had not put the copy back since a visit from Surrey County Council personnel on the 1st April 2010. The commission acknowledge that the home have a documented care plan dated 14.1.2010 in place which details the basic care needs of the resident and includes some agreed working practises to support the resident with their personal care. It is considered that this element of the requirement made during the previous inspection has been met. The care plan however, despite recommendations in previous inspections and as part of good practise described in the National Minimum Standards for Younger Adults is not person centred to include the residents goals or aspirations, their strengths and references to their diversity, their communication abilities and preferred communication style, their full skills and abilities and how they make choices in their life and direct the service they receive. This was discussed with the registered manager during the inspection for further consideration and is strongly recommended that the residents care plan is developed in a person centred manner, with the resident, to give them the opportunity to express themselves and be involved in the decisions regarding their daily life. The care plans contained information regarding the health care needs of the resident and these will be reported more fully in the Personal and Health care Support section of the report. Care Homes for Adults (18-65 years) Page 15 of 46 Evidence: During the previous inspection the residents daily records could not be accessed as the registered manager advised that there were difficulties with the homes computer. The commission requested an email of the daily records yet these were not sent to the commission. During this inspection the registered provider printed off copies of the residents occurrence records which were held on the computer. The records provided indicated when the resident was unwell, attended health care appointments, visited family and friends and any medical interventions. The records indicated that the resident had made a choice that they did not want to attend college on a Monday but still wanted to attend on a Thursday. The Individual needs and choices section of the (AQAA), completed by the registered manager, advises that the resident is able to make choices and decisions about their life, is always consulted about what happens in the home, they are always asked what kind of holiday they would like and what kind of food they would like to buy in the weekly shop and the time of day they like to get up. The section of what the home could do better within the (AQAA) has not been completed. It is stated that the improvements that the home have implemented include an updated care plan (which the resident helped to write), a review of the care plan with a care manager and the development of a quality assurance questionnaire. The improvements made are requirements made during the previous inspection. The residents financial affairs were discussed and the registered manager advised that the resident had poor ability and lack of understanding of the value of money. A finances risk assessment was sampled and documented that the resident threw money away yet the resident told the inspector that they hadnt done this for a long time. There was no evidence available to support that the resident is offered assistance and information about the value of their money or have any involvement in learning how to handle their money which is viewed as limiting the residents choice. Following a review meeting with the residents care manager the registered manager was advised to open a post office account with the resident and the registered manager confirmed this had been done. On examination of the residents financial records it was noted that inconsistent records were kept regarding all incoming and outgoing payments and there was a lack of receipts detailing the residents expenditure. A requirement has been made that arrangements must be made that detailed records are kept which determine the residents income and outgoings and receipts are kept of all expenditure in order that records are able to be monitored and audited to safeguard and promote the residents right to involvement in their financial affairs. During the previous inspection several risk assessments were sampled by the Care Homes for Adults (18-65 years) Page 16 of 46 Evidence: inspector which included assessments for eating and choking, community activities, medication whilst in the community, environment disaster plan, waiting in the porch and bathing. The format of the risk assessments were complex and had been adapted from another source. Standard 9 of the submitted (AQAA) had not been completed to include any reference on how the registered manager supports the resident to take risks as part of an independent lifestyle. A risk assessment sampled during this inspection contained four elements regarding the resident choking, details of the time the resident should eat and the hazard regarding the residents potential weight loss and dehydration. The risk assessment indicates that the resident should not eat after 7pm due to reflux and the risk of choking yet there was no indication that this limitation had been agreed and discussed with the resident and any relevant health care specialists. The hazard identified regarding dehydration remained incorrectly assessed as the section of the risk assessment had not been completed and the risk assessment had not been reviewed or altered from the previous risk assessment sampled in 2009. The inspectors discussed the risk assessment with the registered manager and have recommended that the risk assessment regarding the residents potential dehydration be documented separately due to the residents specific health care needs. Two risk assessments titled waiting in the porch and recreation and leisure activities relating to medication management were sampled. The registered manager acknowledged after discussion that the two risk assessments were not current as the resident was not currently taking any medication and no longer needs to wait in the porch. The bathing risk assessment sampled had not been reviewed or altered from the previous risk assessment sampled in 2009 despite the documented severity rating of serious injury regarding the residents bathing. Additionally the emergency evacuation risk assessment had not been reviewed or altered since the inspection in 2009. It was noted that during the inspection in 2009 a risk assessment for the residents leisure, recreational and educational activities was sampled yet this was not available during this inspection. It was further evidenced that the risk assessments rely on a numerical outcome and there was no documented guidance related to the scoring outcomes which, it was considered, rendered the