Inspection on 11/08/09 for Iona

This inspection was carried out on 11th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Iona 26/02/10

Iona 14/09/07

Iona 07/06/06

Iona 25/01/06

Iona 25/07/05

Iona 02/03/05

Iona 03/08/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Iona 104 Well Street Biddulph Stoke on Trent Staffordshire ST8 6EZ Lead Inspector Rachel Davis Key Unannounced Inspection 11th August 2009 10:00 Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 2 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 Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Iona Address 104 Well Street Biddulph Stoke on Trent Staffordshire ST8 6EZ 01782 523396 F/P 01260 289107 Iona@imladris.me.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Jill Stockdale-Fisher Provider in day to day control Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) 6 2. The maximum number of service users who can be accommodated is: 6 Date of last inspection 14th September 2007 Brief Description of the Service: Iona is a care home for adults providing personal care and accommodation for six people with a learning disability. One place can be used to provide a service for someone with both a learning disability and mental health needs. The home is owned and managed by Jill Stockdale - Fisher The home is situated close to local amenities very close to Biddulph town centre. There are good public transport links to the home. The building is a semi-detached house with a lawned garden area and patio. There is one single ground floor bedroom with a shower cubicle, a further three bedrooms are on the first floor, two shared and one single. There is a bathroom on the first floor. The communal rooms provide adequate lounge and dining space. Details of the weekly fees for accommodation were not available at the time of the inspection visit and the reader may wish to contact the service directly for this information. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process also considers the home’s capacity to meet regulatory requirements, national minimum standards of practice and focuses on aspects of service provision that may need further development. This was an unannounced visit which means that no one at Iona knew that the inspection was going to take place. The visit took approximately six hours by one inspector. To prepare for the visit we looked at the last inspection report, our records, we considered whether any complaints or concerns have been made about the service, and reviewed any notifications made relating to incidents that affect the wellbeing of people living at Iona. We also looked at the survey information completed and returned to us by four people who use the service, three staff also completed and returned the surveys. The service also has to complete and return an Annual Quality Assurance Assessment (AQAA) to tell us how they meet the needs of the people who use, or may use the service. This focuses on what they do well, how they evidence this, and any areas they feel are in need of improvement. When we were at the home we focused on a small number of people who use the service which involved discovering individual experiences of living at the home by meeting and talking with them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people. This helps us to understand the experiences of people who use the service. We looked around the home to make sure it is safe, clean and comfortable. We looked to see whether people who use the service are being protected and the arrangements the service has for listening to what people think about living at Iona. What the service does well: Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 6 People who live at Iona are happy there and like the staff, they told us they felt supported and safe. The staff group are consistent and have worked at Iona for some time, this means they know the people who use the service well. The home has its own transport which is used to support people in maintaining links with the local community. People have an active life with opportunity for leisure activities and to keep in touch with their families and friends. The service involves other professionals to support them in monitoring how people develop and change so they can meet all their health and emotional needs. What has improved since the last inspection? What they could do better: The home must improve their recruitment practice and ensure any new staff have the necessary checks before working with vulnerable people. This means people who use the service are suitably protected. Storage of monies and medication needs to be improved. This will ensure these items are secure. The service should improve the plans of care by offering information on daily routines, choices, likes, dislikes and preferences. This will show the service looks at every individual independently to ensure their lifestyle requirements are met. The service needs to make sure all staff training is up to date to guarantee people using the service continue to be kept safe and are supported by skilled personnel. The manager needs to keep policies and procedures up to date to meet with current legislation. This will make sure that all staff have access to the required information. The Statement of Purpose and Service User Guide need to be updated and provided in a suitable format for the people who live there. This means people have all the information they require and understand what Iona offers. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 7 Information around safeguarding people and the necessary training needs to be in place. This will ensure everyone is aware of the procedures to follow. 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. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People using the 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 current admission information does not enable people wishing to, or currently living in the home to make informed choices about the service offered. EVIDENCE: Before we visited the home, we looked at the AQAA to see what the manager (also the responsible individual) had told us about admissions, the Service User Guide and the Statement of Purpose in the Choice of Home section. We were not provided with any information about these areas. We saw that a Statement of Purpose was available in the home but it was in a written format which most people would not be able to understand. It was dated, referring to previous inspection organisations and had a large amount of missing information. This included; the number, experience and qualifications of the staff, contact details of the Care Quality Commission, the home’s arrangements for a number of areas such as religious services, and the Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 10 number of rooms in the home. Other information was