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Inspection on 30/06/09 for ICS 11&12 Wembrook Close

Also see our care home review for ICS 11&12 Wembrook Close for more information

This inspection was carried out on 30th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People have access to a range of healthcare professionals to ensure that all their healthcare needs are met. People are offered activities during the day that are appropriate and take into account interests and hobbies. The home has an open visiting policy so that people can see their visitors as they choose and can continue to maintain relationships that are important to them. People live in a homely and comfortable environment. People can personalise their own rooms to reflect preferences and tastes.

What has improved since the last inspection?

There were no improvements identified at this inspection, but there was significant evidence to demonstrate that the service has deteriorated since the last key inspection on 30 November 2006.

What the care home could do better:

Care plans for people who live at the home must be kept up to date to accurately reflect their changing needs. They must include up to date information and guidance for staff so they know what they must do to meet peoples` needs. Risk assessment processes must be more robust to enable people to take meaningful risks within a safe framework. Medication procedures and management must be reviewed to ensure that people are not put at risk of harm by dangerous practices. People must be provided with an accessible means of raising concerns and complaints about the service they receive. Staff must not start working in the home until two satisfactory references are in place and the outcome of a Criminal Records Bureau and/or Protection of Vulnerable Adults check has been received, which helps to confirm that the person is fit to work with vulnerable people. Staff training on safeguarding adults, moving and handling, fire safety, first aid, food hygiene, health and safety and medication awareness must be kept up to date. This is to make sure that staff know how to provide safe care, in line with up to date best practice, for people who live at the home. Improvements must be made to the management systems at the home to make sure that the care needs of the people living there are met in the way they would prefer. Regular staff training, supervision and support must be in place so that staff have the necessary skills and guidance to provide appropriate and safe care for the people who live there.People living in the home should be consulted in a meaningful way about anything that will impact on the service they receive.

Key inspection report Care homes for adults (18-65 years) Name: Address: ICS 8 & 12 Wembrook Close 8 & 12 Wembrook Close Attleborough Nuneaton Warwickshire CV11 4LJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Justine Poulton     Date: 0 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 38 Information about the care home Name of care home: Address: ICS 8 & 12 Wembrook Close 8 & 12 Wembrook Close Attleborough Nuneaton Warwickshire CV11 4LJ 02476327797 01527546888 allan.smith@individual-care.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Individual Care Services Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Date of last inspection Brief description of the care home 8 and 12 Wembrook Close accommodates up to three and two residents respectively, in the category learning disability. The houses are situated opposite each other in a small close. There is one staff group and one manager. One of the homes is a detached bungalow whilst the other is a detached house. They are in a quiet residential area on the outskirts of the town of Nuneaton. The accommodation in each is similar comprising of a shared lounge, kitchen and bathroom. 12 Wembrook Close has two Care Homes for Adults (18-65 years) Page 4 of 38 Over 65 0 5 Brief description of the care home bedrooms on the ground floor. 8 Wembrook Close has two bedrooms on the ground floor and has a further two bedrooms on the first floor, one of which is used as the office/sleep-in staff room. Information relating to the fees charged for the service provided at this home was not made available to us. The reader may wish to contact the the home directly for this information. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 Star. This means that people who use the service experience poor outcomes. Two inspectors visited the home unannounced. A pharmacist inspector also inspected medicines management in the home. This inspection took place over two days and included talking to the staff and the acting manager about their work and the training they have completed. The inspection focused on assessing the national minimum 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, allegations and incidents and complaints. We also considered information contained in the services annual quality assurance assessment (AQAA) completed by the homes previous manager on 27 October 2008. We had a number of surveys available to us which were also completed for the homes Annual Care Homes for Adults (18-65 years) Page 6 of 38 Service Review in May 2009. We were told during the inspection that staff did not feel able to complete our surveys honestly as they were instructed to return them to the homes previous manager, and were not provided with prepaid envelopes in order to ensure confidentiality. The previous key inspection visit to this service was undertaken on 30 November 2006. The inspection included meeting the five people currently resident in the service and case tracking the needs of two people. This involves looking at peoples care plans and health records and checking how their needs are met in practice. Other peoples files were also looked at, in part. Care Homes for Adults (18-65 years) Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: Care plans for people who live at the home must be kept up to date to accurately reflect their changing needs. They must include up to date information and guidance for staff so they know what they must do to meet peoples needs. Risk assessment processes must be more robust to enable people to take meaningful risks within a safe framework. Medication