risk assessments incomplete to ensure the safety and wellbeing of the resident. The registered manager confirmed that she did not have a good understanding of the risk assessment process and relied on her husband to email her the risk assessment format from his place of work for her to complete. Care Homes for Adults (18-65 years) Page 17 of 46 Evidence: During the inspection of the 28th October 2009 requirement number 4, within the last report, stated that the standard and format of the risk assessments be revised and improved to ensure that the current hazards in the residents life were fully documented, the measures and actions taken to reduce the hazards were clearly recorded and that review dates were recorded in order that the risk assessments could be audited to promote the residents best interests and safety and ensure their well being as far as reasonably practicable. This requirement has not been met. The inspectors issued a Code B notice of the Police and Criminal Evidence Act 1984 (Code of Practise for the Searching of Premises and the Seizure of Property Found on Persons or Premises) and copies of the risk assessments were seized. The commission will be serving an Enforcement notice under Regulation 43 of the Care Homes Regulations for continued non compliance of Regulation 13. Care Homes for Adults (18-65 years) Page 18 of 46 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The resident is able to exercise some choice about their lifestyle and meaningful relationships and activities are promoted and maintained. The documentation regarding the menus or evidence of the food provided to the resident did not demonstrate that a nutritious, varied and balanced diet was available to promote the residents well being and welfare. Evidence: During discussion with the registered manager and with reference to the (AQAA ) it is advised that the resident is in contact with their birth family twice to three weekly and the resident is taken to social groups twice a week. The resident said that they have maintained a special friendship. The resident said they had recently been to London to see Meatloaf and get an autograph. The resident showed an inspector some
Care Homes for Adults (18-65 years) Page 19 of 46 Evidence: photographs on the digital camera of a local wrestling match which they also said they enjoyed attending with their family. The registered manager advised that when the resident is at home they go to feed the ducks, sit by the river and have an ad hoc day but this does not mean that the resident sits at home all day watching the TV as they are encouraged to do things and are happy to go along with things. Since the previous inspection the resident has been supported on an individual basis each week to access their community and to go bowling or to the cinema. The resident confirmed that they enjoy watching films and was animated when talking about various films they had enjoyed seeing. The AQQA advises that the resident wanted to be more involved within their community and chose to attend a mens group at the local church and join a music group. The AQAA advises that the resident has finished their college course on a Monday. The registered manager advised that the resident had not been to another college for 3 weeks due to their health concerns which the college have advised the registered manager that they are unable to support the resident with yet will contact the home if necessary. The registered manager stated that she assesses the resident on a daily basis to ascertain if they are able to undertake community activities due to their ongoing health concerns. Following the previous inspection it was required that an up to date activities programme be developed to detail the current meaningful activities undertaken by the resident both within the home and the local community. It was considered that this requirement had been met as an activities programme was sampled during the inspection and offered some evidence that the resident has some involvement in their local community, maintains friendships and participates in meaningful activities. When the resident returned home following going out with his support person he advised the inspector that he had been out bowling. The resident went to their bedroom and began to look at a book whilst sitting on their bed with a back rest support. The residents room had been redecorated following the previous inspection and it appeared they had new furnishings. The room contained a variety of DVDs and CDs, a music centre, disco lights and a large screen television. The resident said I have a TV in my room and Vicky tells me not to have it on too late. During the previous inspection in October 2009 it was noted that the care plan could be misleading as it stated that the resident is on a soft diet but also stated that they could eat sausages, chicken, chips and toast. This reference has also been included within the residents current care plan. It is noted that the residents care plan Care Homes for Adults (18-65 years) Page 20 of 46 Evidence: documents that their breakfast meal includes a cup of tea, toast and spaghetti with the toast being broken into bite size pieces with the tinned spaghetti on top, with a little water, heated in the microwave to make sure the toast is soft. A lunch time meal would include a sandwich, or sausage and chips from the local chip shop and or a fillet of fish with water from Mc Donalds. The care plan states that the resident has to have soft foods ie no burgers, lamb steak etc as this is due to food getting stuck in the residents throat however it is recorded that it is alright for the resident to have chicken, sausages and cold meats. The care plan states for the evening meal that the resident can take a long time to eat their meal and should be offered soft foods only ie lasagna and cottage pie with vegetables and potatoes ie chips, mash or boiled. Evidence was sought during the inspection to ascertain if the registered manager had any medical evidence to support the limited decisions being placed on the resident regarding their diet. The registered manager showed the inspectors two letters dated 2002 and 2003 which had been written by a senior dietitian for people with learning disabilities which stated that the resident, in 2002 and three months later, in 2003 ate a varied diet with the exception of fruit. Following the previous inspection there was no evidence available to support that the resident was receiving a balanced and healthy diet as no menus were available. During this inspection the registered manager provided a typed menu which included some soft diets for example mince, mashed potatoes, cottage pie and corn beef hash yet also included roast chicken, mixed grill, chicken portions, and chicken stew. The registered manager advised that the menu was