Inspection on 04/02/10 for Josephine Butler

This inspection was carried out on 4th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Josephine Butler 20/04/10

Josephine Butler 25/03/09

Josephine Butler 10/07/08

Josephine Butler 19/09/07

Josephine Butler 17/05/06

Josephine Butler 20/01/06

Josephine Butler 27/07/05

Josephine Butler 15/12/04

Josephine Butler 23/09/04

Josephine Butler 14/04/04

Josephine Butler 17/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE     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: Lynn Paterson     Date: 0 4 0 2 2 0 1 0 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 33 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 33 Information about the care home Name of care home: Address: Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE 01517277877 01517277877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Harold Smith care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning diability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 Date of last inspection Brief description of the care home Josephine Butler House is a large detached property set in its own grounds in the Sefton Park area of Liverpool. It is short walk from Sefton Park, Lark Lane, shops, pubs and public transport. The home provides care and personal support to younger people between the ages of 18-65 years that have mental disorder. The accommodation is provided on three floors with the communal areas lounge, dining room, conservatory, games room and quite room on the ground floor. All the service users accommodation is provided in single bedrooms. Service users are able to access the first and second floor by the passenger lift. The home is staffed twenty-four hours a day by a Registered Mental Nurse and support workers. The service users are encouraged by Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 21 Brief description of the care home staff to access various community facilities and to maintain their independence. The manager for the service is Phil Wade and the Registered Provider is Mr Harold Smith. The weekly fee is currently GBP450 per week and service users are given written terms and conditions showing what is included in the weekly fee. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: An unannounced visit was made by two inspectors to Josephine Butler Care Home on 4th February 2010. One inspector carried out a general inspection of the care and support services, whilst the pharmacy inspector dealt with the homes overall medication managements systems. During the visit various records were looked at. A number of people who live in the home were spoken with as well as the managers and staff and they gave their views about the service. The visit was just one part of the inspection. Before the visit was undertaken the home manager was asked to complete an annual quality assurance (AQAA) to provide up to date information about the home and the services they deliver. Questionnaires were also made available for people who use the service, relatives and staff to check what they thought about the home. All information gained from discussions, surveys and documentation was used as a Care Homes for Adults (18-65 years) Page 6 of 33 basis of this process of this report. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: A requirement was made at the last key inspection in respect of staffing levels and it was noted that staffing levels remain inconsistent. Staff advised that they often manage with staff shortages due to funding issues and the registered provider will not allow agency staff to be used. Staff say that if staff are off sick or on leave then the numbers on duty diminish. A requirement has been made to address this issue as it is core to the planning and management of care. The manager acknowledges that staff one to one supervision sessions do not take place on a regular basis due to some staff shortages and the need for him to prioritize work.However he realizes that it is essential that staff have the support and supervision they need to carry out their jobs to include ensuring they obtain professional guidance and their continuous personal development needs are met. Staff training is in place however it would benefit staff if the registered manager was provided with a training budget to enable him to make decisions about training needs without having to constantly request funding from the registered providers of the home. The medication management was poor at the time of the site visit and the home manager acknowledged the errors that had occurred and the lack of a medication audit. However an immediate requirement was issued to ensure that people living in the home receive their prescribed medications as recorded on file. Care Homes for Adults (18-65 years) Page 8 of 33 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 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure at the home enables people to know what services are provided and assist staff to understand peoples needs and make sure the home has the staff and facilities to meet these needs. Evidence: Feedback from residents completed surveys and general discussions with the people living in the home revealed that they had been provided with a service user guide when they first visited Josephine Butler Care home. People said that before any decisions were made about whether they went to live at the home ,social workers and staff of the home carried out an assessment to see if the home could meet their needs. People living in the home said that from the time of admission, staff asked them their views and preferences and encouraged them and their family and friends to become involved with producing a care plan package to meet all their needs, wishes and preferences. Records show that if the assessment is positive staff invite prospective residents to stay for a short trial period to enable them to make informed decisions about their future care. Care Homes for Adults (18-65 years) Page 11 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care needs are monitored by staff and details recorded on how staff can enhance their practices to ensure people living in the home can maximize their choice and Independence. Evidence: Four care plans viewed showed that they had been written around the wishes preferences and goals of the resident and included risk assessments on how assessed needs would be met and