Inspection on 09/02/09 for Holmwood

This inspection was carried out on 9th 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmwood 13/02/08

Holmwood 25/01/07

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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: Holmwood 11 Harvey Lane Norwich Norfolk NR7 0BW     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: Jane Craig     Date: 0 9 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 31 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Holmwood 11 Harvey Lane Norwich Norfolk NR7 0BW 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) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Holmwood is a care home registered to accommodate a maximum of 32 people. Of these places 26 are for people who fall within the category of Mental Disorder, with 4 places offered to people who have a learning disability. The premises occupy a sloped site in a residential eastern area of Norwich. There is a small parade of shops, pubs and access to the riverbank all within walking distance. There is a bus service into Norwich that passes close by. The main house is a former period residence, with accommodation for 24 people on 3 floors. A purpose built annex, known as the Lodge, was added some years ago and offers 6 en suite single rooms with an adjoining kitchenette, lounge and bathroom. There are two lounges in the main house along with a dining room. There is a small terrace with a seating area. The main house is approached by a sloped driveway leading to a small car park to the side of it. Information about the home, including the last inspection report, is available from the Care Homes for Adults (18-65 years) Page 4 of 31 info@careholm.co.uk Baytree Community Care (London) Limited care home 32 Over 65 0 28 4 28 Brief description of the care home manager. At 9th February 2009 the weekly fees ranged from 235 pounds to 400 pounds. There were extra charges for hairdressing, newspapers, chiropody and toiletries. People were also charged for transport to health care appointments. Care Homes for Adults (18-65 years) Page 5 of 31 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 last key inspection on this service was completed on 13th February 2008. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 9th February 2009 by one regulatory inspector. At the time of the visit there were 24 people living at the home. A number of the people using the service were over 65 years of age and when assessing the service we looked at how well they met the national minimum standards for older people as well as those for younger adults. We met with some of the people living at the home and asked about their views of Holmwood. We spent time observing daily routines in the Care Homes for Adults (18-65 years) Page 6 of 31 home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection surveys were sent out to people living and working at Holmwood. Ten people using the service, two family carers and two members of staff returned surveys. Their responses have been taken into account when making judgements about the service. We talked to the registered manager and staff. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: What has improved since the last inspection? What they could do better: People were not routinely given opportunities to be involved in drawing up their care plan, this meant that they might not be able to make decisions about what support they wanted. Not all the care plans were thorough enough to make sure that staff had all the information they needed to support people in the way they preferred. Potential risks associated with people carrying out tasks independently must be assessed. The plans to reduce the risk must be clear enough to make sure that all staff are aware of any assistance the person needs. Care Homes for Adults (18-65 years) Page 8 of 31 Some urgent maintenance was needed to make all areas of the home comfortable for people living there. Some areas of the home were dirty and the decoration and furnishings in some of the bedrooms were worn and shabby. The owner or manager must draw up a plan to show when redecoration and renewal is to be carried out. Staff did not always have enough time to help people who were not able to go out or occupy themselves. There were some limited activities but not enough to meet the needs of the people living at the home. In order to protect the people using the service, the manager must ensure that thorough background checks are carried out for all new staff before they start work at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process was thorough enough to ensure that people were only admitted to Holmwood if their needs could be met at the home. Evidence: Anyone thinking of moving into the home was given an information pack. This included a service users guide, which explained some of the services and facilities available at Holmwood. People who returned surveys indicated that they received enough information to help them to decide whether the service was right for them. Anyone referred to Holmwood had an assessment by health or social care professionals. The manager made an initial judgement as to whether the home would be suitable and then conducted a further assessment. He told us that this was to make sure that Holmwood could deal with the persons needs and deliver the necessary care. Information from all assessments was used to draw up an initial care plan. Care Homes for Adults (18-65 years) Page 11 of 31 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. The care planning process was not thorough enough to ensure that people were involved in setting their own goals or that staff had sufficient information to support people in the way they preferred. Most people were supported to maximise their independence by making decisions but risk was not always managed effectively. Evidence: The manager told us that he had tried out several different care plan formats since the last inspection. They were in the process of trying out another system in an effort to find a format that staff could work with on a day to day basis. Only one of the people we case tracked had new care plans. These plans provided more information about the needs of the person and the goals they were working towards. However, the directions were still not detailed enough to ensure that all staff provided a consistent level of care. For example, there were still references