Inspection on 10/12/09 for Karistos

This inspection was carried out on 10th December 2009.

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

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

Other inspections for this house

Karistos 01/09/10

Karistos 04/08/10

Karistos 26/07/10

Karistos 02/06/10

Karistos 17/03/10

Karistos 12/11/09

Karistos 09/11/09

Karistos 22/10/09

Karistos 07/07/09

Karistos 25/07/08

Karistos 29/08/07

Karistos 01/03/07

Karistos 09/05/06

Karistos 18/11/05

Karistos 09/06/05

Karistos 14/12/04

Karistos 01/07/04

Karistos 09/03/04

Karistos 28/10/03

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Karistos 29 Chantry Road Moseley Birmingham West Midlands B13 8DL     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: Lisa Evitts     Date: 1 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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: Karistos 29 Chantry Road Moseley Birmingham West Midlands B13 8DL 01214424794 01214424794 karistosnursinghome@yahoo.co.uk www.karistos.co.uk Mr Gursharn Singh Surdhar,Mr Surjit Singh Surdhar,Dr Harminderjeet Singh Surdhar care home 17 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 17 Date of last inspection Brief description of the care home Karistos Nursing Home has 17 beds and is registered to provide care to younger adults for reason of physical disability. The home is situated in Moseley and is within short walking distance of shops and bus routes. There are no parking facilities at the home and cars would need to be parked on the main road at the front of the building. It is a large three storey converted house and bedrooms are available on all floors. A passenger lift provides access to all floors of the building. There is a lounge and Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 17 0 7 0 7 2 0 0 9 Brief description of the care home separate dining room. The accommodation consists of four shared bedrooms; nine single bedrooms and two have en-suite shower facilities. Wheelchair access and a platform lift have been provided to the front of the building, as the steps are rather steep. There is a garden to the rear of the home with a small patio area, which is accessible via the dining room. However, the incline to the garden makes it difficult for people to use it. Corridors in the home are narrow and do not provide easy access for people who may require assistance with their mobility. There is a shower room and assisted bathing facility to meet the needs of the people living in the home. The home has three hoists to assist people with mobility problems and has specialist mattresses to help prevent peoples skin from becoming sore. Information is available about the services and facilities on entering the home and this includes a copy of the most recent inspection report, for anyone who may wish to read this information. Current fee rates range from £400 - £600 per week and this information is provided in the service user guide. These fees are reviewed annually. Additional costs include newspapers, hairdressing, clothing and personal effects, chiropody, dentist and optician. 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: The focus of inspections undertaken by us, the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This is the second key inspection of this service this year. It is recommended that this report is read in conjunction with the previous report from the 7th July 2009. Due to concerns around the quality of care and fire safety at the home, we have made three random inspections to the home since the last key inspection, to monitor the homes progress. During these visits we looked at care records, observed staff interactions and spoke with staff. The findings from these visits are included within this report. We also asked the owner to meet with us so that we could share our concerns in order for them to make the required improvements. Care Homes for Adults (18-65 years) Page 6 of 33 At the end of October 2009, Adults and Communities placed a suspension on the home, which meant that no more people could go and live there. This was following concerns raised about the service being provided by the home. Adults and Communities are monitoring the home and will review the suspension in the future. Two days before this visit, a pharmacy inspector visited the home and looked at the management of medication. Their findings are included within this report. This visit to the home was undertaken by two inspectors over a full day. There were 14 people living at the home on the day of our visit and the home did not know that we were coming. One inspector completed a Short Observational Framework for Inspection (SOFI) over two hours. We completed a SOFI because some of the people in the home are unable to verbally tell us about their experiences. We use a formal way to observe people to help us understand. The SOFI involved us observing five people who use the services for two hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use the service and the environment. The results of this observation are included within the report. Information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. We also looked at staff files, training records and health and safety files. Four people who live at the home, one relative and three staff were spoken to. Reports of any complaints or incidents reported to us were reviewed in the planning of the visit to the home. 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: We have found that the home responds well when they are told they need to put something right but this response is reactive. The home must now demonstrate that it can be proactive in identifying concerns and act upon them in the best interests of the Care Homes for Adults (18-65 years) Page 8 of 33 people who live there. Some work has been undertaken in a number of areas such as care records, activities, meals and staff interaction, however these could all be further developed. The home had reviewed the menu and choices of food offered to people, however this needs further work to ensure that everyone at the home receive food that they like. One person told us Often we get the same food all the time, its too curryfied for me, I like basic meals. Activities should be reviewed for people who are not able to verbally communicate as they are currently very limited. Care records should show the outcomes of visits to hospital appointments so that staff can continue to monitor peoples needs. Complaints must be recorded and people need to know that they are listened to and their complaints acted upon. Staff should have further training about how to recognise potential abuse and how to report allegations to the relevant authorities. This is to ensure that people are safe in the home. Arrangements must be made to ensure that bed rails and wheelchairs are checked for safety. Staff must have guidance about how this should be done. The owners need to ensure that the passenger lift is in full and safe working order. The home needs to sustain the improvements made while also continuing to improve the quality of the service in the best interests of the people who live there. 