for guidance only and was subject to change. Records were requested to detail what the resident had actually eaten and these were typed documents covering three weeks in March 2010 and three weeks in April 2010. The records bore limited reference to the menu as the record detailed that the resident had cheese jacket potatoes and cottage pie once a week, fish and chips once a week and tuna pasta bake six times in the three weeks. There was no evidence that the resident had had fresh vegetables or deserts as recorded on the typed menu. Whilst it is acknowledged that the registered manager has supplied a written record of the food provided to the resident the document sampled did not reflect that the residents diet was satisfactory in relation to nutrition in order to promote the residents health and well being. The (AQAA) submitted indicated that the registered manager has noted that it is not applicable for the home to carry out nutritional screening despite the risk assessment indicating that the resident has difficulty eating and also hides their food and may be at risk of malnutrition. When asked the registered manager advised that the resident no longer hides their food. Care Homes for Adults (18-65 years) Page 21 of 46 Evidence: Additional concerns regarding the residents health is documented within the next section of Personal and Health care support. It has been required that the registered manager must make arrangements for appropriate health care referrals to be arranged in order that the residents nutritional and health care needs related to their diet are fully assessed to ensure the residents well being and welfare. Care Homes for Adults (18-65 years) Page 22 of 46 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. The resident continues to receive personal support in a planned and consistent manner. There was a lack of documented evidence to support the medical interventions and practises regarding the residents physical and health care needs. Medication procedures do not ensure that medication would be administered in a safe and appropriate way. Evidence: It was noted that the residents current care plan regarding their personal care support needs contained some changes since the previous inspection and that the routines in place for the resident met their assessed needs. As previously documented there was no evidence within the residents care plan that they had been involved in making the decisions regarding their preferences of receiving support. The (AQAA) advises that the resident receives a high level of support and care in attending health appointments and has full support. The resident has had a lot of medical appointments recently as the resident has complex medical needs and has always attended appointments on time and has a check up every 12 months ie
Care Homes for Adults (18-65 years) Page 23 of 46 Evidence: dentist, eyes, heart and sees the GP on a regular basis. The section within the (AQAA) of what the home could do better with regard to the Personal and Health care support of the resident has not been completed. Concern was raised during the last inspection regarding the residents care plan that referred to the residents posture following eating a meal and also the residents fluid intake and output. A requirement was made that the home must keep documented evidence of any plans relating to the resident in respect of their fluid intake and output, body weight, special diets and records of appointments attended with health care professionals. It is considered that elements of the requirement have been met. Clarification was sought during this inspection with regard to the guidelines within the residents care plan which detailed that the resident had to sit upright following a meal for thirty minutes, which, it was reported they did not like to do. The resident showed the inspector how they are supposed to sit after their meals and said it helped to get their food down. The inspector asked the resident how long they sit like it and the registered manager answered for the resident stating they had no concept of time. The registered manager stated that the resident had some guidelines about how to sit and the resident described that the document had pictures but they couldnt find the document. The registered manager has developed a fluid intake and output chart which was printed off from the computer. The record was sampled and it was noted that the residents fluid input was in pints and the output in millilitres. The registered manager advised that they did not know how much a cup of fluid held or understood the quantity comparisons. It has been recommended that the fluid measurements be recorded in the same measures for example either metric or imperial in order to ensure that the residents well being and health are promoted with regard to their fluid intake and output. During the inspection a letter was located from a health care specialist which states that it is recommended that the resident drink at least 2 litres of fluid a day and has decaffeinated fluids e.g. tea, coffee, coke and chocolate. During the previous inspection concern was raised regarding the measuring of the residents body weight as the risk assessment sampled indicated that the residents GP measures their body weight. There were no records available within the home to clarify what the residents current weight was and the registered manager advised that the GP undertakes the monitoring of the residents weight by measuring the circumference of their abdomen. The registered manager confirmed that the home do not weigh the resident and it was noted that the resident would be able to stand on a domestic weighing scale if one was available. The registered manager advised that the Care Homes for Adults (18-65 years) Page 24 of 46 Evidence: resident was due to see their GP the day after the inspection for a routine check and for a weight measurement. An inspector asked the registered manager when the resident had last seen their GP and the registered manager advised it was on the 4th January 2010. The occurrence records detail that there is nothing to report yet the registered manager gave assurances that the resident saw their GP on that day. The registered manager stated that the resident always goes with her to appointments and that the resident would remember if they had seen the GP, when asked the resident was unsure the last time they had seen their GP but thought their GP was a woman. It was noted that there were several entries within the occurrence records submitted during the inspection and since the last inspection in October 2009 that the resident had regularly visited their GP and had attended a number of specialist health care appointments. There remains concerns, which were also raised at the last inspection, regarding the lack of and limited