Inspection on 14/01/09 for Highbury House Nursing Home

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Larches, The

Sunnycroft

Willowdene Farm

Grindley House Care Home

Pirton Grange Nursing Home

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: Highbury House Nursing Home The Old Rectory Parkfield Road Stourbridge West Midlands DY8 1HB     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: Yvette Delaney     Date: 1 4 0 1 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Highbury House Nursing Home Parkfield Road The Old Rectory Stourbridge West Midlands DY8 1HB 01384354455 01384358309 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Rushcliffe Care Limited care home 21 Number of places (if applicable): Under 65 Over 65 0 0 0 past or present alcohol dependence past or present drug dependence mental disorder, excluding learning disability or dementia Additional conditions: 21 21 21 The maximum number of service users to be accommodated is 21. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 21 Past or present Drug dependency (D) 21 Past or present Alcohol dependency (A) 21 Date of last inspection Brief description of the care home Care Homes for Adults (18-65 years) Page 4 of 33 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 that people who use the service experience adequate outcomes. This was a key unannounced inspection visit. The inspection focused on assessing the main Key Standards. As part of the inspection process we reviewed information about the home that is held on file by us, such as notifications of accidents, complaints, allegations and incidents. This type of inspection addresses all essential aspects of operating a care home and seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection visit showed that staff in the home were positive about the running of Care Homes for Adults (18-65 years) Page 5 of 33 the home and standards of care were good. Residents were relaxed and comfortable in the home. There was opportunity to meet and talk to the residents about their experience of their day-to-day life in the home. General conversation was held with some residents along with observation of working practices and staff interaction with the people living in the home. Two residents were case tracked. This involves discussion with the resident about their experience of care and living at the service, examination of records, discussion with staff and assessing the facilities available to meet their needs. During the visit, records and documents were examined and an opportunity was taken to look around the home. Staff files and records related to administration, health and safety, maintenance of the premises and equipment used in the home in the home were examined. Other records examined during this inspection include staff recruitment records, training records, staff duty rotas, medication records and health and safety documentation. The manager was asked to give questionnaires to residents and their relatives, this includes the residents followed through the case tracking process. Very few questionnaires were returned. Case tracking, which involves looking at peoples care plans and health records and checking how their needs are met in practice. The inspection included meeting some of the people living at the home, including the two people whose care was being examined. Discussions took place with some of the people that live at the home in addition to care staff and managers for the service. The manager completed and returned an Annual Quality Assurance Assessment (AQAA) questionnaire, containing helpful information about the home in time for the inspection. The manager of the home was available throughout the visit and staff were spoken with during the inspection. The inspector would like to thank the manager and staff for their positive response to the inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: As a result of this visit we have made two requirements and a number of recommendations: Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. This must include, two written references, including where applicable, a reference relating to the persons last period of Care Homes for Adults (18-65 years) Page 7 of 33 employment, which involved work with vulnerable adults. The outcome of checking the Protection of Vulnerable Adults register (PoVA). The outcome of a Criminal Record Bureau (CRB) disclosure. This will ensure that the homes staff recruitment practices safeguard people living in the home. The home must comply with fire prevention procedures at all times. This will maintain the safety of people who live and work in the home. Sufficient and suitable information must be gathered when recruiting staff to work in the home. This will make sure that all staff are suitable to work with vulnerable people and provide accurate information if needed for reporting unsuitable staff to the PoVA register. Recommendations made are that: Written information which shows the progression and outcome of the admission assessment process should be available. This will help to confirm that the person has been placed safely in a home that will meet their needs. Written daily statements should be dated, timed and signed to provide a robust audit trail of the care received and daily life of residents. The maintenance programme should include plans for the ongoing re-decoration of the home. This will help to make sure that people live in a comfortable and well presented environment. The laundry room should be kept clean at all times; this includes cleaning the air vents so they are not blocked. This will help to prevent the risk of cross infection in the laundry area. Staffing levels should be reviewed to make sure that sufficient numbers are on duty at