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. Arrangements are in place to ensure that people have the information they need and know what can be provided if they decide to live at the home. Evidence: The service users guide and statement of purpose give people information about the home. They are available in the reception area and are in each persons bedroom so that they can refer to them if they want to. The guides can be made available in large print so that people with visual impairments can access the information. The manager confirmed that there had been no changes to these documents since the last key inspection in July 2009. The certificate of registration and a copy of the last inspection reports are displayed in reception so that people can read these if they chose to. Since our last key inspection, there has only been one person come to live at the home. We looked at their pre admission assessments and found it had good information about the persons needs so that the staff knew they could meet this Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: persons needs. The manager had sent a confirmation letter so that the person knew the home could meet their needs before they moved in. We spoke to the person who moved in and they told us the manager and a carer came to see me at the hospital and brought me a brochure. Due to a number of concerns raised about the quality of care at the home, there is currently a suspension placed upon the home. This means that Birmingham City Council will not pay for anyone new to live at the home until they are happy that people are receiving a good standard of care. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people are supported to make some decisions about their lives. Evidence: Each person has a written care plan. This is an individualised plan about what the person is able to do for themselves and states what assistance is required from staff in order for them to meet their needs. All of the plans had been reviewed and some contained good information for staff to follow but some plans could be further developed to give more details. People who are able to verbally communicate are given choices about meals and activities for example. People who are not able to communicate verbally are not always given choices. An example of this is one person who is never taken out of the home and either spends their time in the lounge or in bed. This means that some people do not receive a stimulating and interesting lifestyle. During the SOFI we saw one member of staff playing a card game with one of the Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: people living at the home. It was disappointing that mid way through the game, the member of staff left the room and did not tell the person where they were going. This resulted in the person who was playing cards becoming fed up and was no longer interested in the game. They were not given a choice about whether they wanted the game to continue. Another person had been watching a TV programme and staff also put music on and started a sing a long with other people at the home. This resulted in the person watching TV becoming distressed as they were no longer able to watch the programme and had no choice, as the room had become noisy. One person told us that during the night they had asked for a cup of tea but that they never got one as staff said you should be asleep. The person told us that they did not bother to ask for one anymore and this does not mean that people had a choice about when they could have a drink. This was discussed with the manager on the day of the visit so that this could be addressed with the night staff. Since our last visit the bath had been repaired so that people could have a choice of a bath or a shower. One person said they help me have a shower when I want one. Risk assessments are undertaken each month for skin soreness, nutrition and risk of falls. The risk assessments for use of bed rails were not consistent and one had not been reviewed to ensure that they were still relevant for this person. A resident and relatives meeting had been held at the home in October. Five people who live at the home and three relatives had attended. This means that some people can be involved in making decisions about the home. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the people using the service experience a lifestyle that is meaningful and meets their preferences. Evidence: Since the last key inspection at the home, a full time activity coordinator had taken up post and works Monday to Friday. She was previously a carer at the home and knows peoples needs well. Following the last visit the manger told us that the home had purchased two small fish tanks, some indoor board games and a karaoke machine for people to use. During our visits to the home we saw one person being taken out shopping and for a meal and we observed staff playing board games and cards with people. One person continues to attend a day centre twice a week. The home now has a regular supply of newspapers for people to read and one person was seen to read them. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: We completed a two hour observation, after lunch. We saw some improvements with staff interactions from the last key visit but there were still some poor interactions. We discussed these with the manager on the day of the visit. One person had 96 engagement with staff when a task was being completed and another person 37 . This shows that some people get less interaction and staff need to be mindful of this. People were generally in a passive state of being. This means that there were no observable signs of well being but no signs of ill being either. Some people at the home were involved in a sing a long with staff. Music was playing and the television was also on, which was noisy and confusing. One person who had been watching TV became distressed and while staff approached them to try and find out what was upsetting them, they failed to realise that this person was now unable to watch the TV. We saw that staff woke people up to say hello but then left the room and made no further engagements with them. One person who is unable to verbally communicate only received any interaction when staff were carrying out a task, often tasks were done to people without any explanation. One persons care plan said to position them in a place where they could see the TV. On the day of our visit the Christmas tree was directly in front of this person and they would not be able to see the TV. Receipts for peoples personal money showed that people had been out shopping for laptops, TVs and small Christmas trees for their bedrooms. One person said Ive been out shopping a couple of times and I enjoy it. One person has cable TV and had internet access. It was pleasing to see in records that staff had helped them to set up an email account so that they can access things they like to do and that interest them. There is an open visiting policy, which means that people can see their friends and relatives as they choose and can continue with relationships that are important to them. One person told us that her brother had been to visit and they went out shopping. A new menu has been produced since our last visit. The manager told us that people had been involved with this but there were no minutes to support the meeting which had been held. Pureed meals are now served in separate portions so that people can experience the different tastes of the food. Staff were observed to assist people as they needed and encouraged people to maintain their independence. Artificial flowers and condiments have been added to the dining tables to make the tables more attractive and give people the choice of salt and pepper if they chose to have this. There was no one living at the home who required special diets for religious needs on this occasion. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: One person told us Often we get the same food all the time, its too curriefied for me, I like basic meals. We discussed this with the manager on the day of the visit and he told us that he would discuss this with the person to ensure they had meals that they liked. Records were now kept to show what people had eaten however these could be developed further to show amounts of food taken. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements in the arrangements for meeting peoples healthcare needs so that they stay healthy. Evidence: Each person has a written care plan. This is an individualised plan about what the person is able to do for themselves and states what assistance is required from staff in order for them to meet their needs. All of the plans had been reviewed and some contained good information for staff to follow but some plans could be further developed to give more details. When we spoke to staff they were able to tell us about peoples needs. One persons plan referred to a rescue pack but did not give any further guidance of what this was. In the daily records we found that this meant specific medication for breathing difficulties, but there was no guidance for when this should be given. One person had cataracts but there was no mention of this on the communication plan. One person was fed by a tube through their stomach. Staff recorded the amount of fluid given but were not recording fluid output. This should be recorded so that staff Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: can monitor the person. The plans gave conflicting advice for staff about how much water to give with medication as one said 10 to 15 mls and another said 50mls. This may mean that staff would not use the right amount of water to flush the tube with and the tube may become blocked. People had been supported to wear clothing appropriate for the time of the year. During one of the random visits we saw that one person had a large catheter bag on display in the lounge, we brought this to the managers attention at the time. It was pleasing during this visit that peoples dignity appeared to be being met by staff. Records showed that external health professionals were involved in peoples care. This included general practitioners, nurse specialists in tissue viability (sore skin) and respiratory nurse specialists (breathing difficulties) and chiropodists. People are supported to attend appointments at the hospital to ensure that they receive specialist advice. Records did not always clearly state the outcome of these visits and this should be recorded so that staff know if there are any changes to peoples care. One person said Staff get the doctor out to me if I need it, there are no problems there. The pharmacist inspector visited the home two days previous to this visit. Five peoples medicines were looked at together with their medicine administration record (MAR) charts and care plans. All the medicines were kept in a dedicated locked medicine room and were stored in compliance with their product licenses to maintain their stability. All the prescriptions were seen prior to dispensing, checked and a copy taken to check the MAR chart and medicines dispensed by the pharmacist received into the home. The quantity of all medicines received or balances carried over, were recorded enabling audits to take place to demonstrate that they have been administered as prescribed. Audits indicated that medicines had been administered as prescribed and records reflected practice. The nurse had an understanding of what the medicines were for, which would enable her to support the peoples clinical needs. A requirement from the last inspection required that protocols were written detailing how to administer medicines prescribed on a when required basis. The nurse gave information of how and when she would use these to treat the medical condition but was unsure of the frequency between doses. Further training is required to ensure that staff are fully aware of when to administer these medicines. Protocols for medicines to be administered when required were not readily available in the MAR chart folder. All controlled drug balances were correct. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not confident that their concerns are listened to and acted upon. People are not always protected from harm. Evidence: The complaints procedure is displayed in the home in large print and is included in the service users guide so that people know how to make a complaint if they need to. Since the last inspection we have received one complaint which we referred back to the provider to investigate using their own complaints procedure. The complaint was not upheld by the providers following their investigation. One person told us that they were unhappy with the food choices. They told us I expressed my concerns with this when I moved in and the chef came to see me and it got better but now its the same again. There were no records of this complaint and the manager told us that he was not aware of it. This does not ensure that people can be confident that their concerns are listened to and acted upon. During one of the random visits to the home we looked at the complaints records. We were concerned that a potential safeguarding concern had been dealt with using the complaints procedure and had not been referred to social care and health as the lead in coordinating any investigations. The person was no longer living at the home and we told social care and health so that they could follow up the concerns. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: Since the key inspection in July 2009, there have been three safeguarding referrals made by external professionals, to ensure that people are safe from harm. One of these referrals relating to personal care needs was highlighted during this inspection and it was concerning that staff did not appear to recognise the safeguarding concerns. Some staff spoken to were not able to tell us what they would do to safeguard people in the event of an allegation. One member of staff did not know who should be contacted and one member of staff said it wouldnt happen here. Training records indicated that staff had received in house adult abuse training in August. It is concerning that staff had not recognised potential safeguarding concerns and this may mean that people are not protected from harm. The manager should complete audits on staffs understanding of training received, so that they are competent to keep people safe. We looked at three peoples money and found records and balances to be correct. Each person has their own records and receipts were kept. An audit is completed each month so that any discrepancies are found. This should ensure that peoples money is kept safely. 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 environment does not meet the needs of all of the people who live there. Evidence: The home had been decorated with a Christmas tree and trimmings for the festive period, and the atmosphere was more friendly and relaxed than on previous visits. At the previous key inspection we found that the lift had broken down on several occasions and that engineers had been called out to repair it. We were told that quotes were being obtained for a new lift but there were no dates confirmed for work to begin. During this visit we found that the emergency call bell in the lift was not working and this may mean that people could be trapped in the lift and be unable to alert anyone. This must be resolved to ensure that people are safe. Serious consideration should now be given to replacing the lift as should the lift breakdown; most people would not be able to use the stairs due to mobility difficulties. This could place people at risk of harm and isolation. Three peoples bedrooms were seen and were found to contain personal possessions as they had chosen. This means that people can have things that they like and are familiar to them. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: The assisted bath was now in working order and the bathroom was in the process of being retiled. This means that people can now have a choice of a bath or shower in a homely bathroom. During one of the random visits we saw that the door to the shower room was damaged and this has now been repaired. There were no offensive odours noted during this visit to the home. 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. Not all staff have the knowledge to meet peoples individual needs. Evidence: During the day there are five care staff and one nurse, and two care staff and one nurse at night. The home also has domestic, kitchen and maintenance staff to meet all the needs of the people living at the home. One person said the staff are alright, except in the night, they come quickly when I call them. During our two hour observation we saw more neutral and positive interactions from the staff with people living at the home than on the previous key visit. One person had 100 neutral interaction. One person had 37 neutral with 58 positive interaction and another had 46 neutral and 41 positive interaction. The negative interactions seen were greatly reduced from the last visit with people receiving 5 , 11 , 13 , 15 and 25 negative interactions. We saw that staff had some good interactions with people who could verbally communicate, but interaction remains limited when people cannot communicate. We saw that staff sometimes did things to people without explaining what they were doing. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: The manager confirmed that 80 of the staff have a National Vocational Qualification (NVQ) level 2 in care and that the last four staff have been registered to complete this course. This should mean that staff should be able to meet the needs of the people living at the home individually and collectively. Some of the staff we spoke to during the random visits were unable to tell us how to safeguard people from harm in the event of a fire and further training had been given in this area. During this visit some staff were not able to tell us how to safeguard people in the event of an allegation being made. Further training should be given so that staff know what to do. We looked at one new staff file. All of the checks required were in place to ensure they were suitable to work with vulnerable people. The person had been employed to work 24 hours but their visa only allowed them to work for 20 hours per week and this was brought to the attention of the manager. Training records showed that staff had had training in Infection control, moving and handling, health and safety awareness, principles of care, fire and adult abuse. These topics are relevant to the needs of the people living at the home. Epilepsy, care planning and managing aggression training was booked for trained nurses in February 2010. 