Inspection on 13/02/09 for Heathcotes Care (Blythe Bridge)

This inspection was carried out on 13th February 2009.

CSCI found this care home to be providing an Adequate 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathcotes Care (Blythe Bridge) 03/07/09

Heathcotes Care (Blythe Bridge) 06/03/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Heathcotes Care (Blythe Bridge) Southlands Aynsleys Drive Blythe Bridge Stoke on Trent Staffordshire ST11 9LR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Jones     Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Heathcotes Care (Blythe Bridge) Aynsleys Drive Southlands Blythe Bridge Stoke on Trent Staffordshire ST11 9LR 01782398372 01782393577 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Heathcotes Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: either, whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD of the following age range: from 18 years of age and above, maximum number of places: 6. Date of last inspection Brief description of the care home The service is a large detached property in its own grounds in a well established residential area of Staffordshire. It provides accommodation for up to 6 people, all bedrooms are for single occupancy and all have en-suite facilities. Communal facilities are satisfactory and provide comfortable accommodation for the people who live there. Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home The service is located within walking distance of local facilities, but also has its own transport for access to facilities further away. The Service User Guide does not contain the range fees and cost of the service, any prospective user of the service or their supporters should approach the provider for this information. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 1 star, this means the service offers adequate outcomes for the people who live there. This was a key inspection site visit of this service undertaken on 13 February 2009 by an inspector and an expert by experience and his supporter. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. In total the visit took approximately 08:00 hours and the purpose was to assess the services performance and to establish if it provides positive outcomes for the people who live there. Care Homes for Adults (18-65 years) Page 6 of 36 We checked that any requirements and recommendations of the previous inspection visit of 06 March 2008 have been acted upon; looking at information the service provides for prospective users of the service, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The deputy manager, staff and people who use the service were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment AQAA. We sent out four surveys to people who use the service, six to staff, and sent one GP, three health professional and three advocates surveys to the home for distribution. At the time of this report we havent had any of these surveys returned. We sent two surveys directly to named social workers and have received both surveys back, the comments will be included in the main body of this report. What the care home does well: What has improved since the last inspection? What they could do better: The service needs to develop and fully implement the person centered planning model that has been introduced. Support plans and risk assessments need to be dated, relevant and reviewed regularly to ensure they are up to date. There is a need to support people who use the service to engage in community activities and to integrate in the local community, and further efforts to ensure that current activities are meaningful. The service needs to review the health action plans it has introduced, to ensure that staff know what they need to do to support people using the service with their health needs. Medication issues need to be addressed to ensure that people who use the service are protected and staff must be trained. Care Homes for Adults (18-65 years) Page 8 of 36 The service should address environmental concerns about the first floor bath and consider further how this facility can be more easily accessed by people who use the service. Staff must be properly recruited and all pre employment checks undertaken to ensure that people using the service are not at risk. Staff must also receive the training they need to meet the individual needs of people using the service, and must be enrolled on mandatory training sessions. The provider must ensure that it has a manager in post who is registered and approved as a fit person. Fire safety issues need to be addressed to ensure that people living at the home are protected and staff know what they need to to do if there is a fire. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their supporters have the information needed to be sure that the service will meet their needs. And can be confident that their needs will be assessed. Evidence: The service told us in the AQAA that,We carry out assessments of need prior to an individual deciding to move in and make arrangements for them to visit the home. We liaise with other professionals involved in the individuals life. We saw a sample of pre admission assessments for one individual which demonstrated that the service had worked with the individual, his family and social workers to ensure that the placement meets his needs. A social worker said, Relatively new service however my clients transition was managed well. Clients parents very anxious and advocate strongly for their son, staff managed to reassure and calm parents during transition the period. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: We looked a copy of the Statement of Purpose that is available in the home, and also saw that each person using the service has a copy of the service user guide in their care records. The guide has been produced in a user friendly format and contains relevant information about the terms and conditions of residency. The deputy manager said that there are also plans to produce another version for those people who have poor literacy skills. The Service User Guide stated that the fees for the service start at 1,600 pounds per week, but did not contain the fee range for the service or the additional costs the individual may need to pay. We also saw that the guide tells the individual which bedroom they have chosen but this wasnt specified in the document we looked at. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that their needs are assessed and plans are in place to meet them but must be sure that they are reviewed regularly and up to date. Evidence: The service told us in the AQAA that, People meet weekly with their key worker to discuss how they are doing with their support plans, and people have come up with their own house rules. We looked at a sample of care records and saw that none of the support plans have been dated, this means that we cant be sure that they are up to date. The service has started to introduce Person Centered Planning(PCP), but further work is needed in this area and staff need to have training and guidance in the implementation of them. The records include information such as Good things about me, Hopes and Dreams, and a keeping safe section. But in the sample we saw they hadnt been properly Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: completed. We saw support plans in place for areas that the individual didnt need support with according to the assessment information, we spoke to the deputy manager about this. We saw that the person using the service had signed some support plans to indicate he had been involved in them. The section titled My Life Story was very brief and could be more detailed but did contain an entry, written by the person whos plan it was, I went to Blackpool, I saw some fish and chips and ice cream. The expert by experience said, I asked a member of staff if everyone had a care plan? She said that they did and this included all of the information about the men. I was told that nobody has a person centred plan. It was clear that some planning was going on with the residents, especially with the man who is getting a job but this needs to be written into a proper plan so that they can make sure everyone is fulfilling their goals. We spoke to a member of staff about her role as a key worker, she confirmed that as a key worker she plans weekly sessions with the person she is supporting and gave an account of the key worker role. She also said that her role is shared with another member of staff but they dont have an opportunity to meet to discuss how they can best support the individual. We asked about training, the member of staff said, I would like training in autism and epilepsy because this affects the majority of the people living at the home. We looked at a sample of peoples financial records and saw that they tallied with the amounts of money kept in the home. We also saw that the service has a standard that says there should be two signatures for each transaction or when money is checked at handover. But there are many examples when this does not taken place. We also saw a note in the communication book that said, Can you check the money as your totals were not right. We would recommend that the service looks at these issues and ensure that staff follow procedure to ensure that peoples monies are properly managed. The expert by experience said, I asked the people living at the home if they had their own money or if they knew where it was kept? They said they had their own money and one of the men told me he goes to the bank with one of the staff to get his own money out. This is good. While I was there one of the men said that he wanted a magazine from the shop so one of the staff helped to sort his money out so that he could go and buy one. I was told that people only have to use their own money for their own things like toiletries and magazines all of their other activities are paid for by the home. Care Homes for Adults (18-65 years) Page 14 of 36 Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involved in making choices about their lifestyle, but would benefit from having opportunties to be more actively involved in social, educational and occupational events that are socially valued and help them with community participation. Evidence: The service told us in the AQAA that, Each person has an independence plan that they work through each week and have been involved in developing their weekly activities plan. We looked one persons record of likes and dislikes and compared this against the weekly activities he has been involved in, we noted that, there is very little on the activity plan that relates to the list of things he says he liked doing. We talked to the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: deputy manager about this we have been told that the individual sometimes doesnt co-operate and refuses to do some things but the service is working with him to support him in this area. We felt that the service could be more proactive. The expert by experience said, I asked if I could look at the activity sheets for the people using the service and it appeared that they had plenty to keep them occupied. Each person has his own activity plan and I was told that these are updated weekly depending on what the person wants to do. The activity plans appear to be quite flexible and people can change things if they dont want to do them on the day. This is good. Everyone had an independence day each week where they do all of the household tasks and cooking. They do not have to stick to the independence day though, they can do household tasks throughout the week if they want too. This is good as they are learning skills to make them more independent and they are not having everything done for them. The expert by experience went on to say, I was told that all of the people like Bowling and a staff member said that they all go