all times. This will help to ensure that residents care needs can be met safely at all times. Monitoring of the number of hours worked by staff on long shift patterns must be carried out to ensure that staff are fit and safe to work. Documents related to the employment of staff should be reviewed to make sure they are up to date and provide accurate information. The number of a staff with an appropriate Food Hygiene based on the kitchen duties they have to carry out in the home should be reviewed to make sure they are suitably trained. This will make sure that staff know the requirements related to preparing and cooking food. Staff supervision records should include more details to show what took place at the meeting, the discussions that took place and details of the outcome and action agreed. An application should be made to us requesting the registration of the home manager. Care Homes for Adults (18-65 years) Page 8 of 33 This will support the running of the home in a way that supports and benefits people living in the home. The new owners should meet with the residents to discuss their plans for the home. This will help them to allay their fears and clear up any concerns they may have. Fire exits should not be obstructed at any time, to ensure the safety of people living and working in the home. Staff told us that there could be More therapeutic activities for service users and more one to one time with all service users. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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. Standard 1, 2, 3 and 4 was assessed. Information about the home provides details on the services the home provides. This will help people to make an informed choice about moving into the home. Full written information was not available to demonstrate the extensive pre-admission assessment process that takes place in the home. Evidence: The files of three people who live in the home were examined, one of which was for the most recent person admitted to the home. Speaking with the manager and a member of staff and details in the homes AQAA told us that residents have an extensive assessment of their needs conducted by staff working in the home over a period of time. We were told that the time taken for the assessment can take up to six months. The assessment starts in the home where the person lived before being admitted to Highbury House. The prospective resident also spends time visiting Highbury House these include visits during the day and overnight. Visits to Highbury Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: House gives the opportunity for the perspective resident, their carer, other residents and staff to get to know each other, identify and assess care needs in the care home environment. Information in the AQAA tells us that residents are asked how well the person got on with other people living in the home during their stay. Following the extensive assessment process a multi disciplinary meeting takes place to review the outcome of the assessment. A detailed report of the homes findings is discussed as part of the review. This process helps to give assurance as to whether the home has the resources to meet the needs of individuals and provide the support required to ensure their safety and stability of their mental health whilst living in the home. At the time of this inspection visit a potential service user was visiting the home as part of the assessment process. He told us that he was happy with the home and was aware of the assessment process. One person said in their questionnaire that they had enough information about the home and said And I really liked it. A resident told us that they were asked whether they wanted to move into the home. Written information in the care file examined for the potential new resident did not have details recorded to demonstrate that the homes pre-admission process was being followed. Care Homes for Adults (18-65 years) Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 6, 7, 8 and 9 were assessed Service users changing needs are recorded and reassessed, and risks involved in relation to leading an independent life style are reviewed and supported. Evidence: People living in the home have care and support plans developed. Residents are supported to write plans, which focuses on their individual needs. Nursing and care staff meet with residents to support them to write their goals and identify the level of support they need to achieve them. Care plans are written to show that choices are supported and discussed to meet individual needs while increasing the independence of residents. Care files contained risk assessments, the outcome of the assessment are developed into agreed goals. Examples include how people living in the home handle their Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: money, helping or cooking in the kitchen and access to the community. Risk assessments seen are based on allowing residents to take risks by reducing, removing or controlling the risk of harm. People living in the home were able to explain and show that they lead independent lives. Care plans showed the level of risk they could take and when and how much support individuals require. Written daily reports in care files provided information on peoples day-to-day life in the home and provides details on their health and well being. Written entries were not always signed, dated and timed by the member of staff writing the daily report. This does not help when auditing care plans and trying to follow the day to day care given to residents. Residents manage their own personal money unless it is documented in the individuals profile or care plan that they are unable to do so and need support. A review of the personal