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 home needs to sustain improvements while continuing to further improve. The home is not always managed in the best interests of the people who live there. Evidence: Since the last key inspection, we have made a further three random visits to monitor progress at the home. We also asked the owner and manager to a meeting with us so we could discuss our concerns and how the home needed to improve. We have found that the home responds well when they are told they need to put something right but this response is reactive. The home must now demonstrate that it can be proactive in identifying concerns and act upon them in the best interests of the people who live there. The manager told us that he now has some control over the budget for the home and this means that he can order equipment, for example when it is needed. The manager was able to tell us how the food was ordered and had control over what was brought. A representative visits the home and has started to complete regulation 26 reports Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: each month. (These are reports about the quality of the service being provided). We found that these reports were quite brief and should be more detailed so that the quality of the service is monitored. During one of the random visits, one of the owners showed us a new tool they had developed to monitor the quality and this will need to be tried and reviewed to ensure it is a useful tool. The manager told us that the support from the owners was much better now. The manager had planned a number of audits to be completed each week, and progress on this will be reviewed at further visits to the home. At the last visit to the home we told West Midlands Fire Service about our concerns around fire safety. Following this visit staff received fire training however the fire service told us that they had a number of other concerns. During our first random visit to the home we looked at the fire risk assessment which did not provide staff with enough details about how to keep people safe in the event of a fire. The owners asked an external company to come and complete an assessment. The company made a number of recommendations and we were concerned that some of these had been signed as completed when they were still outstanding on the day of our second random visit. We had identified in the July 2009 visit that staff were not receiving fire drill training and it was disappointing to find that not all staff had participated in fire drill training on the visit in November. Some staff were unable to tell us how they would protect people from harm in the event of a fire. We expressed our concerns to the owners and action was taken to provide further staff training and a number of fire drills were completed. Some bedroom doors were not closing fully and would not protect people from harm. We left an immediate requirement and we visited two days later to check they had made the doors safe. The home had responded to this and had adjusted the doors. The fire service has now told us that they have visited the home and are satisfied with the actions taken by the home to improve the fire safety. We found that there were no checks in place on wheelchairs to ensure that they were safe and in working order. The manager told us that wheelchair services check them but records indicated they were only seen when there was a fault. One person who lives at the home said No one checks my chair unless there is something wrong with it. Arrangements must be made for regular checks to be completed. The emergency call bell in the lift was not working and this may mean that people could be trapped in the lift and be unable to alert anyone. Whilst the home was aware of the fault they had not taken any action to get this repaired to keep people safe. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: While there have been some improvements at the home we have concerns around the management of complaints and protection of people who live at the home. We will continue to monitor the home and its progress. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Bed rails risk assessments must be reviewed and contain sufficient information so that full safety checks are completed. To ensure that people are safe. 31/01/2010 2 22 22 Systems must be in place to record peoples complaints. So that people can be confident they are being listened to and their concerns acted upon. 31/01/2010 3 23 13 Staff must have the knowledge to recognise and report potential safeguarding concerns. So that people are safe from harm 31/01/2010 4 42 13 The lift call bell must be in full working order. 11/01/2010 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 So that people can call for help. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 16 People should be more involved in making decisons about their lives and activities they participate in. Activities offered should be reviewed for people who have limited or no verbal communication so that they have activities which provide stimulation and an interesting lifestyle. All people should have a choice of food that meets their individual preferences. Food records should give details of the amounts of food people have eaten so that their dietary intake can be monitored. The outcome of any hospital visits should be clearly recorded so that staff can easily find information. Care plans should be under continual review to ensure they provide staff with up to date information. Protocols should be written so that staff have guidelines to follow about when to give as required medication. It is advised that further training is given so nursing staff understand how to follow and administer medicines prescribed on a when required basis Consideration should be given to replacing the lift so that people can be confident it is safe to use at all times. Staff should only be employed for the number of hours that their visa allows them to work. Audits of staffs understanding of training should be undertaken so that the manager can be sure that staff understand the training they have received. Page 31 of 33 3 4 17 17 5 6 7 8 18 18 20 20 9 10 11 24 34 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 12 42 Arrangements should be in place so that wheelchairs are checked to ensure that they are in full and safe working order. 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. 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