evidence to support that a range of health professionals were and are involved in the ongoing health care support needs of the resident. The only current medical records available were those of the district nurse who visits the home every six weeks to offer specialised support. The registered manager was not able to provide any information regarding the numerous appointments for the consultations listed previously and there was no current evidence to support the practise of the resident having to sit for 30 minutes after a meal. There was no current evidence of input from a dietitian or speech and language therapist, with regard to the residents history of difficulty in swallowing and no documentation regarding continence management advice. These concerns have been brought to the registered managers attention and the care managers attention. It was observed that the residents documents file was poorly managed and it was difficult for the registered manager to find documents when they were requested during the inspection. It has been required that arrangements must be made that current documentation is sought from health care specialists relating to the residents exercises following their meal, records to evidence the residents weight, documented evidence from hospital appointments and admissions to hospital. The records must be available to support and evidence the current health care needs of the resident are being appropriately met in order to ensure the residents well being and welfare. During the previous inspection a requirement was made that the home develop a medication policy and procedure that includes the arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home in order to ensure the safety and welfare of the resident. An inspector sampled the new policy and it is considered that the home have met the requirement. The registered manager confirmed that the resident is not currently taking any Care Homes for Adults (18-65 years) Page 25 of 46 Evidence: medication. The inspectors requested evidence that the registered manager had undertaken medication training as they are the primary carer for the resident and no training certification was located. A medication training record for the registered provider was located and dated 20.9.07. It has been required that arrangements must be made that the registered manager and provider undertake accredited medication training in order to ensure that the resident is protected by the homes policies and procedures for dealing with medicines. Care Homes for Adults (18-65 years) Page 26 of 46 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 complaints procedures of the home have been revised to assist any complaints and concerns received by the home to be addressed and acted upon appropriately. The home lacks robust procedures and understanding regarding the safeguarding of the resident and do not promote the residents rights to be protected from harm and abuse. Evidence: During the last inspection a requirement was made that arrangements must be made for the registered person to establish a complaints procedure for considering complaints in keeping with the Care Homes Regulations which must include all details outlined in Regulation 22 in order to ensure that any person, including the resident who may wish to raise a complaint have the correct information and are assured their views and opinions about the service will be acted upon. The complaints procedure sampled during this inspection had been updated and was considered relevant to the service. The (AQAA) submitted indicated that the home has never had any complaints from the resident and that the resident has always said to their advocate that they are happy and they are happy with what they do. The resident has access to other people and if they were unhappy and did not like anything and the people include their care manager, mother, college tutors and advocate and they are fully aware of how to
Care Homes for Adults (18-65 years) Page 27 of 46 Evidence: make a complaint. The section in the Concerns, Complaint and Protection regarding what we could do better has not been completed. The registered manager advised that the resident has a copy of their own complaints procedure. During the last inspection a requirement was made that the home must obtain the current local authority multi agency safeguarding protocols, develop a whistle blowing policy and safeguarding policy related to the care home, undertake training regarding the Mental Capacity Act and Deprivation of Liberty Standard and review the homes policies related to codes of conduct and restraint and intervention and develop a documented inventory of the residents furniture and clothing. It was confirmed that the home have obtained the current local authority multi agency safeguarding protocols dated 2008. The home are subject to one safeguarding referral which has not been concluded. It was noted that the resident has their own easy read pictorial copy (Say no to Abuse) booklet and it is recommended that they are also provided with the current DVD as they enjoy watching the TV and this medium may support the resident to have a better understanding of abuse and what actions to take if they were unhappy. During previous inspections requirements had been made that the registered manager undertake safeguarding vulnerable adults training and this was confirmed as met during 23rd October 2008 key inspection. There was no evidence available, when requested, that the registered provider had undertaken safeguarding vulnerable adults training and as primary carers for the resident it has been required that arrangements must be made that the registered provider undertakes safeguarding vulnerable adults training and it is recommended that the registered manager undertakes safeguarding vulnerable adults refresher training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. The safeguarding training records will be sampled during the next regulatory activity to confirm compliance. When asked to supply a whistle blowing policy and procedure the registered manager advised that as the home did nor employ staff and the resident was not supported by anyone else and she would use the complaints procedure regarding any concerns raised about the home. The registered provider and manager are reminded of their duties and responsibilities for observing and reporting, under the local authority safeguarding procedures any allegation of harm or abuse related to the resident in their care. The homes safeguarding policy and procedure has been reviewed and amended since the previous inspection and the requirement is considered met. The registered manager showed documents to the inspectors regarding undertaking Care Homes for Adults (18-65 years) Page 28 of 46 Evidence: training related to the Mental Capacity Act and