monies for residents followed through the case tracking process were observed to be stored safely, accurate balance and is audited twice daily. Care Homes for Adults (18-65 years) Page 14 of 33 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. Standards 11, 12, 13, 14, 15, 16 and 17 were assessed Residents are given the opportunity to join in a range of activities and are able to choose an activity appropriate to their age and interests. Food available offers residents plenty of choice. Evidence: There is a designated team of staff who support residents to fulfil their enduring interests and long term educational needs. Residents are supported to develop their own individual plan of activities and learning based on their interests and hobbies. These help residents to lead an active and normal day to day life while living in the home. Attending educational courses means that residents can achieve recognised qualifications, which will help with their rehabilitation back into the community. The Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: age group of people living in the home is varied and group activities are planned. This helps residents to learn acceptable social skills and relationships between people living in the home. Activities or events that residents wish to get involved in are identified in their individual goals. Daytrips are organised by the home. Residents spoken with confirmed that planned activities could be changed at any time for something they want to do. Residents were also seen to go out into the community on their own, this includes doing their own shopping. Residents are encouraged to maintain contact with families and friends. Families and friends confirm that they are made welcome and are happy with the service the home offers. The manager told us that some residents spend weekends or days with their family outside of the home. Staff and residents do the cooking in the home. Residents are involved in shopping for food and local supermarkets are used to purchase groceries, especially when planning meals that they will be cooking. People living in the home are encouraged to join in with the preparation and serving of meals. One of the residents was supported to cook the evening meal, which was sausages, mashed potatoes and vegetables. Residents are encouraged to eat their meals together in the dining room but are given the choice of eating meals in their rooms if they wish. Residents were observed to have their meals when they were ready. Individual assistance is provided if needed and residents help to clear up after their meals. Information in the AQAA told us that involving residents in cooking for the home should help to address diversity. This will also help residents to learn lifelong skills and social skills. The home also has plans for residents to undertake a basic food hygiene course. The manager told us that they have plans to start a cooking and budget club. This will involve residents with support from staff where needed planning a menu, purchasing the food within an allocated budget and cooking a meal for everyone living in the home. Other events and activities taking place in the home include a garden club led by one of the residents, film evenings and karaoke evenings and as the home have a pool table, pool competitions take place. Residents also have the opportunity to go on holiday both in the UK and abroad. As part of the of the service user contract the organisation makes a contribution of 175 pounds towards the holiday each year. Residents told us that the capacity to do what they want is dependent on staffing levels and this is not always possible especially during the day Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Residents knew the carers by name and who to go to if they needed to ask a specific question. Staff treated residents with kindness, respect and understanding of their individual needs. Staff do not enter peoples bedrooms without consent knocking before they entered. This was seen when we looked around the home. Care Homes for Adults (18-65 years) Page 17 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19 and 20 were assessed. The healthcare needs and risk assessment are fully identified for all residents this means that people living in the home could receive inappropriate care at times. Evidence: The home offers accommodation, support and services for up to 20 men and women with varying types and stages of mental health problems. We examined the care files for three residents. Residents spoken with were happy to be living in the home. All residents had comprehensive care plans detailing their individual care needs. Care plans are written to be person centred. Writing care plans in this way will help to make sure that residents individual needs are identified. People will also receive the care they need in the way they prefer. For example information in a care plan identifies that a resident has problems with their diet. A risk assessment had been completed and a care plan developed. Written information showed that the person had been referred to a dietician. The care plan included how staff should help the person manage their dietary needs and an agreement to undertake exercise. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Personal care needs are included in residents agreed plans of care. Files showed that residents require varying levels of support to help meet their care needs. Details of health care needs, which include medication people are taking, are included in care plans. People living in the home are supported to access health professionals within the community setting this includes doctors, dentists and optician. District nurses visit the home to support ongoing health care needs for example where dressings are required. One of the residents followed through the case tracking process has visits from the district nurse to review and change dressings to leg ulcers. Another resident told us that they were taken to see their doctor that day due to a cough and chest problems. Residents have access to their own health care professionals, which means that they are able to retain their own GP and any other health professionals involved in their care. Residents are supported to attend planned appointments and arrangements are made for those who have been in the home for a longer term to receive ongoing review of both their physical and mental health. Risk assessments had been reviewed and completed in all care plans examined. Information available shows that psychological assessments had been carried out. These had been linked to include risks related to self harm, neglect, and violent behaviour. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. Risks identified are discussed with residents and their family as appropriate. Medication practices in the home have improved. Medicines are appropriately stored. Medicines are safely administered before staff sign to confirm that the medicine has been given to the resident. This helps to make sure that people living in the home are safe from the risk of harm. A policy and procedure is available to support the safe administration of medicines. A medicines fridge is available and daily recordings of the temperature were within recommended limits. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. Care Homes for Adults (18-65 years) Page 19 of 33 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. Standards 22 and 23 were assessed. People living in the home can be confident that their concerns will be listened to. Some practices in the home do not show that people living in the home are protected from harm at all times. Evidence: A copy of the complaints procedure is displayed in the home this makes sure that it is accessible to people using the service or visiting the home. A resident spoken with felt that most staff were very understanding and listened to them, which helped to prevent problems getting worse. Residents spoken with, information in the AQAA and questionnaires sent out told us that residents know how to make a complaint and who to complain to. A resident told us that I can speak to any member of staff another resident said they would speak to RMN or Key worker. We have not received any complaints about the home. Complaint records maintained show that the home has received two complaints since the last inspection, which have been resolved. Policies and procedures are available to ensure staff are aware of the procedures to follow to safeguard people living in the home from the risk of harm or potential abuse. Staff have received up-to-date training in the identification and awareness and action to be taken in the event of an alleged abuse. People who live in the home have access Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: to information on what they should do if they feel they are being abused, bullied or harassed. There has one referral made through adult protection procedures. This was due to concerns between residents and has been resolved. As discussed under the staffing section of this report robust recruitment procedures were not followed and appropriate check were not completed before staff started working in the home. This could expose residents to the risk of harm. Care Homes for Adults (18-65 years) Page 21 of 33 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. Standards 24 and 30 were assessed. The home is maintained to provide a safe and homely place for people to live. Evidence: The home offers accommodation, support and services for up to 20 men and women. The home is a converted Georgian dwellings situated in a residential area of Stourbridge near to shops and other local facilities. There is a garden area at the back of the home, which are maintained and residents tell us they make full use of it in the summer. It was noted that in some areas the home would benefit from re-decoration. Continuous maintenance is carried out in the home to make sure the home is safe for use. Secure systems remain in place to protect people living in the home. The home has a seven foot perimeter fence, the main gates area opened with required actions and the pedestrian gates are locked at night. Residents who wish to go out at night have a key if they return to the home after the gates are locked. Residents have their own bedroom and some of these were viewed with the permission Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: of the occupant. These were furnished with residents personal items. Laundry facilities are provided in the basement of the home. The location of the laundry shows that it would not provide a safe environment for residents to do their own laundry. The laundry area was also not at its cleanest at the time of the inspection. The air vents in the laundry show they need cleaning. Care Homes for Adults (18-65 years) Page 23 of 33 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. Standards 32, 34 and 35 were assessed. Appropriate checks are not made on staff before they start working in the home, which means that people living in the home are exposed to the risk of harm. Staffing levels in the home are sufficient and residents benefit from being cared for by trained staff. Evidence: Discussions and interactions observed between residents and staff showed that they were clear about who the individual staff are in the home. The duty rotas for a four week period showed us that there are two nurses on an early shift and the number of carers varied between four and six. On a late