to the person needing encouragement with personal care, rather than detailing how they Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: wished to be supported. None of the care files we saw included evidence that the people using the service had been involved in planning or reviewing their care. Consulting with people could help to improve the care plans and make them more individualised. All the plans we saw had a section to address needs associated with the persons culture and religion. The plans specified whether or not the person practised their individual religion. However, there was nothing to show that staff assessed whether the person had specific needs associated with their culture. Despite a recommendation at the last inspection the staff did not keep daily progress notes. The manager stated that staff would keep a record of any important occurrences or activities and this was confirmed by the notes we saw. However, the lack of regular notes meant that there was no record of the care that staff had provided on a day to day basis and no records to assist in evaluating care plans. Care plans were reviewed on an ad hoc basis. Some of those we saw had been reviewed every month but there were no notes to show whether the plan had been effective in helping the person progress towards their goals. Everyone had a monthly assessment that scored how dependent they were on staff to carry out their activities of living. The manager said that care plans were reviewed and amended if the persons score altered. This was confirmed by one of the care plans we saw, which had been rewritten to reflect a change in the persons dependence. However, the lack of regular reviews could result in minor changes in care needs not being addressed. Despite the shortfalls in care plans, the people we spoke to said they received the help they needed. One person told us, I do most things myself and staff help me if I ask them. Another said, If you ask staff to do something for you they do it without question. A family carer wrote that the care of their relative was excellent. Some people had risk assessments on their files. These gave an indication of the level of risk attached to a particular activity, for example, bathing or going out alone. However, it was not clear how the level of risk had been calculated or what factors had been taken into consideration when judging that someone was low, medium or high risk. There were action plans to reduce the risk but these were too brief and in some cases lacked clarity. For example, the risk management plan to enable one person to bathe independently contradicted his care plan, which said that he needed staff to assist. This could give rise to misunderstandings. Similarly, staff we spoke to had different opinions about how far the person could safely go out on their own. The action plan was not clear enough to ensure that staff were consistent in their support. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: There was a lack of information on care plans about peoples strengths and abilities to make decisions. Despite this it was evident from observation of care practices and discussions with residents and staff, that people were supported to make choices and decisions in their daily lives. People who returned surveys all indicated that they made decisions about what they did every day. One person we spoke with said, There are no rules and regulations, we can do what we want to. The annual quality assurance assessment (AQQA) indicated that the manager was planning to establish a residents committee to have some input into the running of the home. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines and meals suited the majority of people living at the home but not everyones social and recreational needs were met. Evidence: Many of the people living at Holmwood were able to organise their own time. Those who were able to went out alone and pursued their own activities. One person said that he usually went into the city every day. Staff had assisted people to find day centres and educational classes. A few people did voluntary work. One person said, When I came in here I couldnt write my name and now I can write a story. Another person who had been out said he had been busy enjoying himself. A small number of people were not able to occupy themselves. The member of staff who took the lead in organising activities had been off for a few weeks. With the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: exception of a fortnightly music therapy session and weekly bingo games there were no pre-planned activities. Staff did not have sufficient time to spend on one to one activities with people. For example, one of the care files we saw included a plan for assisting the person to socialise. The plan indicated what the persons interests were and directed staff to encourage them to participate in group and one to one activities. There was little evidence that the one to one activities took place. There was information regarding visiting in the service users guide. Family members who returned surveys indicated that their relative was supported to keep in touch with them. People using the service said they were satisfied with the visiting arrangements. One said, we can have visitors at any time but we only have to say we dont want to see someone and they wouldnt let them in. Independent living skills were being encouraged. Along with their key workers, people were taking responsibility for tidying their own rooms. One person said they did the light work and staff did the rest. People who were hoping to move into their own accommodation when they left Holmwood also had opportunities to practise their cooking skills. One person said he had been watched making a snack so that staff knew he would be safe when he was on his own. There were some good examples of staff putting core values, such as promoting privacy and dignity, into practice. There were locks on bedroom doors and everyone held their own keys. Staff did not enter rooms without permission. However, there were some poor practices. For example, neither of the shared rooms had privacy screens. Staff had not kept this under review even when one of the people sharing had started to use a commode in the room. The service did not employ a designated cook and all meals were prepared by care staff. There were no set menus and staff said that they made a decision about what to