the Deprivation of Liberty Standards. The commission have requested confirmation dates when the registered manager has booked or undertaken this training which can be included within the requested improvement plan sent when the report is finalised. The homes code of conduct and the policy and procedure regarding physical intervention and restraint have been revised following the previous inspection and were sampled by an inspector as relevant to the home. During the course of the last inspection the registered manager advised that due to the residents current health she was throwing away the residents clothes and bed linen which could not be laundered. It was advised that the residents care manager was aware of the current situation however there was no documented evidence to support that the resident or the care manager had agreed for clothing or bed linen to be thrown away and no evidence of a clothing inventory to document a current account of the clothes and bed linen owned by the resident. This issue was not discussed at this inspection and the commission are aware that the care manager has been informed of the disposal of the residents clothing. A documented inventory of the residents clothing has been submitted to the commission following the inspection and it is noted that the inventory does not contain any information that the resident owns any items of furniture. During the previous inspection the homes missing person policy was sampled and it was noted that it was a generic policy which was not dated, did not contain information for example a description or photograph of the resident and contained incorrect information regarding the commission. The document sampled during this inspection was noted to be the same document sampled previously and had not been altered to include the details required. The commission consider this requirement not met and the registered providers are reminded that continued failure to comply may lead to enforcement action being considered. The registered manager advised that her husband and her are the sole carers of the resident and evidence of their Criminal Records Bureaus (CRB) disclosure checks were requested as these were not sampled as part of the last key inspection. The registered provider had a disclosure dated 26.2.08 which related to their place of work and no CRB disclosure was located for the registered manager. It has been required that arrangements must be made that the the registered manager must undertake a Criminal Records Bureaus check and retain the documented evidence to support that the check has been undertaken in order to promote the resident rights to safety and protection. Care Homes for Adults (18-65 years) Page 29 of 46 Evidence: It was confirmed that the resident still has an advocate and the registered providers are are only acquaintances of the individual and do not mix socially. During the previous inspection no records were sampled regarding the involvement of the advocate and the AQAA submitted indicated that the home did not have a policy or procedure or code of practice regarding working with volunteers. During this inspection the registered manager confirmed that the home do not employ any other staff or work with volunteers and thus had not developed a policy and procedure regarding working with volunteers, which was accepted by the commission as the homes practice. It was explained that the individual called the residents advocate, is a volunteer as they are acting of their own free will and are not receiving payment to offer support to the resident. The registered manager advised that the volunteer had an up to date CRB check and the commission requested details of the disclosure which were submitted to the commission following the inspection. In consultation with senior CQC management the commission have strongly recommended, that as part of best practise, the home develop a code of practice which details the services provided by any volunteers and safe vetting procedures are undertaken by the home to ensure the safety and protection of the resident. The resident when asked if they were ever left alone in their home stated that they sometimes were but it was not for long yet sometimes someone would come to sit with them if it was a longer time. This information conflicted with the information given to the inspectors by the registered manager who advised that the resident is never left alone. The conflicting information was concerning as there was no documentation, in the form of assessment of risk, or evidence to support who the resident was being supported by in the absence of the registered manager who advised is the sole carer of the resident and whether the person who was supporting the resident had undergone safe vetting processes. It has been required that arrangements must be made that a risk assessment is developed to assess the hazards and measures in place regarding the resident being left on their own and documented evidence to detail that safe vetting procedures have been undertaken to ensure the safety and protection of the resident when they are being supported alone by persons other that the registered providers. As previously documented in Standard 7 of the report the residents finances regarding their incoming and outgoings were discussed with the registered manager during the inspection. In addition the registered manager when asked explained that the resident, owns through their benefits, a 7 seater mobility vehicle which the registered provider uses sometimes to go to work in as they will also use the registered Care Homes for Adults (18-65 years) Page 30 of 46 Evidence: managers vehicle. The registered manager confirmed that the resident was aware that the car is theirs as are members of their family and social services. It was noted that there was no documentation relating to the resident owning or using the car. It has been required that arrangements must be made that documented protocols are developed to provide evidence that the residents vehicle is at their disposal when they require it in order to ensure that the use of the vehicle is for the residents purposes to improve their quality of life and social engagement. Care Homes for Adults (18-65 years) Page 31 of 46 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home currently promotes the residents independence. Standards of cleanliness, comfort, safety and hygiene in the home have been improved in order to ensure the safety and well being of the resident. Evidence: As reported during the previous inspection the registered providers home continues to offer the resident a familiar environment where they can be supported. During the last inspection it was acknowledged that the home is a family home yet there were areas of concern regarding the general cleanliness and hygiene standards in the home, the lack of comfortable floor covering in the residents bedroom and the lack of documented evidence regarding the safety and well being of the resident. It had been required that the standards of cleanliness, comfort, safety and hygiene in the home were considered and improved and the documented policy and procedure regarding infection control and staff training certification were to be forwarded to the commission. The commission confirm that the records were not received as requested. Following the previous inspection the registered providers have decorated the hallway. The residents bedroom has been decorated and it was noted there was appropriate