Ten Pin Bowling every week. Another person liked Football and he supports a local team but the staff member said that he only goes to watch the team play when his parents take him at other times he watches the matches on the television. Everybody goes home to see their families regularly. One man goes home every weekend. It is good that they are encouraged and supported to see their family if they want too. We looked at the menus on display and saw that they need to be more user friendly to ensure that the people who use the service understand them. We observed one person helping to prepare and cook his evening meal, this is a scheduled activity in his weekly plan. We saw food stocks are adequate and understand that people who use the service help with the food shopping. The expert by experience said, I asked about mealtimes and the choice of food. I was told that everyone helps to cook the meals, I saw a rota on the wall that said who was cooking on which night. I also saw one of the men helping to prepare the dinner whilst I was there. I was shown the menu. It was all written and it was quite small. It would be better if there were some pictures of the different meals on it. There was not a lot of choice on the menu but I was told that they dont always stick to the menu and often have different things. The night before they had cooked Pork and Cider with potatoes, which I thought sounded really nice. There could be more choice on the menu but it is good that it is flexible. Everyone goes shopping for the food and they were going to Tescos whilst I was there to get the food for their tea. Care Homes for Adults (18-65 years) Page 17 of 36 Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that their health and medication needs are known but cannot be sure the service knows what action to take to meet their health needs or that it is managing their medication properly, this potentially places them at risk. Evidence: The service told us in the AQAA that, each person has their own health action plans and all staff are trained to administer medication. We saw in the records we looked at, that a Health Action Plan has been completed, this contains information about the health needs of the individual and should include the action the service needs to take to meet their needs. But in the sample we saw it didnt do this. We saw from the record that the individual had visited dental, chiropody services and had a flu jab, and we saw that he is registered with a GP and has access to specialist health support. We saw that there are plans in place for supporting this individual at Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: times of anxiety, clear guidance about the triggers to behaviour and the support staff should provide. We looked at medication and saw that the current storage facility is suitable for the purpose, in a secured lockable trolley. The service monitors and records the room temperature of the medication room daily. There is a medication fridge that displays the fridge temperature, we recommended to the service that they obtain a maximum/minimum thermometer. The service does not currently have a controlled drug cupboard this is a requirement for care services. The deputy manager told us that they have ordered one and we discussed the specific requirements of fitting a controlled cupboard. We saw the medication administration records(MAR) and talked about how the service monitors medication stock control. We saw that there is a need for a more robust system to be put in place as we could not complete an audit trail because of the limitations of the records. For example we couldnt see a record of medication received in the home and therefore could not calculate the number of tablets that should be left. We saw that the service has recently changed how they sign for the medication they administer, but this has created a confusing picture on the MAR, we recommended that the service indicates on the MAR the method of signing that they no longer use. We saw Desloratadine 5mg prescribed once a day had not been signed for. We saw Lorazepam 1mg prescribed up to three times per day as required, but it did not have a protocol in place. We saw the prescribed instruction on the MAR for lorazepam was not dated, was handwritten and did not have a stock count. We saw other similar examples of medication management that need to be improved. We saw chloramphenicol eye ointment for application twice a day the date received has not been recorded and there is no record of when the tube was opened this means we could not be sure when the treatment had started or if the tube of ointment is in date. We have been involved in a safeguarding meeting where allegations have been made that staff have administered medication when they have not received training to do so. The provider has been asked to investigate this and currently medication is only administered by senior staff. The training records show that nine staff have received training, but the organisation is Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: not sure if the training provided meets the minimum standards recommended. Because of this they have sourced other training. We have been satisfied that the service has acted responsibly, since the safeguarding referral, to ensure that people who use the service are protected. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service must be confident that they are protected from the risk of abuse, the current recruitment procedures place them at risk. Evidence: The service told us in the AQAA that, We have a complaints procedure that has been produced in a format that people can easily understand, ie widget and pictures. Staff have received training in protecting people. We saw that the service has a complaints procedure in place and we looked at the record of complaints the home is asked to maintain. The service has received seven complaints since the last key visit, two complaints have been about staff attitude towards people who use the service, we saw that the service had acted to address these concerns. We saw that one person has been dismissed as a result of a complaint of this nature. According to our records we have not been informed of this as we would expect to be. We have received a complaint about the service and have referred these matters to the Local Authority under safeguarding procedures. The organisation has been asked to look into the concerns raised and report on their findings. Action has been taken to ensure the welfare and safety of people who use the service until the investigation can be concluded. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: We looked at the record of incidents and accidents in the home, there is at least one of these incidents we should have been informed of but according to our records we have not. The service is reminded of its regulatory responsiblities in this respect. We looked at staff recruitment records and are concerned that at least two new staff have been employed to work at the home prior to a Protection Of Vulnerable Adults check being carried out. This places people who use the service at risk. We have spoken to the current acting manager of the home about this and are aware that she has taken action to protect people living at the home. We interviewed one member of staff who confirmed that she has received training in recognising and reporting abuse, and during this visit 11 staff attended training sessions on this topic. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a well maintained, spacious home, that meets their needs and is a comfortable place for them to live. Evidence: The service told us in the AQAA that, We continue to improve on the general appearance of the home to try to create a homely environment. This visit did not included a detailed inspection of the environment, the evidence we have is that the service has been commissioned to a good standard. The expert by experience said,Southlands is a residential home in Stoke on Trent, Staffordshire. Southlands is home to four men. The home is located down a narrow lane and it was not easy to find. Most of the houses in the area had names displayed on the front but Southlands didnt. It would make it easier to find if there was a name outside. I noticed that Southlands did not stand out as residential home but looked like many other houses in the area, which was good. On arrival at Southlands I rang the doorbell and was greeted by a very polite member of staff. Three of the men that lived there were in the living room, the other man was in the kitchen and looked like he had been washing up the dishes, which is good. We were introduced to all of the residents Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: and the staff. Me and my supporter were asked if we wanted a drink and a member of staff supported one of the men to make the drinks. It appeared that she was supporting him to be independent which was nice to see. I was then asked if I would like to have a look around the home. The member of staff supported one of the men to take me round. The home felt quite big even though there are only four people living there. All bedrooms are en-suite and exceed the minimums requirements regarding space. Communal space is sufficient for the need of people who use the service. We talked to the deputy manager about maintenance and environmental issues affecting people who live at the home and have been told that the first floor bath cannot be used by all of the people living at the home due to the style and design of the bath. We also saw that a recent environmental health report has recommended that the grouting around the bath could not be cleaned, potentially presenting an infection control risk and should be replaced. When we looked at the bath and the tiled surround we saw that there are gaps between the main side panel of the bath and the surround presenting a potential risk and the grouting has not yet been replaced. We would recommend that the organisation looks at this and takes action to either ensure that the recommendations of the environmental health report have been carried out, or replace the current bath to ensure that people who use the service can have a bath safely if they choose to do so. It is accepted that the home also has a seperate ground floor shower. We also recommend that an emergency call point is fitted in the bathroom. We saw the main kitchen is spacious and well equipped, people who use the service have free access to this area. The expert by experience also said, Each bedroom had been individualised according to the persons chosen colour scheme and they all had personal items relating to their favourite hobbies. We saw all four bedrooms belonging to each man but she did not ask for their permission to view their rooms which I did not think was very good. Each room had an en-suite, which is good. There were also some other bathrooms that were shared and these had baths and showers in. The bathrooms were very nice and modern. The lady told me that the men can have a bath or a shower whenever they want to and that most of them have a bath or shower twice a day. This is good. There is a garden at the back of the house where the men like to do gardening when the weather is good. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service must be confident that staff are properly recruited and trained, when they are not people are placed at risk. Evidence: The service told us in the AQAA that, People who use the service are protected by a well trained and recruited staff team. We looked at the staff rosters for a five week period, the staffing levels are usually three/four for the morning period and the same for the afternoon shift but the records show there have been occasions where staffing levels have been lower than this. We saw that during the afternoon shift of 17 January, 18 January, 24 January, 6 February and the morning and afternoon of the 7 February only two staff were on duty. The reduced staffing levels may impact on the opportunities people have to go out of the home. The expert by experience said, I asked about the staff structure. I was told that there were three shifts per day, which is good so nobody is working too long hours. They are aiming for one to one staff but there were people off sick when I visited. Everyone has a Key Worker. I observed that the staff had very good relationships with the people Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: who live there and that their values seemed very good. The staff appeared to be encouraging everyone to be as independent as possible and I observed them letting the residents take the lead on what they wanted to do. We have noted from the information available to us in the AQAA, that there has been a high turn over of staff since the last key visit, in total 17 are reported to have left, this is over 85 of the workforce. We would recommend that the service reviews how staff are recruited and how it can better retain staff in the future to ensure that the people who use the service are not affected. We interviewed a member of staff who confirmed that she had received training in managing people who may challenge the service, health and safety, food hygeine, manual handling, first aid, medication training/competency assessment, safeguarding and has nearly completed her National Vocational Qualification (NVQ) 2. She would like epilepsy and autism training, as three people living at the home have this condition, and the person she is key worker for has some autistic traits. She confirmed that as a key worker she plans weekly sessions with the person she is joint key worker for and gave an account of the key worker role. But commented that both key workers dont have much of an opportunity to meet and discuss how to progress and how best to work with the person they support. During the visit, 11 staff were attending training sessions on safeguarding adults, we spoke to the training co-ordinator who stated training has been highlighted as an issue in this service and there is now a programme in place. We have been provided with evidence that additional training sessions are scheduled for Food Hygeine, Fire Safety, Health and Safety and Equal Opportunties during February. Records also show that 8 staff have received emergency first aid training one person has the full First Aid in the Workplace training. 8/16 have received food hygiene training, 10/16 have manual handling training and up until the day of the visit, 3/16 staff had received adult abuse training. The records show that no one has received fire safety training, and 4/16 have received training in Health and Safety also according to the records no staff have received training in Infection control, Epilespy or Autism. Information in the AQAA states that 3 staff have been trained to NVQ level 2, information provided on the day of this visit shows that 12 staff have enrolled on the training. We looked at a sample of six staff recruitment records, we saw that the records show that two people have commenced work prior to the receipt of POVA checks being received. This is unacceptable and has potentially placed people at risk. We saw that one person began work on 29/12/08 her POVA checks is dated 20/01/09 another is on Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: the staff rotas from 19/01/09 and his POVA is dated 03/02/09 and had no written references in his file. We spoke to the deputy manager about this he said that both employees had been recruited thorough the job centre and are on work trials which means they complete 15 supervised shifts, we could not see evidence that these staff had been supervised. In fact we saw in one record that the member of staff with no references and accompanied one person on an activity out of the home. We have written a letter of serious concern to the provider about these failings. We saw in one example that staff have received very regular supervision. We saw records of staff meetings that show they have been held regularly the last recorded meeting is 28/01/09. The service has a communication book in place and a handover book, we talked to the deputy about these as they appear to be unnecessarily repetitive we are told that the service is introducing one method of passing on information between shifts. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that the service is well managed or that there is a development plan in place to improve it. Evidence: The service told us in the AQAA that, We have an experienced manager in place and the organisation has started to monitor the quality of the service we provide we have sent out surveys to people who have an interest in the service. The AQAA was received when we asked for it and provided a reasonable picture of the service, but it was limited in the detail in some areas. We have not received any surveys from service users, relatives or staff. There have been statements made in the AQAA about the quality of the service that we have not been able to evidence as stated in the Individual Needs and Choices, Health and Personal Care, Complaints and Protection and Staffing sections of this report. This means we have a number of concerns about how the service is managed. We also remain concerned that the service has not complied with our requirement from the last inspection to ensure that Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: the manager is registered with us by 06 June 2009. We have spoken to the manager about this. However at the time of this inspection the manager is not working at the service. The organisation has made temporary interim arrangments for the management of the home. We are being kept informed of these matters. A professional stated in a survey that, The service and the management have supported my client well and have worked closely