cook based on what meat was in the freezer. We discussed that this lack of forward planning could increase the possibility of repetition and the records of meals served showed that at least two meals were served almost every week. The manager told us that there had been some changes to the supper time choices following a discussion at a residents meeting. The people we asked all said they liked the meals. One told us, The food is a lot better than it used to be, we get a choice. Care Homes for Adults (18-65 years) Page 16 of 31 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. Staff did not have sufficient direction to fully meet the health and personal care needs of people using the service. Improvements in medicines management meant that people received their medication as it was prescribed. Evidence: Everyone had a care plan to address their personal hygiene needs but they did not specify what peoples preferred routines were. The plan for one person, who had significant hygiene needs, stated that staff should prompt them to bathe or shower regularly. The report notes indicated that this person had only had a bath three times in four weeks. The notes did not show whether this was because the person had chosen not to bathe or whether staff had not provided the prompts. A shower room had recently been installed in the home. One person using the service told us that it had made a big difference to their life because they hadnt been able to have a bath for a long time. There were care plans in respect of physical and mental health care needs. However, these focused on the medical care that was to be provided and contained little Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: direction for staff on how to support the person on a day to day basis. For example, the plan to support one person during a relapse in their mental health indicated that staff should arrange appointments and encourage the person to take their medication but there were no therapeutic interventions for staff to follow. There were insufficient directions for staff with regard to supporting people with ongoing physical health care needs such as diabetes and epilepsy, including how to support them during an emergency. People were referred to health care professionals when necessary. There were records of consultations with GPs, district nurses, physiotherapists, occupational therapists and other members of the community health care team. There had been significant improvements in the way medicines were managed in the home. At the time of the visit no-one managed their own medication, consent forms were in place to show that residents agreed to this practice. We were told that all staff with responsibility for handling medication had received training. Medicines were stored securely and at the recommended temperatures. There were safe systems for ordering medication. Records of medicines received and disposed of were complete and up to date, which helped with stock control and also provided part of the audit trail. There were no unexplained gaps on medication administration record (MAR) charts, which indicated that people received their medicine as it was prescribed. Medication left over from the previous month was recorded. We checked a small sample of MAR charts and found that the amount of tablets left in stock agreed with the records. A number of people had medication that was prescribed when required. Each person had a care plan to guide staff as to when they should give the medicine. We discussed how this could be further developed to ensure that staff had more specific instructions to prevent people being over or under medicated. Variable doses were recorded which helped staff to evaluate the effects of the medicines. There were some handwritten entries on MAR charts. Special instructions were recorded but the entries were not witnessed, which could increase the risk of transcribing errors. Controlled drugs were stored, recorded and administered safely and in accordance with the policy. Care Homes for Adults (18-65 years) Page 18 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure ensured that formal complaints would be investigated and acted upon. Training was in place to ensure that people using the service were protected from abuse. Evidence: There was a complaints procedure on display in the home and anyone thinking of moving into the home received a copy in their information pack. The procedure explained who to speak to and indicated when the person could expect a response to their complaint. The contact details for the Commission were out of date. People who returned surveys said they would speak to the manager or staff if they were not happy about something and they all knew how to make a complaint. Staff who completed surveys indicated that they knew how to respond if someone raised concerns about their care. Complaint records showed that the service had not received any complaints for over a year. Two people had raised concerns directly to the Commission during this period. Their concerns were centred around standards of care, care records, lack of social stimulation and the environment. We looked at all these issues during the course of this key inspection and where we found shortfalls we made requirements or recommendations for improvements. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Staff received training in safeguarding during their induction and the manager said that most had received refresher training, which meant they should be aware of current procedures. The local social services policy was available for reference and the service had its own procedure. This provided information about the definition of abuse but there was nothing about recognition and the directions for reporting were not completely clear. We discussed how the procedure could be improved upon. Staff we spoke to understood their role in reporting abuse to the manager and outside the home if necessary. The manager was clear about his role and had made one referral to the safeguarding team when a resident had accused a relative of financial abuse. We were told that none of the people living in the home at the time of the visit had a history of aggressive behaviour or were a risk to the safety of others. One person using the service told us that they felt wanted and safe living at Holmwood and said, no-one would hurt me, (the manager) and staff wouldnt let them. Care Homes