also lacking and the service needs to refer to the Care Home Regulations to ensure all areas are covered. Not having this information means people who use the service are not able to make informed choices and understand what is available to them. The deputy manager confirmed to us that a Service User Guide is provided but one could not be found on the day of inspection. It was clear through discussion that fees were not recorded within the missing guide. The service needs to be more explicit with their guide and include information about the fees, this should also offer people advise on what they will receive for their money e.g., are excursions, a holiday, or activity budgets included within the fee? This means people will be clear of what to expect when they move into the home. No new admissions have taken place since the last Key inspection. The home has no vacancies with two men and four women living there. We were able to see that appropriate assessments had taken place. We saw information from the social worker and other significant people was kept in the care planning file, which had been used to support the formulation and writing of the care plan. We spoke with people living at Iona and they confirmed they were given the opportunity to spend time in the home before making a decision to move in. One person said, I looked at three homes and liked this one best, I came and had a trial and my social worker helped me. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people using the service. Information should be expanded upon to fully support people in living their lives in the way they so choose. EVIDENCE: From our discussions with people who use the service it was clear that the key principle of the home is that people using the service are in control of their lives. This means the staff are committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 12 Two peoples care records were looked at in depth, they included relevant background information. Each person has a care plan which is drawn up in an appropriately person centred way. This means that the plans detail people’s wishes and goals as well as their needs, with actions needed to meet their personal goals specified, and any outcomes. However, each persons likes, dislikes and preferred daily routines should be clearly outlined and it was difficult to evidence if people living in the home had involvement in drawing up their support plans. It is clear that the staff team are very aware of peoples needs and wishes and staff are allocated to certain people as their key workers. This means they spend more individual time with them and take a leading role in making sure their needs are met, such as obtaining toiletries and clothes and maintaining contact with their family. Key workers are also fully involved in drawing up and reviewing people’s support plans. They get to know and understand peoples needs and wishes and can advocate on their behalf. Plans of care are regularly reviewed and the funding authority arranges a placement review as required. This is where people who live in the home and their representatives are invited to share any concerns, discuss whether their needs are being met satisfactorily and whether there are any changes to the persons care needs. The home was able to demonstrate this had recently been undertaken for a person whose needs changed. Daily records are kept by the home which provide helpful information about peoples ongoing lives, their health, welfare and progress and show their plans are being followed. This information sharing is in relation to people living in the home and describes life events, their behaviours and health problems. Some risk assessments are carried out and included in plans showing that staff are taking appropriate steps to keep people safe, whilst promoting their rights to lead a normal lifestyle. We feel risk assessments need to be expanded to include bathing, financial management and when people are out of the home, especially alone. These need to be adapted to each individual and evidence made available to show that people who use the service have been included in the decision making process. People living at the home clearly make decisions about their lifestyle and choose daily routines, although choices are limited when there is only one staff on duty. Staff told us: We provide a well established environment. Home from home. Good communication, we work alongside key professionals. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 13 People who use the service told us: We all get on; I came and stayed for a short while to see if I liked it, I settled in well with everyone. I am very settled here. The staff are nice. People living at the home require assistance with managing their money and there is evidence to show people are making use of high street banks and building societies and people who use the service withdraw money on a regular basis for purchases. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support is given to promote peoples rights and independence. People are able to enjoy a full and stimulating lifestyle; routines are flexible meaning people make choices in all areas of their life. EVIDENCE: The Assurance Quality Assurance Assessment (AQAA) tells us: Community presence maintained and improved over the last year, but it does not tell us what these improvements are. We looked at the plans of care for two people using the service; we also talked to staff about how they support people using the service. Plans show there are Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 15 opportunities to maintain and develop social skills and take part in appropriate activities, for example going to work or college, shopping, visiting family, eating out and regular outings. One person attends church on a Sunday when they want to. People who use the service said they enjoyed living at Iona, one person said: I like living here, do you like our home? Another said I am very happy, we are one big family. The home arranges transport for everyone but payment for this needs to be clearer as everyone pays £5 petrol money and there is no record of how this decision was reached. The home needs to reflect this was the individual’s choice and not the homes. Everyone living at Iona participates in the home’s food shopping and their personal shopping. They access community facilities for activities and health appointments. People receive varied meals and have chosen to plan their menus on a weekly basis but this is flexible. People said they discussed this regularly at house meetings. People prepare meals with support, or independently, and a range of foods are available in stock to facilitate choice. There is a good selection and ample quantity of fresh fruit and people are free to help themselves. Healthy options are available and weight and diet are regularly monitored with professional support where needed. People who use the service said: We all help with the menu and we all choose. I like the food. I would like more choice. I enjoy the meals. I like healthy food and the staff always offer me a choice. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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 health and personal care needs of people living at the home are met. Medication is safely administered but not securely stored. EVIDENCE: People living at the home are making use of community health care facilities, such as doctors, dentists and opticians. Routine health checks are being undertaken regularly and preventative measures such as well man and well woman appointments are taking place where people want this. Medication is being managed using a monitored dose system whereby the pharmacist pre-packs tablets into blister packs. The medication cabinet is not secure, it is kept locked when not in use; no controlled drugs were being administered at the time of the inspection. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 17 The medication storage needs to be addressed to guarantee it is safe, this means it needs securing to the wall and the home needs to ensure the cabinet it is stored in is fit for purpose. There is a medication policy in place but it does not cover all aspects as required, for example, management of medication errors. Staff have received medication training but they are not observed to check they are competent, the manager needs to ensure a system is put in place to evidence staff are continually assessed to confirm their ability. We were not able to observe medication administration as no one required any during the time we were there. We did check their systems and medication administration records were suitably completed, medication was returned when not required, and there was a signature sheet confirming who can administer the medication. The home needs to ensure they always record the carry over figure to confirm how much medication is in stock, this was not evident in some instances. The service has not mentioned anything about medication or the management of such within their Annual Quality Assurance Assessment (AQAA), we feel this needs to be included as evidence to show whether the service manages this area appropriately. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not suitably protected. EVIDENCE: The Assurance Quality Assurance Assessment (AQAA) tells us in the section, what they do well: All staff have adult abuse refresher programmes, staff have Mental Capacity Act Deprivation of Liberty Safeguarding training, no complaints, complaints procedure accessible and current, undertaken assessment of decision making capacities for all residents. Our findings did not portray this. We found that not all staff have received training for safeguarding adults, this was also confirmed by staff. We could not see any evidence of Deprivation of Liberty Safeguarding training and there is no policy or procedure for this. The staff we asked did not consider they had received this training. We could not find the required safeguarding policy from the local authority; the staff did not think they had the policy. The deputy manager was not aware of Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 19 any paperwork they would need to fill in should a safeguarding referral be required. We read the home’s abuse policy which has been signed by staff as read and understood. It does not give the correct information and may therefore put people who use the service at risk. When looking at staff recruitment files we found evidence that the majority of staff had started work before the receipt of a protection of vulnerable adult (POVA) first check. This is not safe practice and contravenes Regulation. We would normally require these members of staff to be withdrawn from the rota until the POVA first arrives, but in this situation the necessary checks are now in place. However, people were working long periods with vulnerable adults without the required checks, meaning people who use the service were put at risk by not following the correct procedures. In the Annual Quality Assurance Assessment (AQAA) the manager said there had not been any complaints since their last inspection and the complaints log verified this. No complaints have been made direct to us either. Through our inspection we identified some areas where comments and concerns had been made; some were recorded in residents’ meeting minutes, some in our returned questionnaires and some vocally, for example wishing for more activities and food choices. We recommend that all comments are recorded in a central log so that the manager has the opportunity to note if there are any patterns or trends; it also gives an opportunity to raise issues within their quality assurance questionnaires. The complaints procedure does not comply with regulation and has information missing. It is not in a format that the people living there understand. It also states that complaints must be put in writing. We asked the staff on duty if everyone can write, it was confirmed they could not without assistance. No incidents or allegations of abuse were noted on the Annual Quality Assurance assessment (AQAA) and we have not been made aware of any from other sources. We also checked our records and can confirm nothing is recorded. Two peoples finance records were looked at and the receipts of each purchase were available. Staff sign monies in and out of the home in front of the person whose money it is; this means that peoples money is safeguarded. However, the area where money was stored was inappropriate and we requested it be moved to a safer location during the inspection, this was done immediately by the staff on duty. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30. People using the 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 home is a pleasant, safe and homely place, which people have personalised to reflect their interests. EVIDENCE: Iona is a two-storey property that is in a satisfactory state of repair. The home is safe, comfortable and has a relaxed feel. The house is kept clean and is free of any unpleasant odours. It does not have a lift or wheelchair access, and the stairs are only accessible to people with good mobility as only one handrail is provided. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 21 One bedroom is located on the ground floor and three are on the first floor. The bedrooms we saw reflected individual tastes and preferences. Shared rooms do not offer screening and this needs to be provided, especially when people are being supported with personal care. If people choose not to use the screening this should be documented within their plans of care. Another person, whose bedroom is upstairs, does not walk up the stairs; we saw them adapt their own methods of getting from one place to another. We asked the staff whether the person had mobility difficulties or required aids or adaptations. We were informed that this was the person’s chosen method of ascending the stairs. Again personal choice needs to be evident and recorded with their plan of care. People confirmed they have involvement with choice and, liked living here. Staff and people who use the service used the word homely and home from home on a number of occasions. People may come and go as they please, and those who choose to, have a key to their room although no one has a front door key. There are no restrictive rules in place although no one is allowed to smoke in the house; smoking is permitted in the garden. Infection control management could be improved upon by removing hand towels and using disposable paper towels. Acetate bags could be used to manage soiled laundry and the staff considered a pedal bin would prove useful to assist in managing incontinence waste. Staff confirmed they have plenty of personal protective equipment such as disposable gloves and aprons. The washing machine and tumble dryer are stored in the office; three of the six people living at Iona do their own washing. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People using the 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 using the service cannot be confident that they are supported by a suitably recruited, trained or supervised workforce. EVIDENCE: The AQAA asks the manager in the Staffing section, ‘Did all the people who have started work in your home in the last 12 months have satisfactory pre employment checks? It was answered, Yes We found evidence that does not substantiate this statement. We saw staff had started work before a protection of vulnerable adult (POVA) first check, one staff member had worked in the home for over a year. This leaves vulnerable people at real risk. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 23 Due to our concerns we checked every staff file, but one of them was not available as it was at the managers house. Our Regulations dictate that staff files need to be on site, so that current information is readily available. On looking at all of the files it was clear that the majority of staff had started work before they the home had completed or received the required information from pre-employment checks. The service needs to make every effort to ensure that new staff do not start work until a satisfactory criminal record bureau (CRB) clearance has been received. However before staff start work, the home must have received the information from their protection of vulnerable adult (POVA) first check. In this situation, whilst waiting for the CRB check, the home must ensure that these staff are being supervised at all times so that people are protected from harm. We saw no evidence that this is the case. We can confirm all staff working at the home do now have a CRB in place although one was not up to date and one file could not be checked as it was not there. Staff files do not contain identification or a photograph as required. Medical questionnaires are in place however these did not verify if people are physically and mentally fit for the work. We saw that references have been requested and received by the home. We could not find any evidence on the files that new staff had completed induction training. Induction training should meet with the Skills for Care common induction standards. We saw the newest recruit’s file and there had only been one supervision session in 12 months. A pre-appraisal form had been completed in January 2009 but no actual appraisal undertaken. Staffing levels do not always meet the needs of the people using the service. This is because when there is only one member of staff at the home people who use the service requiring community support cannot go out. It also means that staff cannot do one to one activities with people using the service without it impacting on other people’s support. We could not see activity records within the plans of care. We were told by the staff that there should normally be two staff on each shift, however, there is no contingency for annual leave or sickness and at these times, it is normal practice for there to be only one member of staff on duty. From reading rotas, of which there were only three available, we saw that the manager of the home has identified that two staff are required and therefore this ratio should be in place at all times. We recommend that there should, at the very least, be an overlap period where two staff are in the home for a Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 24 period of time so that activities can take place or people’s wishes can be accommodated on an ad hoc basis. However staffing levels should be determined by the needs of the people using the service and following regular review of these needs these levels should be maintained The home does not use a training matrix and the only way to verify if staff are trained is from certificates on staff files, we recommend a training matrix is implemented. Observing files and talking with staff revealed that not all mandatory training is available for staff in core areas including moving and handling, food hygiene and the protection of vulnerable adults. Training has been offered in fire safety, medication, infection control and health and safety. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management procedures do not fully ensure that people’s health, safety and welfare is protected and promoted. EVIDENCE: The manager/owner was on annual leave when we undertook our inspection. The manager has experience of managing the home, but from the AQAA it appears that she still needs to complete the necessary managers qualification. We also found that she is not fully conversant with some very important legislative requirements, including staff recruitment and what to do if people Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 26 experience abuse. Staffing levels and training are not provided to meet the needs of the people using the service. The insurance for the home is valid; it requires renewal in November 2009. The home’s certificate was on display but only one page; both pages need to be visible so that the categories of registration are clear to see. From our discussions with staff we are confident that the staff are generally competent to care for the people who live there. We saw that they focus on the individual, take some account of equality and diversity issues, and work in partnership with families or close friends, as appropriate, and professionals. We have however identified a number of areas that need improvement and the manager needs to demonstrate she provides