shift there is one nurse and four carers. A member of staff said that there was usually four staff on each shift, which they told us is not enough. Residents told us that the capacity to do what they want is dependent on staffing levels and this is not always possible especially during the day. At the time of the inspection there was sufficient staff on duty and this includes an additional team of staff employed to support residents with activities and enduring learning skills. Duty rotas showed that nurses work shifts of up to sixteen hours or more. For example Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: one shift indicated that the person would be working from 1pm to 9pm and then continues onto a night shift, finishing at 8am. One member of staff completed an early shift the next day. This concern was discussed with the manager who told us that one of the members of staff on night duty does a sleeping-in shift. This shift is covered by the member of staff that has worked part or the entire late shift. A sleeping shift, the person is called only if needed is considered suitable for the residents living in the home. We spoke to staff who told us that they were generally happy in their individual roles Staff were knowledgeable about the residents in their care. Staff have attended mandatory training sessions, which include fire and health and safety. Ongoing training is available to ensure that staff are confident and competent in providing care to people living in the home. We were told that new staff are included in a Buddying programme where they work supernumerary alongside a mentor for four weeks. A response in a questionnaire told us that the staff induction mostly covers everything staff needed to know when they started the job. Staff files are not kept at Highbury House but at the companys head office. A second visit was arranged to complete the inspection giving the home time to get the files for the most recent staff recruited to the home. The files of four staff were examined and these show that safe recruitment procedures are not robust to ensure that residents are protected from the risk of harm. The recruitment process is controlled centrally at the Rushcliffe head office. There were a number of concerns discussed with the manager and an immediate requirement was issued. Staff files showed us that all staff started working in the home before the receipt of the outcome of checking the Protection of Vulnerable Adults (PoVA) register or the outcome of a Criminal Records Bureau (CRB) disclosure. For example the start date for one member of staff was stated as September 2008, the outcome of the PoVA was received in October 2008 and the CRB disclosure November 2008. For a second member of staff of staff the outcome of the CRB disclosure was not available in their file. A copy of this was sent to us the following day. In two cases staff started working in the home before PoVA and CRB declarations were requested. All files only contained one reference. There was no information on file to show details of the interview process, for example questions asked. This would help to demonstrate equality in the recruitment process. The letter offering a person a job with the home states that the job is dependent up on receipt of satisfactory references, POVA First and CRB disclosure notice. Job descriptions were not up to date the Nurses job role refers to the UKCC instead of the NMC, which is the current professional body for Nurses. The support workers job Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: description states that they should be Responsive to standards as identified in NCSC guidelines. Both the UKCC and NCSC have been non-operational for some years. Staff training records show that 48 percent of care staff have completed a National Vocational Qualification (NVQ) in care. A further four staff are in the process of completing the qualification. The home will then have 62 percent of care staff with a qualification in care. Staff are required to do the preparation and cooking of meals alongside people living in the home. Information in the AQAA and training records tells us that there are only 55 percent of the staff with a Food Hygiene certificate. This does not ensure that sufficient staff have the training needed to undertake the work they are required to do in the kitchen safely to support the prevention of cross infection and contamination. Care Homes for Adults (18-65 years) Page 26 of 33 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. Standards 37, 38, 39 and 42 were assessed The home is managed by a competent person, however management and administration practises related to the recruitment of staff is not carried out in a way that promotes the safety and best interests of people living in the home. Evidence: The home is now under new ownership and a new manager is in place. The new manager is a Registered Nurse (Mental Health). The manager has experience of managing a mental health unit and is demonstrating that he is highly motivated and is receptive to suggestions to further develop practice and the management of the home. The manager is undertaking the NVQ in leadership. He has seven years experience in the mental health field including the community, acute and forensic work and has kept up to date with issues related to mental health through training. The managers hours are supernumerary, this is good practice and allows the manager time to monitor and audit the services provided by the home. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: There are clear lines of management accountability and residents are aware of the responsibilities of each member of staff. Residents talked about staff in the home and told us that they are approachable. Residents expressed their concerns about the new organisation. One concern relates to a decline in personal financial support. Their example was that the usual allocation of money for Christmas (100 pounds) and birthdays was going to be stopped. Residents had also noted that the home was now slow in getting things done. Through the course of the inspection and during discussion, staff and the manager were able to demonstrate that they have good knowledge of the residents and services offered. Residents are involved in the running of the home through meetings, general conversations, forums and during the care planning process. This gives people the opportunity to discuss and suggest what improvements could be made in the home to provide better outcomes for themselves and other residents. The AQAA told us that annual quality questionnaires are given to all residents to complete. These allow people living in the home to make known their views about life in the home. Plans are also to provide suggestion boxes for residents to share their views more regularly. Staff records to show supervision carried out with staff are not always detailed to demonstrate the discussions that take place, the outcome and action to take place. A comment from a member of staff said that Supervision is not regular enough. All records seen as part of this inspection visit relating to health and safety and safe practices include fire equipment checks these were up to date and fire alarms had been tested and checked. PAT testing on electrical equipment used in the home was up to date. Staff have received up to date training in Fire Safety, Basic Food Hygiene, Moving and Handling and Infection Control. The fire exit situated in the office adjacent to the office was blocked, obstructing the escape route for both the office and the laundry. These items were removed at the time of the inspection. Concerns are discussed in the Staffing section of this report about the poor recruitment procedures carried out by the organisation, which could leave residents exposed to the risk of harm. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 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 23 13 Sufficient and suitable information must be gathered when recruiting staff to work in the home. This will make sure that all staff are suitable to work with vulnerable people and provide accurate information if needed for reporting unsuitable staff to the PoVA register. 31/03/2009 2 33 18 Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. To include: Two written references, including where applicable, a reference relating to the persons last period of employment, which involved work with vulnerable adults. The outcome of checking the Protection of Vulnerable Adults register (PoVA) 31/03/2009 Care Homes for Adults (18-65 years) Page 30 of 33 The outcome of a Criminal Record Bureau (CRB) disclosure. This will ensure that the homes staff recruitment practices safeguard people living in the home. 3 42 13 The home must comply with fire prevention procedures at all times. This will maintain the safety of people who live and work in the home. 4 43 18 There must be robust systems in place to ensure the effective recruitment and selection of staff. This will help to ensure that people living in the home are not exposed to the risk of harm. 31/03/2009 31/03/2009 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 2 Written information which shows the progression and outcome of the admission assessment process should be available. This will help to confirm that the person has been placed safely in a home that will meet their needs. Written daily statements should be dated, timed and signed to provide a robust audit trail of the care received and daily life of residents. The maintenance programme should include plans for the ongoing re-decoration of the home. This will help to make sure that people live in a comfortable and well presented environment. The laundry room should be kept clean at all times; this Page 31 of 33 2 6 3 24 4 30 Care Homes for Adults (18-65 years) includes cleaning the air vents so they are not blocked. This will help to prevent the risk of cross infection in the laundry area. 5 33 Staffing levels should be reviewed to make sure that sufficient numbers are on duty at all times. This will help to ensure that residents care needs can be met safely at all times. Monitoring of the number of hours worked by staff on long shift patterns must be carried out to ensure that staff are fit and safe to work. Documents related to the employment of staff should be reviewed to make sure they are up to date and provide accurate information. The number of a staff with an appropriate Food Hygiene based on the kitchen duties they have to carry out in the home should be reviewed to make sure they are suitably trained. This will make sure that staff know the requirements related to preparing and cooking food. Staff supervision records should include more details to show what took place at the meeting, the discussions that took place and details of the outcome and action agreed. An application should be made to us requesting the registration of the home manager. This will support the running of the home in a way that supports and benefits people living in the home. The new owners should meet with the residents to discuss their plans for the home. This will help them to allay their fears and clear up any concerns they may have. Fire exits should not be obstructed at any time, to ensure the safety of people living and working in the home. 6 33 7 34 8 35 9 36 10 37 11 38 12 42 Care Homes for Adults (18-65 years) Page 32 of 33 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. 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