procedures and management must be reviewed to ensure that people are not put at risk of harm by dangerous practices. People must be provided with an accessible means of raising concerns and complaints about the service they receive. Staff must not start working in the home until two satisfactory references are in place and the outcome of a Criminal Records Bureau and/or Protection of Vulnerable Adults check has been received, which helps to confirm that the person is fit to work with vulnerable people. Staff training on safeguarding adults, moving and handling, fire safety, first aid, food hygiene, health and safety and medication awareness must be kept up to date. This is to make sure that staff know how to provide safe care, in line with up to date best practice, for people who live at the home. Improvements must be made to the management systems at the home to make sure that the care needs of the people living there are met in the way they would prefer. Regular staff training, supervision and support must be in place so that staff have the necessary skills and guidance to provide appropriate and safe care for the people who live there. Care Homes for Adults (18-65 years) Page 8 of 38 People living in the home should be consulted in a meaningful way about anything that will impact on the service they receive. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 38 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 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Basic information about the home is available to people who may potentially wish to use the service. Evidence: No new residents have moved into the home since the last inspection. A general statement of purpose and service user guide dated October 2008 were on display on the notice board in the kitchen of number 8. The acting manager said that personalised copies of the service user guide are in each persons support plan. These were not available in the two support plans that we case tracked. Neither was there one available in the plan looked at in part. No information regarding the fee levels of the service was available. Care Homes for Adults (18-65 years) Page 11 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home cannot be certain that their assessed needs will be met. People cannot be certain that the risk management strategies in place will support them in taking meaningful risks within a safe framework. Evidence: Two people were identified for case tracking purposes, which meant that their support plans and other pertinent information was looked at in detail. One other support plan was looked at in part. Both of the support plans looked at in detail had a standard layout and covered all of the areas relevant to the support needs of each individual. This included information about behaviour; diet, eating and drinking; education, work and daytime occupation; health; leisure and self care. Although each section contained a lot of information, they lacked the basic detail of how to support someone. For example one sentence regarding communication in one plan read as ...will require staff to empower her to communicate effectively while out in the wider community and in some situations may Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: need staff to advocate for her. There was no detail as to how to support the person with this in line with their individual needs. Information recorded within the homes AQAA states that;Care plans are updated with the resident every six months or more frequently if required. Evidence available within the two files looked at did not fully support this statement. The review dates recorded within one support plan were 22/08/2008 complete review and rewrite and 21/01/2009 review and update. In the second plan looked at there was a review sheet at the front, signed by the registered manager on 2/6/08 and 18/12/08. There was no evidence to indicate how this support plan had been reviewed. It was noted throughout the inspection that people were being encouraged to make decisions for themselves. This included things such as what to have for breakfast, whether to get up or go back to bed for a lie in, and what show to go and see at the local civic hall. Most staff were seen to assist people with making decisions in a sensitive manner to ensure that they didnt take the decision making process away from people. Each individual care plan within the support plans looked at contained a risk assessment. These detailed any risks linked to the care plan but were not robust enough to ensure that people could take meaningful risks within a safe framework. Care Homes for Adults (18-65 years) Page 13 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are offered a variety of age, peer and culturally appropriate activities that make best use of in house and community facilities. Peoples relationships with families and friends are promoted. People can be sure that a healthy, nutritious diet is now being provided. Evidence: The organisation has recently commenced a day service provision in Hartshill. We were told that some of the people living in the home attend this on an occasional basis. There was no evidence within the two support plans looked at of people going to formal day services, instead, activities are offered by the staff team based on what they know people enjoy doing. There was a daily activities sheet on the board which was dated January 2008. We asked if there had been any changes to this over the previous 18 months, and were told no. On the first day of the inspection two people had gone out to Weston Super Mare for a day trip, and another was taken out for Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: lunch to a local pub. Activities undertaken by people were recorded within their daily diaries, and included things like going out for meals, going to the cinema, going out to play bingo, going for a walk in the park, cooking, shopping and going to Hartshill. There was very little information recorded alongside these activities to confirm whether they had been enjoyed by people. As recorded later in this report, there is only one staff member on duty in each house from 4:00pm. This severely restricts the opportunity for spontaneous activities in the evenings. We read in the file for one