how any risks would be minimized. People living in the home said they were generally happy with the support they got from staff and they said they were able to go about their daily lives and maintain their independence wherever possible. Staff said they have tried to expand the amount of involvement on the part of residents in the day to day running of the home, encouraging residents to do more for themselves whenever possible. Staff said they had achieved some success, with residents having some more involvement in carrying out necessary day to day activities. Information on care plans included how people wished their finances to be managed and what they wished to do each day. However , whilst the money Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: management details were clear,some details on file about peoples wishes abut their daily life had not been acted upon. People said they did not have much to do during the day and comments included: Could do better with social events or relaxation classes Maybe arrange a little bit more in the line of recreation Could arrange some activities like home entertainment outings and other things. The home has a weekly planner for each residents and shows how residents can make decisions about their daily lives wherever possible. However the plans were not realistic and people living in the home said that what was written down and what actually took place varied greatly. For example one resident had attendance at a day center as part of his plan but in effect this placement was not available. The manager advised that he and his staff have encouraged a number of residents to join local day centers, with some success.However he said that the difficulty was gaining access to the centers and whilst a request was made, some people had to wait a while before a placement was found. Records show a number of residents now attend a local day center for most of the week. Most of the residents of the home were spoken with and general comments were that the home had very good staff who did their best to care for the people living in the home. Residents said staff treated them very well ,tried to keep them contented and provided good food. Observation of staff practices show that staff support residents to take responsible risks and will endeavor to maximize peoples Independence wherever possible. Care Homes for Adults (18-65 years) Page 13 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy their daily life and staff have introduced more opportunities to enable people living in the home to become more independent and enhance their life quality. Evidence: Discussions with residents indicated that they had a member of staff who was their key worker and together they worked out a plan as to what was the residents responsibility in all aspects of daily life.This included maintaining their bedrooms, what time they spent in their own rooms, what help they required to develop their education or carry out therapeutic activity. Comments from people who live in the home were very positive about the way staff treated them and observations of staff and residents interactions identified they shared a relationship of mutual trust and rapport. Residents comments included: Staff help us all the time, they are kind and very nice people. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: Staff care for us. They do well in the way they treat us. Staff keep me contented and feed me well. The manager advised that he and his staff have encouraged a number of residents to join local day centers, with some success. A number of residents now attend a local day center for most of the week. He said that staff have also managed to find a number of opportunities available to be taken up by residents including learning computer skills, gardening and art classes. Residents said they were able to make decisions about their daily life and said they had freedom to come and go as they pleased. However they said they needed to make sure they were signed in and out of the building so staff knew where they were. One resident said s/he liked listening to music another said s/he enjoyed going out to the shops. The home is situated near to a main road where residents can access buses which have varied routes across the city. General discussions and observations revalued that the residents are comfortable and relaxed in the home and people living in the home invited me into the smoking room where they say they enjoy the atmosphere. Most residents wished to show their rooms and all rooms viewed appeared comfortable and personalised with photographs ,radios , televisions and other items of their choice. The visitors book indicated that family and friends of the residents were welcomed into the home and staff advised that if the resident wishes, family and friends can be involved in their daily routines. It was noted that staff knock on residents doors prior to entering and all residents are provide with keys to their rooms to assure them of their privacy Residents were seen to be helping out in the dining room, laying tables and organising seating.One resident spoken with said s/he liked to assist with the dining arrangements and looked Freda to carrying out these tasks each day. Discussions with the people living in the home identified that they all liked the food that was provided and comments included: The food is very good. The food is well cooked. We all like the food here. We know what we are having and can have a choice if we want but all the food is good and tasty. The menu varies and we can have what we want. Its always good and we like the way the food tastes. We can choose the menus so we know we like them. We can have our meals at different times if we want. I have my breakfast as late as possible so I dont have to et up early. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Staff said that peoples various dietary needs,likes and dislikes are recored so that the chef can prepare balanced meals. The daily menu is displayed on a board in the dining room and staff said they ask residents on a daily basis what they want for their meals. Care Homes for Adults (18-65 years) Page 16 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor 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 is carried out in a way that maintains the privacy and dignity of the people living in the home. However the medication management is poor and could endanger the health and wellbeing of the residents. Evidence: The manager said the home have a care team that has built a very healthy rapport with residents and revealed this has permitted a good understanding to be built about the amount of help and support residents need relating to caring for personal hygiene and bathing. Staff said they have deepened the relationship between residents and staff and that has enhanced the influence that staff can have to wards encouraging residents to be more pro-active with regards to their own care. Discussions with people living in the home revealed that most of them will accept assistance offered by members of staff with regard to assistance with personal hygiene. Staff said that bathing for example has been built into the culture of the home, though it has taken some time to encourage some residents to develop the routine. However they say that residents now bath regularly and have become more conscious of their hygienic needs. Care plans detail the needs and input from heath care professionals and care staff and discussions with residents indicated that they are more than happy with the Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: care and support provided. Comments included: Staff look after me very well and treat me with respect. I like the way the staff ask me what help I want with washing. Staff look after our welfare with the utmost care and attention. Records indicate that staff promote both health and personal care for the people living in the home and all residents seen during the unannounced visit were well presented and said they were happy with the way they were supported by staff to always look at their best. In respect of medication the pharmacy inspector carried out a thorough medication review and this area was found to be poorly managed. Details of her findings are recorded below. This part of the visit was carried out by a Pharmacist Inspector and lasted approximately six hours. Overall we found serious mistakes that were placing the health and wellbeing of people at unnecessary risk of harm. On the day of the visit there were no photocopying facilities available, so we returned another day to take photocopies of some of the records due to the serious nature of our concerns about the handling of medicines within this service. We found gaps on the current medicines records and other mistakes that meant the records were not accurate. We saw that some medicines were not given at the correct time with regard to food and drink intake because staff had not followed the written instructions on the medicines. We found that staff had handwritten some entries onto the medicines charts when medicines had been received from hospital. These entries did not include all the warnings necessary to give these medicines safely and they had not been checked and signed by another member of staff. There was no guidance for staff to follow regarding how medicines prescribed to be taken only when required should be given. This meant that these items were unlikely to be given correctly and consistently. We found that clear explanations had not been recorded when medicines were not given, for example, if they were refused. Inaccurate records can lead to mistakes that can place peoples health and wellbeing at serious risk of harm. We carried out detailed checks of some stocks and records and found that medicines could not always be accounted for. We saw evidence that some medicines had been signed for, but not actually given, whilst others could not be accounted for and appeared to be missing. In many cases it was not possible to tell whether or not the medicines had been given correctly. It was of serious concern that medicines such as those used to control epilepsy, schizophrenia and other mental health problems had not been given correctly. The health and well being of people living in the home is at serious risk of harm if medicines are not given as prescribed. We found that staff were placing medicines into dosette boxes. This is called secondary dispensing and is a particularly risky practice that can lead to serious errors. Due to this, it is against current guidelines. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: We looked at how medicines were given to people who were on periods of leave away from the home. We found that records were poor and it was not possible to see what had been supplied and who had been responsible for the medicine. There were no recorded checks to determine whether or not the medication had been taken correctly whilst away and, more seriously, no back up plans to supply extra medication should the period of leave be extended. This meant that people did not always receive their medication whilst away. We looked at how medicines and staff competency were audited (checked). There was no evidence that staff had been formally observed giving and recording medicines. The audit that had recently been completed by the manager was of a poor standard and had not identified any of the mistakes and discrepancies found at this visit. This meant that problems had not been rectified by the manager. Given the serious nature of some mistakes it was evident that staff need to have their competency formally assessed to make sure they have the necessary skills to handle medicines safely. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe and protected within the home and staff have received training in safeguarding procedure to ensure they can protect the residents from abuse or harm. Evidence: The home maintain a complaints book which shows a record for each week. Staff said they feel that the good positive atmosphere within the home and the daily discussion of issues as they arise has hopefully prevented things reaching the state when complaints are made or voiced. No complaints were recorded in the home records and no complaints have been received by The Care Quality Commission. People living in the home said they speak with staff if anything is wrong and it is quickly sorted. Residents said they know what to do if they need to complain and have a written documented which shows the procedure to follow if required. Staff said that the home work with a Key Worker system which assist people living in the home to have confidence and trust in the staff. They say this again enables effective communication to ensure any concerns are voiced as and when they occur. People living in the home said they feel able to talk to staff and discuss any issues whatsoever and know staff will sort everything out. A copy of the safeguarding procedures were available and the manager advised that he has linked in with the local authority safeguarding team for discussion and advice. Staff were able to explain Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: the safeguarding procedures and said that In house training had been provided and staff training files held information to evidence this. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to improve the accommodation to make it comfortable and safe for the people living there. Evidence: The home continues to effect improvement and employs a maintenance person who has recently painted bedroom areas and worked on improvement to the bathroom and toilet facilities. Staff said they endeavor to ensure the home provides a safe and secure environment for the residents. Residents said they felt the home provides a bright and cheerful environment which is kept clean and is comfortable to live in. Comments from residents included: My bedroom is comfortable and my bed is snug. I can listen to my music in my room and be comfortable. I like my room, I feel safe in it. The premises appear suitable for their purpose and presented as safe, comfortable, bright , clean and free from offensive smells at the time of the unannounced visit. The care home has been re-decorated throughout over the past twelve months with new UPVC windows having been fitted to all bedrooms. All the bedrooms have a set of pine bedroom furniture and an easy chair. Residents said they are encouraged to personalise their bedroom so as to make it as homely as possible. Friends and family are encouraged to take an active interest in this process so that residents feel at ease and as comfortable as possible in what is at present their home. The home have introduced a refurbishment programme to aid the presentation of the care home and Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: maintain it at at the very least its current level. The home offers access to local amenities and transport and is in keeping with the local community. The building is accessible to all people who are eligible to use the service and the furnishing, fittings and adaptations are adequate to fulfill their purpose. Details supplied by the home by way of their annual self assessment identifies that all polices and procedures relating to hygiene and control of infection have been monitored and reviewed and services and facilities comply with The Water Supply (water fittings) Regulations 1999. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels need to be more consistent to ensure that the number of staff on duty can carry out appropriate care and support to meet residents assessed needs. Evidence: At the time of the inspection the home manager was on duty together with one nurse and two carers and a cook. It was noted that a NVQ assessor was undertaking some work with staff members during this time. Examination of the duty rota revealed that there were a number of occasions over the last few weeks where their had been reduced staff numbers. The manager confirmed this and said that when staffing levels were down this did impact unfavorably upon the residents as some personal care programmes had to be missed to include any social activity. Discussions with people living in the home said they were left to their own devices when staffing levels were low and they felt that they had to just sit and watch television or sit in their rooms of staff did not have the time to spare to give them support. However they said that staff were very good and always did their best to make sure the people living in the home were given as much time as possible to assist them to enjoy daily life. The lack of activity was noted during the inspecting visit and residents were observed Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: merely sitting around the home. The management said that the ability to fully cover the staffing rota was very limited due to the home budget and all requests to cover for staff who were off ill or on leave had to be authorized by the home owner. It was said that agency staff are not allowed to be used and as a consequence staffing levels are inconsistent. Staff files viewed revealed that the home fully complies with the recruitment and selection standards and all files held the appropriate details to show all the procedures stated in the home recruitment policy had been carried out. However staff files showed some gaps in their training and the manager advised that due to him not having a dedicated training budget it was sometimes difficult to plan ahead in view of these financial constraints. Staff spoken with said they were happy working in the home and whilst they were always very busy they tried hard to meet the needs of all the people living in the home. They said that staff shortages did impact unfavorably upon staff and people who used the service. Via discussions and staff surveys it was noted that staff said they had received a copy of their job specification and were aware of the standards of conduct and practice that was expected of them. Staff said they received some in house training and were encouraged to complete national vocational qualifications. Staff said that they are supported by the manager however they acknowledged his hands are tied in respect of staffing levels due to him not being able to take decisions in this matter. Staff files showed that one to one supervision and support sessions do not take place on a regular basis and the manager acknowledged that this shortfall is due to him having to prioritise and sometimes cover other duties.It is essential that staff have the support and supervision they need to carry out their jobs to include ensuring they obtain professional guidance and their continuous personal development needs are met. Staff spoken with and those observed carrying out their care practices identified that they were enthusiastic in their role and totally committed to the provision of quality care whilst empowering residents to maximise their daily life. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is valued in his role but has failed to ensure that peoples health is protected by the homes medication policies and procedures. Evidence: Phil Wade is the homes registered manger and feedback from staff and residents revealed that he is trusted as a person and respected for his abilities to provide support to staff and needs led care to the people living in the home. Comments included: He is always willing to listen to us and provide us with sound advice. He is an open and honest man who really does care about he people living here. He is a good leader and we respect him. Phil Wade has a level 4 NVQ award in management, a nursing qualification in Mental Health and Dementia Care Mapping and has many years experience of managing care. The home arranges regular residents meetings and provides surveys and questionnaires. This enables staff to gain an overview of the feelings of the people living in the home and their Representatives about the staff and services provided. The management team have an open door policy with regards to the managers office. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: At any convenient time residents are free to enter the office and discuss matters that concern them with the manager or deputy. Comments made by residents on the Satisfaction questionnaires indicates that residents feel able to discuss concerns with care staff or the manager or his deputy as they feel the need. The homes registered providers complete a monthly audit and produce a report for the manager as part of an overall quality process in the home. The manager and his deputy work hard to effect improvements to the home to ensure that the written aims and objectives are achieved. They make sure that all staff have knowledge and understanding of the policies and procedures of the home and full awareness of the General Social Care Council code of practice and other legal requirements. As previously stated the management approach of the home creates an open,positive and inclusive atmosphere in which the manager communicates a clear sense of direction and leadership and he encourages people to voice any concerns they may have without fear. Discussions with staff identified that they have received training in safe working practices to include moving and handling, fire safety,first aid, food hygiene and infection control. The self assessment document completed by the home held information to confirm they had documentation to prove that all essential services in the home had been properly tested and maintained and that the staff complied with relevant health and safety regulations. By failing to put into place effective arrangements to ensure that people receive their medication as prescribed puts their health at risk. As a result the Commission will now take enforcement action to ensure that medication systems follow good and safe practice in a person centred way that ensures people are safe. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13(6) All management and staff 30/04/2009 must have training in the management and awareness of abuse so that residents can be assured of being fully protected from any risk of abuse. ( Previous requirement date of 1/10/08 not met) There must be an effective 01/05/2009 staff team with sufficient numbers to support residents assessed needs at all times. This will ensure that residents care needs can be met. All staff must receive updates in fire safety and this must be recorded. This is to ensure all staff are aware of fire safety and can maintain safety in this area. 01/06/2009 2 33 18(1)a 3 42 23(d) 4 42 13(4)C The findings of the monthly 01/05/2009 risk assessments of the general environment must be actioned consistently so that residents can be assured of a safe environment. This is particularly with respect to the findings around the external fire escape and the missing rails at the front of Page 28 of 33 Care Homes for Adults (18-65 years) 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 the building. Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Accurate records of all medicines received into the home, given to people and disposed of must be kept. This will help make sure all medicines can be fully accounted for. 26/03/2010 2 20 13 There must be an effective 26/03/2010 system for training and testing the competency of all staff (including carers who apply creams). This is to ensure that staff are capable of performing these tasks safely. 3 20 13 There must be a robust 26/03/2010 system of auditing (checking) all aspects of handling and recording medicines within the service (including medication taken whilst away from the home). Care Homes for Adults (18-65 years) Page 30 of 33 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 so that areas of weakness can be identified and action taken to improve. 4 20 13 There must be clear policies and procedures in place for supplying medication to be taken whilst away from the home. This is to ensure that people receive their medicines correctly and safely whilst they are on leave or attending hospital appointments, day centres etc 5 20 13 Medicines must be given to people as prescribed. This is important because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing 6 33 5A staffing numbers must 19/03/2010 ensure all aspects of care and support identified by the care plan can be carried out effectively and efficiently. The home must ensure they have an effective staff team which sufficient numbers and skills to support service users assessed needs at all times. 26/03/2010 26/03/2010 Care Homes for Adults (18-65 years) Page 31 of 33 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 7 36 6 staff supervision must be in place at least six times a year to ensure staff can be monitored ,supported and training needs identified. Staff supervision must be in place to enable staff development. 23/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Handwritten entries on medication administration records should be checked and signed by a second member of staff to reduce the risk of mistakes. It would benefit staff if the manager was provided with a training budget to enable him to make decisions about staff training and development needs. The manager needs to review as part of the quality assurance, staff training and understanding of the safe handling of medication. There has been a failure to respond to unsafe practice that places people at risk 2 32 3 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: 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. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!