with myself and the family. Another said, I have some concerns about how the service is managing my client and have not been satisfied with some of the responses I have received. We looked at records of fire safety checks, fire drills and fire training and found there are deficits in these areas. We have contacted the fire safety officer about this and have advised the service that it must take action to ensure that staff know what they have to do to evacuate the home safely in the event of a fire. We saw that the provider has made arrangements for monthly visits to the home to monitor the quality of the service provided, but we havent seen evidence that the organisation has produced an annual development plan for the service to show how it intends to improve. The records we have available to us show poor standards of training in relation to health and safety, fire safety, infection control and equal opportunities. It is accepted that the organisation has recognised this and has acted to put in place a programme of training to address the shortfalls. Care Homes for Adults (18-65 years) Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 9 The manager must apply to us to be approved as the registered manager. 06/06/2008 Care Homes for Adults (18-65 years) Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 All medicines must be 20/03/2009 administered from a pharmacy labelled container, dated if there is a short expiry life when opened. To ensure they when they are administered they are not out of date 2 20 13 The quantity of all medicines 20/03/2009 received and any balances carried over from previous cycles must be recorded. To enable audits to take place to demonstrate the medicines are administered as prescribed 3 23 13 The provider must act to ensure that staff are properly recruited and all pre employment checks carried out. To be certain that people who use the service are protected. 20/03/2009 Care Homes for Adults (18-65 years) Page 32 of 36 4 32 13 The provider must ensure that all staff are receive mandatory training. To be certain they have the necessary basic skills to meet the needs of people who use the service. 13/04/2009 5 32 18 The provider must ensure 13/04/2009 that staff have received training to meet the specific needs of people who use the service. To be certain that staff have the knowledge they need to meet the needs of people with epilepsy and autism. 6 37 9 The provider must inform us 20/03/2009 CSCI of the future management arrangements for the service. To ensure we are confident that the management arrangements are suitable. 7 42 13 The provider must ensure that staff receive manual handling training. To be certain that staff have the knowledge they need to support people safely. 20/03/2009 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 The range of fees should be included in the service user guide. Care Homes for Adults (18-65 years) Page 33 of 36 2 1 The service should continue to develop the service user guide to ensure that the format is suitable for all people living at the home. Where people have a copy of the guide it should be individualised so that they can be sure the information relates to their terms and conditions of residency. The service should ensure that staff have received training in meeting the identified needs of people who use the service. Staff should receive guidance or training in the implementation of PCPs to ensure that they know how to support people who use the service with them. The service should make further efforts to ensure that the care and support records are more user friendly. The service should ensure that care plans are dated and reviewed regularly so that people can be confident that they are up to date. The service should ensure that risk assessments are in place to support people and are reviewed regularly. The service should make further efforts to support people who use the service to access a more varied range of social, educational, leisure and occuaptional activities. The service should ensure that the menu is presented in format that is more easily understandable. The service needs to support people who use the service to ensure that staff know the action needed, to be sure their health needs can be met. The service should purchase a maximum and minimum thermometer to ensure that the temperature is accurately maintained. The service should provide a controlled drugs cabinet to ensure that any controlled medication can be properly stored. The service should continue with the planned programme for staff training to ensure that all staff who administer medication are trained to do so. The provider should inform us of significant events affecting the welfare of people who use the service. The service should consider having the name or number of the home fitted at the main entrance to the property. So that visitors can find it more easily. The service should give further consideration to installing 3 1 4 6 5 6 6 7 6 6 8 9 9 12 10 11 17 19 12 20 13 20 14 20 15 16 23 24 17 27 Care Homes for Adults (18-65 years) Page 34 of 36 an emergency call point for people to use should they need to. 18 27 The service should consider adapting or replacing the first floor bath to ensure that all people who would like to use this facility can do so safely. The service should address the recommendations in the Environmental health report regarding the infection control risk associated with the grouting in the first floor bathroom The service should ensure that 50 of the staff have completed NVQ training at level 2. The service should maintain adequate staffing levels at all times. Fire safety issues should be addressed and further advice sought from the fire safety officer. The provider should produce an annual development plan to demonstrate how the service intends to improve. 19 30 20 21 22 23 32 33 37 39 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - 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!