person that they have a close relationship with a sibling. The previous manager had given staff directions to follow when this person visits their relative. It was recorded on the persons care notes that, ...they like to do jigsaws or quietly talk in the lounge. During this time staff must ask all other residents to leave the room and afford X and W an appropriate degree of privacy. The acting manager agreed that people should not be asked to leave the lounge in their own home and that she will discuss this matter with all residents and staff. The organisation continues to consider the involvement of families and friends as important, and two people spoken with said that they enjoy regular contact with their relatives. Both houses have domestic kitchens with appropriate equipment and facilities in them. They were both well stocked with a variety of fresh, frozen and processed foods. Individual menu sheets were available within a file in the kitchen. Staff confirmed that these were a record of what people had eaten. There was no evidence of any choice being offered. Staff said that they tell people what is available and they choose what they want from that. The acting manager said that she was concerned about the diet provided for people living in both houses, as there appeared to be very little consideration given to healthy eating. She said that she has spoken to everyone that lives in the home and obtained a list of their favourite foods, from which she has compiled a menu that offers two choices per meal and also incorporates the recommended five a day fruit and vegetable intake. She also said that she has purchased serving dishes for each home so that meals can be presented in an attractive and appropriate manner to encourage people to make healthy choices from what they can see on the table at meal times. For part of the inspection we sat at the dining table chatting with two people who were having their breakfast. They were offered a choice of cereals from the selection on display or something hot. One person chose rice crispies and the other requested two boiled eggs. We were told this is what she chooses every morning. This person was offered cereal or porridge as an alternative which she declined. It was pleasing to see Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: that her breakfast and drink were served in her own mug and egg cup. It was also pleasing to see that there was a fruit bowl full of fruit available for people to help themselves to in the kitchen of number 12. Care Homes for Adults (18-65 years) Page 16 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that they will receive the care or medication they need. Neither can they be sure that they will have their healthcare needs monitored. Evidence: We talked to staff and people living in the home and looked at care plans and medication records. Care plans relating to personal care and support needs were available within the two support plans looked at. These did not contain basic detail about how to support each person with their assessed needs in this area. There is little information within the AQAA regarding the provision of personal care and support. It is recorded within the AQAA that All residents are assisted to register with a local G.P., dentist, optician, and other specialist services as required. Records of visits are recorded within the home and used to track the medical history of the resident. The only records available to us regarding the healthcare of individuals were all stored within the blue file in the kitchen and commenced around March/April of this year. The acting manager said that all records prior to that should be archived into peoples Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: support plans. We could not find any of these within the two plans that we looked at in detail. Each person has a Health Action Plan compiled by the community nurses. One of these looked at as part of the case tracking process was completed in 2005. There was no evidence to confirm that it had ever been reviewed or kept up to date. Care plans were not always in sufficient detail to enable staff to support people in a person centred way. For example, it said on the file of one person that they can show anxiety during all phases of personal care. There was no guidance available to staff on how they should reduce this anxiety if it occurred. The acting manager also told us of an incident where another resident became angry and upset that they had not been reminded that they normally go to their room at a certain time to do their charity work. The acting manager was unaware of this routine as it had not been recorded in the persons care notes. From the records available to us it was not possible to confirm that people have been supported with visiting routine healthcare professionals at the recommended intervals. In one file we looked at it was noted that there was an entry 24 May 2009 that said ...urine is smelling quite strong. Need to keep an eye on her toileting as she may have another water infection... There was no record of this person being taken to see the Doctor until 10 June 2009 , when records indicate that this person was diagnosed with a severe water infection. We also noted an entry in the communication book on 19 February 2009 referring to another person being prescribed a pessary to ease... thrush. There was no further record of this anywhere, it was not written onto the relevant MAR chart, and there was no indication of whether it was ever administered or by whom. A record had been made in June 2009 in the notes of another person that two of Xs toes on left foot seem red, also by toenail on same foot looks a bit black. Observe. There was no further entries to demonstrate if it had been investigated and what the outcome was. Information was available within one file looked at to confirm that there had been input from an occupational therapist with regards to providing a new hoist sling for one person. There was no information available regarding the correct use of the hoist, and on the morning of the first visit to the home one member of staff had been using it with the individual concerned on her own. We asked if she had received training in how to use it as it was a new piece of equipment