Care Homes for Adults (18-65 years) Page 32 of 46 Evidence: bed linen on the bed and framed photographs on the wall. The general state of cleanliness and hygiene within the residents bedroom had improved. The residents bathroom was clean and it was noted that a documented cleaning routine was attached to the wall. When asked about the routine the registered manager advised it was for the resident to see and also for other people who may need to do the cleaning if the registered providers were not available due to illness. The registered providers are asked to refer to the previous section of the report titled Concerns, Complaints and Protection regarding the resident being supported by people other than the registered providers. The overall standard of hygiene and cleanliness in the communal areas of the home had improved following the previous inspection. The registered manager confirmed the registered providers intention to move. The resident told the inspectors that the home have lots of animals including 2 snakes, loads of cats, two tortoises, hedgehogs, frogs and toads and four dogs. The registered manager provided a certificate of training regarding infection control which was dated 13.10.09. It was noted that timed aerosols were used in the home and no malodour was detected throughout the home or during the inspection. During the previous inspection the registered manager confirmed that clinical waste is disposed of using domestic facilities and there is no indication within the (AQAA) that this arrangement has ceased. Care Homes for Adults (18-65 years) Page 33 of 46 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered providers advise they are the sole members of staff who provide support to the resident. The registered manager is aware of some gaps within their mandatory training and recommendations have been made that these are dealt with to ensure the safety, well being and protection of the resident. Evidence: The (AQAA) submitted indicated that the registered providers do not employ staff and the staffing sections of the (AQAA) had been scored through as not applicable. The registered manager confirmed during the inspection that she is the primary carer for the resident as her husband works in other employment. The information supplied in the (AQAA) on pages 59-60 did not detail the staffing arrangements in the home and this was viewed as misleading. This issue was also raised in the last inspection report. It was observed that the registered manager demonstrated an understanding of the particular day to day needs of the resident and provided for their care and the resident appeared at ease in her presence. It is acknowledged by the commission that the home supports one resident and it is considered that not all mandatory training may be applicable for the registered
Care Homes for Adults (18-65 years) Page 34 of 46 Evidence: manager to undertake. During previous inspections it had been recommended that the registered manager undertake some mandatory training courses which were relevant to the home and these included Moving and Handling, Basic Food Hygiene and Health and Safety. During the last inspection the records of confirmation of the training specified were not available and a request was made that the training records were forwarded to the commission without delay following the inspection. The commission confirm that the training records were not received as requested. During the inspection the inspector sampled the registered managers training records which confirmed she had undertaken Infection Control training, Basic First Aid and Food Hygiene. There was no evidence that Fire safety training and Moving and Handling training had been undertaken. It is acknowledged that the expectations of the National Minimum Standards for Younger People differ marginally within this domestic style service than a larger care home establishment and the commission have recommended, as best practise, that the registered manager undertake moving and handling and fire safety training. It is further acknowledged that the registered manager does not currently undertake any moving and handling techniques related to the direct care of the resident and has fire safety equipment and documented evidence to support that fire safety checks are carried out to ensure the safety and welfare of the resident. The registered providers training records were sampled and indicated that they had undertaken medication training in 2007 and moving and handling training in 2008. No other training records related to the registered provider were available during the inspection. Care Homes for Adults (18-65 years) Page 35 of 46 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home needs to be further strengthened and improved. The procedures for seeking the views and opinions of the resident and others associated with the home have improved and are recorded. The residents general safety and welfare remains inconsistent and is not fully promoted. Some health and safety concerns in the home have improved yet further improvements have been required. Evidence: The home continues to be run by the registered providers and the resident lives as a member of the family. During previous inspections the registered manager has advised the commission that they have a Chartered Management Institute Qualification, has worked in a day centre supporting people with physical and learning difficulties and has a B-Tec certificate in social care. The commission have requested clarification and updated evidence and information regarding the qualifications which has not been forthcoming. Care Homes for Adults (18-65 years) Page 36 of 46 Evidence: It had been required during the last inspection that the home must undertake an annual Quality assurance review in order to promote a culture of self monitoring and take the views of the resident and their representatives into account regarding the services and the manner in which the services are provided to the resident. Following the previous inspection the registered manager has developed a quality assurance questionnaire form and evidence was seen of recent written feedback from some of the