for Adults (18-65 years) Page 20 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was not in a good state of repair and did not provide a comfortable and clean environment. There were some practices that may increase the spread of infection and create risks for people using the service. Evidence: Minor repairs and replacements were carried out by the maintenance staff in the home. There was also evidence that other maintenance work had been carried out since the last inspection and the manager told us that there had been major expenditure on the building and new appliances. For example, repairs to make the chimneys safe, a ramp outside the front door, a new shower room and new laundry and kitchen equipment. There were building repairs being carried out at the time of the visit, which were to make the environment safer. However, there were still a number of areas in urgent need of attention. For example, one of the bedrooms had a hole in the ceiling which had created water damage. Although the manager told us the leak had been repaired, the ceiling was still in need of repair and redecorating. A radiator was broken in one of the shared rooms. A small portable heater was on but it may not be adequate for the size of the room, which felt cold on entering. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The communal rooms in the main part of the home were decorated and furnished to an adequate standard. The furnishings in the part of the home referred to as The Lodge were stained and worn. The manager said that the owner had ordered new furniture for this area but did not know when this was expected. Some of the bedrooms we saw were decorated and furnished to a good standard. However, other bedrooms had worn and heavily stained carpets, divan bed bases that were stained and torn and mismatched furniture that was chipped. Although the manager said that there was a plan to continue refurbishment throughout the home, there was no development plan to show what work had been prioritised and there were no timescales for routine redecoration and renewal of furnishings. A part time cleaner had been employed since the last inspection but this may not be sufficient for the size and layout of the building. Although the residents who completed surveys indicated that the home was fresh and clean, this was not the case on the day of the visit. For example, several chairs needed cleaning, a number of bedrooms and corridors had dirty and stained paintwork. The walls, flooring and paintwork in one of the toilets and bathrooms we saw were dirty. The rehabilitation kitchen in The Lodge was dirty and the fridge which stored a residents food was in urgent need of defrosting and cleaning. Some of the blankets on the beds were in need of washing. Since receiving infection control training the manager had put some new procedures in place. Liquid soap and disposable towels were in hand washing areas and separate aprons had been purchased for staff working in the kitchen. However, there were still some practices that could increase the risk of the spread of infection. For example, a mop and bucket designated for use in toilet areas was in the residents kitchen. Care Homes for Adults (18-65 years) Page 22 of 31 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. Low staffing numbers and unsafe recruitment practices may compromise the care and safety of people using the service. Evidence: Since the last inspection there had been some changes in the staff team. The manager had employed part time domestic staff and the deputy manager had some dedicated time to assist with management duties. There were mixed views about staffing levels. Some staff said that as long as there was no sickness or absence there were enough staff. Others said that some shifts were always short. Most of the residents who completed surveys indicated that staff were available when they needed them. On the day of the visit two residents talked about staff being too busy. One said, They should have one or two more staff, some are working 7.30 in the morning until 10.30 at night and it is not fair on them. We looked at the duty rosters for December to February. These showed that for most of the time the home was staffed to minimum levels. This comprised three care staff during the day and two in the evening and at night. Care staff were responsible for cooking all meals, which meant that one person was taken away from caring duties for a large part of each day. Care staff also did the laundry and on the days that there Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: were no domestic staff they were responsible for cleaning. On most days over the past three weekends there had only been two staff on duty during the day and night. This meant that for the majority of the day there would only be one member of staff providing care because the other one was cooking, cleaning and doing laundry. These low numbers of staff may be a contributing factor in the failure of the service to meet a significant number of the national minimum standards. We looked at the files of two recently appointed staff. Neither contained all the information and documents that we require to evidence thorough recruitment procedures. One person had started work before their CRB check had been returned. This meant that the manager could not be sure that the member of staff had not committed any previous offences which would preclude them from working in a care home. Two out of three of their character references were not impartial. The lack of thorough pre-employment checks could put people using the service at risk. New staff had a first day induction that included an orientation to the home and emergency procedures. Following that, staff undertook a twelve week induction programme which met met the standards set by the national training organisation. The manager assessed them before signing them off as competent. One of the staff who returned a survey indicated that their induction covered everything they needed to know in order to undertake their role. The other one commented that they did not receive enough health and safety training but found it out later from other staff. Both staff who completed surveys indicated that they received relevant training. One commented that the service was good at providing training courses but the other wrote, Sometimes have to learn on my own because not all the right training is given. The training