and were told that she had had a quick explanation from another member of staff that morning. The acting manager Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: said that the occupational therapist had taken step by step photographs of how to use the hoist which were due to be provided to the home within the next couple of days. These would then be placed upon the individuals bedroom wall so that all staff could refer to them when undertaking hoisting tasks. These were not available to staff when we returned for the second visit a week later. Records of visits from the physiotherapist were available in one file looked at. A staff member said that the physiotherapist visits this person every Tuesday. It was noted that the record of physiotherapist visits on the sheet and in the persons individual diary did not always correlate. We asked if there was a programmes of exercises to be carried out for this person between physiotherapy visits and were told not that we know of. The file of another person indicated that the physiotherapist would monitor and observe them when visiting a different person in the home. There were no recordings in this persons files to demonstrate that this was being done. This could mean that this persons mobility could deteriorate if they were not being monitored by a healthcare professional. The pharmacist inspection took place at the same time as the main inspection. It lasted three hours. The medication of all the people who lived in both houses was looked at, together with their medicine administration record (MAR) charts. Only two care plans were available to assess at the time of the inspection. All the medication was safely locked away in dedicated medicine cabinets in the offices in each house and the support worker on duty had the keys to open them. The care plans were not kept on site for House 8 but kept over the road at House 12. We did not have access to all the care plans. Therefore the support worker would not have full access to them either and so not have information to be able to fully support their clinical needs. The medicine management was poor. Not all the quantities of medicines received or any balances from previous cycles had been carried over, so it was difficult to demonstrate whether the medicines had been administered as prescribed at all times. Where audits could be undertaken these showed that some medicines had been recorded as administered when they had not been. Doses had been changed with no supporting reason as to why. Some medicines were available to administer but there was no record of them on the most recent MAR chart, so it was not possible to ascertain whether they had been administered or not. Medicines were missing and could not be accounted for. Medicines had been administered but not recorded as Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: such. An example of retrospective signing was seen. A copy of one MAR chart was found in the kitchen. Staff had failed to record the administration of one medicine on one particular date. (a gap was seen) The original MAR chart was also seen and this showed that this gap had been completed after the actual transaction. This is of concern as staff are not recording exactly what they had administered immediately afterwards. The pharmacist who delivers the medicines to the home. orders all the prescriptions on a monthly basis and delivers the medicines to the home. As the support workers do not see the prescriptions before they are dispensed they do not check what has been prescribed adequately. This resulted in an unnecessary build up of quantity of medicines in the home. Medicines had been ordered and delivered for up to six months which were not required. No one was sure if the medicines had been ordered for this month in time to ensure a continuous supply to the people in the home. Two medicines were unlabelled. All medicines must be administered from a pharmacist dispensed container to ensure that the correct medicine is administered to the correct person. Secondary dispensing was also seen. Staff had put the contents of one pharmacist dispensed box into another. This is considered poor practice and increases the risk of error. Medicines dispensed to one person were administered to another, despite being the property of the person it was dispensed to only. The care plans were incomplete. They did not record all the clinical conditions for each person who lived in the home. Further information was not available, for example protocols detailing exactly when a medicine should be administered if it had been prescribed on a when required basis only. Concern was raised that one letter dated 9th June 2009 from the consultant detailing that a new medicine should be prescribed by the doctor to control behaviour had not been acted upon. The acting manager did not know of the existence of this letter and had not ordered the prescription. Neither had any support workers working in the home. One support worker spoken with had a very limited knowledge of what the clinical conditions of the people he cared for were or what each medicine was for. He said that all the information was kept in the other house, but these were not available. It was difficult to see how he could look after all the persons complex clinical needs without immediate access to important information. Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: The care assistant spoken with had not had any training in the safe handling of medicines. There was no quality assurance system undertaken by the management to assess staff competence in the administration and recording of medication. Limited feedback was left at the end of the inspection as the acting manager felt that this should be addressed to the office and was unwilling to listen to any constructive feedback to address the serious issues found. Care Homes for Adults (18-65 years) Page 21 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home cannot be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm, however staff are not trained in how to use them effectively. Evidence: The home has a written complaints procedure in place however it is of no use to the people living in the home as it is not in a format that is accessible to them. The AQAA states that Individual Care Services has an established complaints procedure. This has been compiled in both text and picture formats to enable accessibility for all. A copy of the written procedure was available in the two peoples files looked at. We showed the procedure to one person and asked if it meant anything to her, to which she replied no. We asked three people living in the home if they knew how to complain, and all three said they did and explained who they would speak to if they were unhappy about anything. We spoke with staff about the homes policy on safeguarding adults. Two recently recruited staff members told us they had not yet done any safeguarding training and were not aware of procedures to follow if they witnessed any abuse while they were shadowing experienced staff. They told us that they would be undertaking two days intensive training at the organisations head office which should include safeguarding adults training. Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: While looking through the care files of two people who live in the home we saw recordings relating to unexplained bruising. For example, we saw a record had been made in March 2009 in the incident book of ...small bruise on left hip, 2p piece with superficial cut about 5 mm long. three bruises on upper left arm, one on buttock. There was no evidence that this had been investigated and reported to the local safeguarding team as possible abuse. Neither was it reported to us under regulation 37 of the Care Homes Regulations 2001. The training plan seen in staff files confirmed that staff had not received recent training in the protection of vulnerable adults and this must be arranged as soon as practicable. As detailed later in this inspection report we could not access the recruitment records of recently employed staff members. This means that we could not be sure that all pre-employment checks had been undertaken to ensure these people were safe to work with vulnerable adults. People have their own cash tins to keep their personal allowance in and savings accounts. We were told by the acting manager that she did not have the keys and that key workers hold the keys to individual tins. We were unable to confirm that peoples financial interests were protected. Care Homes for Adults (18-65 years) Page 23 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at 8 and 12 Wembrook Close are provided with a clean and homely place to live, which is equipped to meet their individual needs. Evidence: The registration covers two properties in the same road, one of which is a large house whilst the other is a dormer bungalow. Both properties were clean, tidy and well ordered. Neither property has been decorated since the last inspection in 2006, and they were beginning to show signs of wear, however they both presented as homely and comfortable. The service has purchased a property next door to one of the houses. This is currently being renovated and when building work is complete three of the people will move into this house. It is unclear if they and their families have been consulted on this proposed move. Care Homes for Adults (18-65 years) Page 24 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that suitable staff are employed or that they have the knowledge or skills needed to meet their needs. Evidence: One staff team covers both of the homes that come under this registration. The staffing rota we saw during our visit showed that there are normally two to three staff on duty during the day until 4pm, and one staff on sleeping night duty in each house. However, as we saw records that one person now needs two staff to help them move with a hoist, the staffing levels may not be enough to ensure that this persons needs can be met at all times, as well as making sure that other people living in the home are able to take part in their chosen activities and lifestyle. During our visit we saw staff talking with and supporting the people who live at Wembrook Close with personal care. People were comfortable in the company of the staff and were seen communicating effectively with the majority of staff. During the second visit of this inspection we noted that one member of staff was talking to all of the people living in number 12 in a very loud voice. Only one person is recorded as having a hearing impairment for which she wears a hearing aid, so this manner of speaking to people was not appropriate. This was raised with the acting manager who undertook to talk to the staff team about how they speak to people. It was also noted Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: by us that this same member of staff spoke to another person in an inappropriate manner. Although the relationship between the two appeared good, the staff member teased the person by telling her the wrong day of the week when she asked. At the same time she winked at us and at no point did she correct the information provided. This same member of staff was also observed to talk to people as if they were children by correcting their manners and then saying good girl, thats better. This was all raised with the acting manager who said she would arrange a supervision session with the staff member concerned as a matter of urgency to address our concerns regarding these issues. Staff recruitment files were not on the premises on the first day of the inspection. We were told all files had been removed by the responsible individual to their head office in Redditch. On the second day we asked to look at the recruitment files for two recently recruited people. The acting manager told us that records for these two people were still at the organisations head office. She said that information regarding appropriate checks, such as Criminal Records Bureau checks and references, may be kept on computer but she was unable to find this information on the day. This meant the home could not show that sufficient checks had been carried out to avoid employing staff who may be unsuitable for work with the people living in the home. We looked at the personal files for four staff members who had been working in the home for some time. Three of these contained all the checks required by regulations to ensure people are safe to work with vulnerable people. One staff members file