residents family and friends of the registered providers all of which were positive and favourable comments. It is acknowledged that the resident has people in their life that are independent of the home and may advocate for the resident. The resident told the inspectors that he was happy at the home and considered it home. It was noted that cleaning fluids and materials were stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of the resident. A documented risk assessment for the residents bathing was sampled and it was noted that the risk assessment had not been updated following the previous inspection in October 2009 and still contained the same shortfalls for example the same dates, the format of the risk assessments remained complex and had been adapted from another source, the risk assessment stated that only an employee or visitor may be affected by the water temperature being too high and the population particularly at risk are the disabled and contamination from soiled clothing would also affect the employee and the disabled. The registered manager confirmed that water temperatures were taken prior to the resident having a bath to ensure their safety. The water temperatures documented that the checks were done daily which could indicate that the resident has a bath each day. It has been recommended that clearer documentation is available, within the residents occurrence records, to evidence when the resident has a bath. During the previous inspection it was noted that there was no evidence of a menu in the home and no records available to record the food or food temperatures served to the resident. As documented in the Lifestyle section of the report the menu provided during the inspection bore limited reference to the food record provided to the resident. The commission have requested that the registered manager forward to the commission following receipt of the report evidence to confirm that food temperature checks are being undertaken. An inspector sampled the homes British Gas Homecare checklist which was considered up to date. The home had some information regarding the electrical testing yet it was Care Homes for Adults (18-65 years) Page 37 of 46 Evidence: unsure if the documentation related to the domestic electrical installation certificate. It is acknowledged that there have been long standing concerns regarding lack of certification regarding the insurance cover at the home which has been raised at previous inspections. During the last inspection the current insurance indemnity certificate was not displayed in the home and the certificate sampled had expired in September 2009. The registered manager advised that another certificate had been sent to the home but this could not be located. It was required that the registered providers obtain an up to date insurance certificate providing adequate cover for the resident in relation to death, injury, public liability damage or other loss. During this inspection a current insurance certificate was seen. It remains unclear if the document is the appropriate insurance cover for the registered care home and the commission have sought further clarity regarding this. Concern was raised during the previous inspection that the commission were not being informed of any incidences which affected the well being and welfare of resident. It is considered that the registered manager following the previous inspection has informed the commission without delay of matters under Regulation 37 of the Care Homes Regulations. During the previous inspection no records were available regarding the the homes health and safety checks, fire equipment checks, fridge and freezer temperatures and records of water temperatures as the registered manager advised these were stored electronically and could not be evidenced during the inspection due to the computer monitor not working. The commission requested the documents to be sent by email without delay to the commission but were not received. The records as listed above were sampled during this inspection and it is considered that the home have met the requirement in order to promote the safety and well being of the resident. During the previous inspection it was reported that the majority of the homes policies and procedures had been adapted from other organisations procedures and those sampled were not not relevant to the care home. It was required that the registered providers review all the home policies and procedures, codes of practise and that records were signed by the registered providers and are dated, monitored, reviewed and amended in order that the documents complied with current legislation and recognised professional standards. The documents sampled during this inspection had been reviewed and where they were not signed and dated the registered manager attended to this during the inspection process. The commission consider this requirement to be met. Care Homes for Adults (18-65 years) Page 38 of 46 Evidence: It was observed that in general the management of the homes documents was poor and the registered manager had difficulty locating documents as papers were stored in loose files. It is recommended that in order to improve the management of records that the registered manager considers filing the residents care plan and associated documents within one file and file all other documents related to the home in other files in order to improve the standard of paper management within the home. It is acknowledged that the registered providers have made improvements following the last inspection as recorded within this report. However there remain a significant number of aspects of the homes management that are potentially putting the health, safety and welfare of the resident at risk due to the management and administration of the home not being robust. These include the poor management of risk assessments and the residents protection regarding their finances. The lack of appropriate health care referrals related to the residents diet, nutritional and health care needs. The lack of documented evidence to support the medical interventions and practises regarding the residents physical and health care needs. The lack of training regarding medication procedures do not ensure that medication would be administered to the resident in a safe and appropriate way. The home lacks robust procedures and understanding regarding the safeguarding of the resident and do not promote the residents rights to be protected from harm and abuse. It was required following the last inspection that the home forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of resident. The commission confirm that the improvement plan was not received by the commission due to difficulties getting the report to the registered providers. It has been required that arrangements must be made