records were not up to date and it was not clear whether all staff had received recent training in the safe working practice topics. Following a requirement at the last inspection, the manager had arranged for most staff to receive training in mental health awareness to assist them to understand the needs of people using the service. One member of staff said this had been useful and she had learnt new things. We discussed with the manager how the increased understanding of mental health needs could be reflected in the care plans and, therefore, transferred into practice. The annual quality assurance assessment (AQAA) told us that over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. Care Homes for Adults (18-65 years) Page 24 of 31 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. Although improving, the management and administration systems were not effective enough to ensure that the home was always run in the best interests of the people living there. Evidence: Since the last key inspection the manager had registered with the Commission. He had the appropriate qualifications and experience to take on the role. The manager discussed some of the improvements in all areas of the service since he commenced in his role but acknowledged that there are still more improvements needed to bring the service up to a good standard. Staff who returned surveys indicated that they often met with the manager for support and to discuss their work. One member of staff we spoke to said she found it useful to be able to have the opportunity to talk. The records of supervision showed that staff were supported to discuss their practice and identify any further training they may need. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: People using the service had some opportunities to make their views known and to suggest ideas for improvement of the service. The results of the survey carried out in 2008 showed that residents, relatives and health professionals were satisfied with most aspects of the service. The survey was due to be repeated in January this year but so far the questionnaires had not been sent out. People using the service could also attend regular residents meetings. The notes of these showed that residents were consulted about staff changes, activities and changes to the environment. The manager said that the owner carried out an unannounced visit every month to check on different aspects of the service and to provide support to the manager but there were no reports of these visits available at the time of the inspection. All staff had received fire safety training. The fire alarms were tested regularly and other fire safety equipment had been serviced. The AQAA told us that maintenance and servicing of some of the equipment in the home had not been done. We found that the portable appliance testing was out of date, which meant that people were using electrical items that could be potentially unsafe. There were certificates to show that servicing of other installations had been carried out. Care Homes for Adults (18-65 years) Page 26 of 31 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 33 18 (1) (a) Staffing levels and arrangements must be reviewed to ensure that these are adequate to meet the assessed needs of the service users. Staffing levels must be adequate to allow rehabilitation of all service users. 13/03/2008 Care Homes for Adults (18-65 years) Page 27 of 31 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 6 15 People using the service must be provided with opportunities to be involved in drawing up and reviewing their care plans. Plans must include sufficient detail for staff to provide individual care and must be reviewed on a regular basis. In order to promote the health and welfare of people using the service. 31/03/2009 2 9 13 Risk assessments and risk management strategies must be clear and relevant. To support people using the service to be more independent and to ensure their safety. 31/03/2009 3 16 12 Privacy screens must be 28/02/2009 made available in shared rooms and there must be privacy locks on toilet doors. Care Homes for Adults (18-65 years) Page 28 of 31 In order to promote the privacy and dignity of people using the service. 4 19 15 Care plans must contain sufficient directions with regard to health and personal care In order to ensure that staff are able to understand and meet the needs of people using the service 5 24 23 The registered person must 31/03/2009 conduct an audit of all areas of the home and draw up an action plan for repairs, redecoration and renewal. The action plan must include realistic timescales. To ensure that all areas are safe and in a good state of repair and the decor and furnishings in all areas of the home are brought up to a satisfactory standard. 6 30 23 All areas of the home must be kept clean and hygienic. To ensure the comfort and safety of people using the service. 7 33 18 There must be sufficient staff on duty at all times to meet the needs of the people using the service. To promote their health, safety and welfare. 8 34 18 All pre-employment checks 28/02/2009 must be carried out and new staff must not start working Page 29 of 31 28/02/2009 28/02/2009 28/02/2009 Care Homes for Adults (18-65 years) at the home until they have a satisfactory POVA first or CRB check. To safeguard people using the service. 9 42 13 Portable electrical appliances 28/02/2009 must be tested annually or in accordance with the advice of a registered electrician. In order to protect the health and safety of people living and working in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 In order to keep a record of care provided and to be able to evaluate care plans effectively, progress notes should be written every day. People who are not able to occupy their own time in a meaningful way should have support from staff. Activities should be recorded. The complaints procedure should be revised to include up to date contact details for the Commission and other agencies that people may wish to contact for advice. The safeguarding procedure should be revised to include clear procedures for reporting poor and abusive practice. The staff training records should be brought up to date and any shortfalls should be rectified. 2 12 3 22 4 5 23 35 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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). 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