only contained one reference and it was unclear if this was from a former employer or from a family member. Training records and certificates in the files showed that staff had not received basic training, for example, in moving and handling, fire safety awareness or adult protection for some considerable time. One staff member said that we have had no training for a couple of years. The AQAA states that Service users benefit from a well trained staff team who receive mandatory and specialist training... Two recently recruited staff members told us they had not had any training, but would be attending the head office the following week for specific training. We were told by the acting manager that staff undertake intensive training over a number of days. There may be too many subjects covered at these training sessions as when we asked a member of staff if they had done safeguarding training, they replied, we did so much that day, I cant remember what I did. We spoke to two members of staff about fire safety arrangements. They were not clear on whether they are meant to evacuate people when they are lone working Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: during the day or at night. They were also not sure if night time drills or night scenarios exercises have been held. This means that the service may be putting people at risk by not ensuring staff are aware of clear fire safety arrangements. The AQAA states that the people that live in the home benefit from a staff team that receive regular supervisions. The files seen indicated that supervision of staff is not taking place on a regular basis. For example, on one of the files we looked at, supervision had last been completed in August 2008 and another persons records indicated supervision last took place in October 2008. Supervision can be an essential tool in staff development and to help protect residents by giving staff the opportunity to speak in private about their work. It would be positive if the frequency of sessions were set at six per year as detailed in the National Minimum Standards. We saw on one of the supervision records that a staff member had recorded that they wished to discuss a concern they had about peoples monies. It was recorded at a supervision session in February 2007 that the staff member had concerns about colleagues, on a couple of occasions using clients money for their own use which I am strongly opposed to, as is not their money to use. The supervision sheet was signed off by the then manager. We have been unable to find evidence that this was followed up and investigated as possible financial abuse of residents by staff. Care Homes for Adults (18-65 years) Page 27 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home cannot be sure that the home has been run with them in mind. The lack of an effective quality monitoring system in the home means that people are not listened to or consulted about how the home runs or develops. People cannot be sure that their health and safety is maintained. Evidence: The former registered manager of the home was not available for this inspection as he was on suspension without prejudice following allegations of abuse made against him under whistleblowing procedures. These allegations are currently the subject of the joint agency safeguarding process and investigation by the police. The registered manager or provider are required by law to provide us with notifications under regulation 37 of the Care Homes Regulations 2001, regarding any event in the care home which adversely affects the well-being or safety of any service user or any allegation of misconduct by the registered person or any person who works at the care home, amongst others. We have not been routinely provided with Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: this information in relation to incidents recorded within the home in relation to unexplained identified injuries to people or staff suspensions and dismissals. At the time of this inspection interim management arrangements had been put in place by the organisation. A registered manager from another home within the organisation has been seconded to work at Wembrook Close until a full time manager has been appointed. The AQAA used for this inspection states that copies of visits made to the home by the senior management team can be evidenced. A copy of the homes quality audit report is available at the home as evidence. We were unable to locate any evidence of a quality assurance process at the home. Similarly we were unable to find any copies of visits made to the home by the registered provider as required under regulation 26 of the Care Homes regulations 2001. The organisation has purchased property number 9, which is currently in the process of being altered and adapted in preparation for the current residents of number 12 to move into. There was no evidence of any consultation with the people living in number 12 regarding this having taken place. Information in the AQAA records that all of the routine health and safety monitoring and checks are in place and up to date. A sample of these which included the landlords gas certificate, the electrical installation certificate and fire alarm testing confirmed that these were up to date. The testing of portable appliances (PAT) was due imminently and this was brought to the attention of the acting manager. It was noted that all of the Control of Substances Hazardous to Health data sheets were out of date, with dates ranging from 2003 through to 2006, and need updating. Records showed that the emergency lighting in the home had not been tested since April 2009, however a test had been carried out by the acting manager in the week prior to the inspection visit. There was no record of when the hoist had been serviced within the home, even though the AQAA states that it was last serviced in October 2008. The acting manager said that she had arranged for this to take place over the next two days. As indicated in the staffing section of this report, staff training is not up to date on health and safety matters, including safeguarding adults, moving and handling, fire safety awareness, basic food hygiene and medication training. This means that staff may not be aware of up to date guidance on how to provide care safely for the people who live in the home. Care Homes for Adults (18-65 years) Page 29 of 38 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 30 of 38 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 Care plans must be enhanced to include the basic care needs of each individual and how they like to be supported with these. This will ensure that peoples assessed needs, wants and aspirations are being met in the most effective way. 30/09/2009 2 9 13 A more robust framework for assessing risk must be introduced. This will allow people to take meaningful risks within a safe framework. 