that the registered providers must forward to the commission upon receipt of the final report an improvement plan detailing how the home intends to improve the service provided in the home to ensure the safety and well being of the resident. The registered providers are reminded that these requirements have a bearing on the safety of, and outcomes for the resident and the failure to comply with the regulations is an offence and may lead to enforcement action being considered. Care Homes for Adults (18-65 years) Page 39 of 46 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made 19/02/2010 that the standard and format of the risk assessments are revised and improved. In order to ensure that the current hazards in the residents life are fully documented, the measures and actions taken to reduce the hazards are clearly recorded and that review dates are recorded in order that the risk assessments can be audited to promote the residents best interests and safety and ensure the residents well being as far as reasonably practicable. Care Homes for Adults (18-65 years) Page 40 of 46 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 Arrangements must be made that detailed records are kept which determine the residents income and outgoings and receipts are kept of all expenditure. In order that records are able to be monitored and audited to safeguard and promote the residents right to involvement in their financial affairs. 31/07/2010 2 17 13 Arrangements must be 31/08/2010 made for appropriate health care referrals to be arranged. In order that the residents nutritional and health care needs related to their diet are fully assessed to ensure the residents well being and welfare. Arrangements must be made that current 31/08/2010 3 19 17 Care Homes for Adults (18-65 years) Page 41 of 46 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 documentation is sought from health care specialists relating to the residents exercises following their meals, records to evidence the residents weight, documented evidence from hospital appointments and admissions to hospital. The records must be available to support and evidence that the current health care needs of the resident are being appropriately met. In order to ensure the residents well being and welfare. 4 20 13 Arrangements must be made that the registered manager and provider undertake accredited medication training. In order to ensure that the resident is protected by the homes policies and procedures for dealing with medicines. 5 23 13 Arrangements must be 31/08/2010 made that the the registered manager must undertake a Criminal Records Bureaux check and retain the documented evidence to support that the check has been undertaken. 31/08/2010 Care Homes for Adults (18-65 years) Page 42 of 46 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 In order to promote the resident rights to safety and protection. 6 23 13 Arrangements must be 31/07/2010 made that a risk assessment is developed to assess the hazards and measures in place regarding the resident being left on their own and documented evidence to detail that safe vetting procedures have been undertaken to ensure the safety and protection of the resident when they are being supported alone by persons other that the registered providers. In order to promote the resident rights to safety and protection. 7 23 13 Arrangements must be made that documented protocols are developed to provide evidence that the residents vehicle is at their disposal when they require it. In order to ensure that the use of the vehicle is for the residents purposes to improve their quality of life and social engagement. 31/07/2010 Care Homes for Adults (18-65 years) Page 43 of 46 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 8 23 13 Arrangements must be made that the registered provider undertakes safeguarding vulnerable adults training. In order to ensure that the residents rights to safety and protection against abuse or harm are promoted. 31/08/2010 9 42 24A Arrangements must be 30/09/2010 made that the registered providers must forward to the commission, upon receipt of the final report, an improvement plan detailing how the home intends to improve the service provided. In the home to ensure the safety and well being of the resident in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 1 It is strongly recommended, as best practise, that the registered providers develop the information within the Statement of Purpose and the Service User Guide in an alternative format which would assist and include the resident to have more information about their home. It is strongly recommended that the residents care plan is developed in a person centred manner, with the resident, to give them the opportunity to express themselves and be
Page 44 of 46 2 6 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations involved in the decisions regarding their daily life. 3 9 It has been recommended that the risk assessment regarding the residents potential dehydration be documented separately due to the residents specific health care needs. It has been recommended that the fluid measurements be recorded in the same measures for example either metric or imperial in order to ensure that the residents well being and health are promoted. It is strongly recommended, that as part of best practise, the home develop a code of practise which details the services provided by any volunteers and safe vetting procedures are undertaken by the home to ensure the safety and protection of the resident. It has been recommended that the registered manager undertakes safeguarding vulnerable adults refresher training in order to ensure that the residents rights to safety and protection against abuse or harm are promoted. It is recommended that the resident is provided with the current safeguarding vulnerable adults DVD as they enjoy watching the TV and this medium may support the resident to have a better understanding of abuse and what actions to take if they were unhappy. It has been recommended, as best practise, that the registered manager undertake Moving and Handling and Fire Safety training to ensure the safety and welfare of the resident. It is recommended that in order to improve the management of records that the registered manager considers filing the residents care plan and associated documents within one file and file all other documents related to the home in other files in order to improve the standard of paper management within the home. It has been recommended that clearer documentation is available, within the residents occurrence records, to evidence when the resident has a bath. 4 19 5 23 6 23 7 23 8 35 9 40 10 42 Care Homes for Adults (18-65 years) Page 45 of 46 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 46 of 46 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!