enough time for these issues to be dealt with. We will require the home to complete an improvement plan. This will show us how the home is going to make improvements and demonstrate ways in which they have met the requirements. The staff told us: The manager is rarely here, she pops in now and again and, We are told she is working from home. People who use the service said: We see Jill now and again. The rotas we saw indicated the manager is only at the home once a week. The home does have a Statement of Purpose that sets out the aims and objectives of the service. The manager must improve and develop systems that monitor practice and compliance alongside the plans, policies and procedures. The Annual Quality Assurance Assessment was returned to us before our visit and within the timescale we provide. However, it did not offer us clear information and some of the information conflicted with our findings. Some areas of the AQAA were not completed (workforce section) and some information was not relevant to the section it was written in. There is evidence that people’s opinions about issues that affect them are sought at meetings, which are supported by staff and an advocate, minutes are also taken. We are confident that people who use the service receive appropriate support and they are clearly happy, however improvements in documentation, recruitment practice, updated policies and a review of staffing levels will offer improved and potentially safer outcomes. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 3 X 4 X 5 X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Version 5.2 Page 28 Iona DS0000004962.V376637.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA18 Regulation 12(4)(a) Requirement Timescale for action 07/10/09 2 YA20 13(2) 3 YA20 13(2) 4 YA23 12(3) The home needs to ensure peoples dignity is respected by the provision of screening in shared bedrooms. This will demonstrate people who use the service are valued. Medication must be stored 07/10/09 securely at all times in suitable locked storage areas. This is to ensure medications cannot be removed, contaminated or accidentally ingested by persons who should not have access to it. Accurate, complete and up to 07/10/09 date records must be kept of all medication received. This is to ensure medication is accounted for, is available and is given as prescribed. To make sure people are 07/10/09 safeguarded you must ensure there are policies and procedures in place in regard to The Mental Capacity Act deprivation of liberty safeguards. This is to make sure staff know what course of action to take, understand the assessment processes and DS0000004962.V376637.R01.S.doc Version 5.2 Iona Page 29 5 YA33 6 YA34 7 YA35 are clear of their legal responsibilities. 18(1)(a) To make sure peoples needs are fully met you must take action to ensure staffing levels are reviewed in conjunction with occupancy and dependency levels confirming that each person’s needs are consistently being met throughout the day. This is to safeguard the health, well being and safety of people living at the home. 19(1)(b)(i) Staff must be recruited in a safe and robust way. This means the people who use the service are suitably protected. 18 (1) (c) Staff must receive the training (i) they require to develop the skills and competence to meet peoples support needs and to keep them safe. This means staff have the skills and confidence to support the people who use the service. 07/10/09 07/10/09 07/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA1 YA1 YA1 Good Practice Recommendations The service user guide needs to contain information with regard to the costs for living at Iona. This means people are clear about what they receive for their money. The home should consider providing information to people in alternative formats such as easy read and pictures to enable them better access to information. The Statement of purpose should be updated to ensure it contains all required information, as described in Schedule One. DS0000004962.V376637.R01.S.doc Version 5.2 Page 30 Iona 4 YA6 5 6 7 YA6 YA9 YA22 8 9 10 11 YA22 YA22 YA23 YA34 12 13 14 15 YA34 YA34 YA35 YA39 16 YA39 This will enable people who use the service to have access to relevant information about the home. Information within the plans of care should offer more information on people’s personal preferences. This means staff have all the information necessary to fully support people in living their lives in the way they so choose. Peoples records should be reviewed to incorporate the following areas of diversity: race, gender identity, disability, sexual orientation, age, religion and belief. To consider support plans being written in other formats, such as, using photographs and symbols. This will make them more accessible to people living in the home. Potential risks should be subject to an appropriate risk assessment and management plan. The complaints procedure should contain details of how to contact the provider, the Care Quality Commission and include timescales for complaints to be resolved. This is to enable people to know who to contact with their concerns. The complaints procedure should be available in a picture format to enable improved access to information for people who find it difficult or are unable to read Complaints, comments and grumbles should be kept together to assist the manager in identifying any patterns or trends. The manager should ensure a copy of the safeguarding of adults is available to support staff in decision making and following any updated procedures. The home needs to evidence that staff are appropriately supervised between the receipt of a Protection of Vulnerable Adults First record, and the subsequent Criminal Record Bureau disclosure. Under regulation staff files need to be on site, this is so current information is readily available. The date of birth should be removed from the homes application form to comply with age discrimination legislation. Prioritised action must be taken to ensure essential mandatory up to date training is provided for all staff commensurate with their role. The home should have a development plan in place to ensure there is a proactive management approach which ensures that the home is up to date with current practices responds to CQC report findings and develops the service it provides. The outcomes of quality assurance should be collated and made available to interested parties. DS0000004962.V376637.R01.S.doc Version 5.2 Page 31 Iona 17 YA42 The manager could add further evidence into the annual quality assurance assessment to show how they promote the health, safety and well being of the people who use the service. This will help to support their information. Iona DS0000004962.V376637.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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