30/09/2009 3 18 12 Details of support provided to people must be recorded. This will ensure that the service can be confident that peoples needs are being met in accordance with their agreed support plan. 30/09/2009 Care Homes for Adults (18-65 years) Page 31 of 38 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 4 19 12 Records to indicate that people are supported appropriately with their healthcare needs must be available. This will ensure that people are supported to maintain good health 30/09/2009 5 20 13 All prescribed medicines 11/09/2009 must be available for administration and must only be administered to the person they are prescribed for from a pharmacy labeled container. The practice of administering medicines prescribed to one person but dispensed to another must cease immediately. This is to ensure that the people are administered their prescribed medication only as the doctor intended. 6 20 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that 11/09/2009 Care Homes for Adults (18-65 years) Page 32 of 38 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 individual staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that they do not administer the medicines as prescribed. 7 20 13 The quantity of all medicines 11/09/2009 received and any balances carried over from previous cycles must be recorded. This is enable audits to take place to demonstrate the medicines are administered as prescribed 8 20 13 All medicines held on the premises must be recorded on the MAR chart if still prescribed. Any medicines that are no longer required must be returned to the pharmacy for destruction. This is to ensure that the records regarding what medicines have been prescribed are accurate. 9 20 13 A system must be installed 11/09/2009 to check the prescriptions prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. 11/09/2009 Care Homes for Adults (18-65 years) Page 33 of 38 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 This is to ensure that all medicines are administered as prescribed at all times 10 20 13 The medicine chart must 11/09/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of individuals medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right person at the right time and at the right dose as prescribed and records must reflect practice 11 23 13 All staff must be trained in the protection of vulnerable adults from abuse. This is to ensure that vulnerable people are effectively safeguarded at all times. 12 34 19 Recruitment records and 30/09/2009 checks must be open and available for inspection, and must include two references and Criminal Records Bureau disclosures (CRB) must be undertaken on all staff working in the home. 30/09/2009 Care Homes for Adults (18-65 years) Page 34 of 38 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 This will help to ensure that the person is fit to work in the home and people are protected from the risk of being harmed. 13 35 12 Staff must receive updated training on moving and handling. This is to make sure that they know how to move people safely without risk of injury to the person or themselves. 14 35 18 The home must have a staff training and development plan in place. This is to ensure that staff collectively receive the training necessary to meet peoples needs. 15 35 23 Staff must receive up to date fire safety training. This is to make sure that they know what to do to protect people who live in the home and themselves in the event of a fire. 16 39 24 An appropriate method of assessing the quality of the service provided to people must be implemented. This will ensure that people 30/09/2009 30/09/2009 30/09/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 35 of 38 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 living in the home and other key stakeholders will be at the forefront of service delivery. 17 41 12 Health and safety records and checks must be brought up to date. This will ensure people are safeguarded from risk of injury. 18 42 37 The home must ensure that all accidents and incidents, that affect the well being of people living in the home, are reported and where necessary referred to appropriate authorities. All staff must be trained to ensure that they know the procedure to follow for accidents and incidents that occur in the home. This will ensure that the health and well being of the people who live in the home is not compromised. 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 30/09/2009 31/08/2009 1 2 People should be provided with their own personalised copy Page 36 of 38 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations of the homes service user guide in a format that is meaningful to them. 2 13 Consideration should be given to increasing staffing in the evenings to enable people to participate in activities outside of the home during this time. It is advised that all medication policies are reviewed to reflect good practice and staff are trained to adhere to them It is recommended that staff that handle medicines are further training in the indications and side effects of the medication they handle, to enable them to support the clinical needs of the service users. It is recommended that the complaints procedure be made available to people living in the home in a format that is more meaningful to them. People should be able to access their personal monies at all times. Staff should receive formal supervision at least six times per year. This is to ensure that individual training and performance needs are being addressed and met. 3 20 4 20 5 22 6 7 23 36 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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