Inspection on 02/06/10 for Karistos

This inspection was carried out on 2nd June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 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 17/03/10

Karistos 10/12/09

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 03/09/2010.

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: 0 2 0 6 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Akinwumi Olusegun Akinpelu Type of registration: Number of places registered: care home 17 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. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 17 1 0 1 2 2 0 0 9 Brief description of the care home 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 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 £500 - £800 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 32 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. Since the last key inspection in December 2009, we visited the home and completed a random inspection on the 17th March 2010. The purpose of this visit was to monitor the homes progress at meeting the outstanding requirements. At this visit we found that the home had made some improvements and these now needed to be sustained. At the time of our last key inspection, Adults and Communities had placed a suspension upon the home. This meant that no more people could go and live there until the home had improved. They lifted this suspension on the 1st March 2010. Care Homes for Adults (18-65 years) Page 6 of 32 This visit to the home was undertaken by two inspectors over a full day. There were 13 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 tell us verbally about their experiences, so we use a formal way to observe people to help us understand. The SOFI involved us observing five people who use the service for two hours and recording their experience 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 this report. Information was gathered from speaking to three people and observing people who live at the home. Two 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 partly looked at one other care file, we also looked at staff files, training records, and health and safety files. We spoke to four staff. Before this visit duplicate surveys were sent out to the home which means they received 20 for people who live there and 20 for staff. This may mean that some people have completed a survey twice. We received 13 surveys from people who live at the home and most people had been helped by staff to fill them in. We received 10 surveys from staff. Peoples comments are included within the report. Reports of any complaints or incidents reported to us were reviewed in the planning of the visit to the home. We left an immediate requirement on the day of the visit regarding hot water temperatures in peoples bedrooms. This was to ensure that action was taken to minimise the potential risk of scalding to people. The manager told us that risk assessments had been written for people and that staff had been informed of the hot water temperatures. He told us that work had been completed on the water system to reduce the temperatures. We visited the home when the work was completed and found that water temperatures had been reduced and the potential risk to people had been minimised. Due to concerns identified during this visit about some peoples health care needs we have issued the home a Statutory Requirement Notice. This is to make improvements in the quality of service for the people who live at the home. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: As identified at previous visits to the home, the home responds well when they are told to put something right but this is a reactive response. We are concerned that without the continued input from external agencies, the home would not identify and act upon areas of concern. The home must demonstrate that it can be proactive in identifying concerns and act upon them in peoples best interests. People should be given choices and be supported to make decisions about their lives. Care plans and risk assessments must be improved to ensure that peoples needs are planned for and that staff have guidance to follow to support people. Staff need to have the knowledge and skills so that peoples needs are met and people are safe from harm. Offensive odours in the home should be addressed so that people live in a pleasant environment. Recruitment procedures must be robust so that staff have appropriate checks to ensure they are fit to work with vulnerable people. The home must ensure that bed rails are safely fitted so that people are safe from Care Homes for Adults (18-65 years) Page 8 of 32 harm. 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 32 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 32 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 to know about the home if they decide to live there. Evidence: We saw that the service user guide and statement of purpose are available in the reception area of the home and in each persons bedroom so that people can refer to them if they want to. The manager confirmed that there had not been any changes to the documents since July 2009. We were told that they can be made available in a large print format so that people with visual impairments can access the information. The certificate of registration and copies of the last inspection reports are available in the reception area so that people can read these if they choose to. At the previous key inspection a suspension had been placed upon the home which meant that no one else could go and live there. The suspension was lifted on the 1st March 2010. One person had moved into the home but they had moved out again the next day. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: We were not able to assess the admission process at this inspection as there was no one new living there. The AQAA stated residents are given the opportunity of viewing the home prior to being admitted and if possible allowed one or two days sleep over. This means that people can sample life at the home before they decide if they want to live there. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the people are supported to make decisions about their lives or are given choices. Some people may not experience a lifestyle that meets their individual needs or expectations. 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. Some of the plans we looked at were confusing and did not contain enough information about peoples individual and specific needs. People are not always offered choices. Examples of this are during the morning when drinks were being given out, there were seven people in the lounge but only one person was offered a choice of tea or coffee even though both were available. Different types of biscuits were available but no one was given a choice. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: During the SOFI one person was woken and moved to different chairs three times. Staff did not give any explanation. This was to make room to get chairs past or because another person living at the home wanted to sit in that space. This meant that this person had no choice about where they wanted to sit. We saw that people who have verbal communication skills receive more interaction from staff and people who cannot verbally communicate receive little interaction. One person prefers to stay in their room and they told us theres not really anyone I can talk to, the staff come up and see me. This means that some people do not receive a stimulating and interesting lifestyle. A member of staff said to one person who lives at the home smile for me baby. This does not ensure that people are treated with respect for their age. One person told us that they had been involved in choosing the colour for their room and had been involved in interviewing a new member of staff. This means that some people are involved in some decisions within the home. Risk assessments were completed for nutritional needs and when people were at risk of choking. At the random inspection in March we recommended that these were improved with current information and proactive measures to minimise the risks to people. One persons plan and risk assessment made no reference to the thickening powder that should be used in fluids to minimise the risks and we were told conflicting information by the staff. This does not ensure that risks to people are minimised. Meetings are held with some people who live at the home and their relatives so that they can discuss any ideas or concerns and things that are happening in the home. Care Homes for Adults (18-65 years) Page 14 of 32 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 needs and preferences. Evidence: Since our last visit to the home a new activity coordinator has been appointed. He was a carer at the home and knows the people who live there. During the visit we observed staff playing cards and games with people and reading to them. The AQAA told us that some people go out to church and out shopping, so that they continue with things that are of interest to them. One person said I went into town with X and had a McDonalds, it was a nice day out. Before lunch we completed a two hour observation. We found that there were some good interactions but there were still many poor interactions. We found that as on previous visits to the home, people who can verbally communicate receive more Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: interactions from staff than those that cant. One person had positive interactions of 21 and another had 57 . We saw that one person hardly had any interaction from staff at all. Staff need to mindful that people who cannot verbally communicate still require interaction and stimulation. One person who appears to engage in the TV is not seated in a position that means that they can see the TV without straining their neck. We had discussed this at our last visit to the home but people were still sitting in the same places. We saw that staff were still waking people up but then not engaging with them any further, an observation we made at the last visit to the home. Receipts for peoples personal money showed that people had been out shopping to but things that they liked such as mobile phones, portable TVs and clothes. One person had been out to an Irish centre and one person had been to a community cafe. A day trip has been organised to a nature centre. Ideas for days out had been discussed in a residents meeting so that people had a say in where they wanted to go. The home has an open visiting policy, which means that people can see their friends and relatives as they choose and can continue to maintain relationships that are important to them. The manager confirmed that there had not been any changes to the menu since our last visit. There is a choice of cereals or cooked breakfast and two choices for lunch and supper. One person said Its improved, I wanted fish and chips and they fetched them for me from the shop. We observed the lunch and saw that staff offered gravy from a gravy boat so that people had a choice about sauces. One person was feeding themselves but were using their fingers to scoop food up. A simple adaptation such as a plate guard would have increased this persons independence whilst promoting their dignity and this was brought to the attention of the manager on the day. Care Homes for Adults (18-65 years) Page 16 of 32 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. Staff knowledge and systems do not always ensure that peoples health needs are met 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. The plans we looked at were confusing and did not contain enough information about peoples individual and specific needs. We saw that the manager was implementing new typed care plans. These had been put into the files with the older hand written care files and information in these was different. When we spoke to staff they gave us conflicting information about peoples needs. Some senior staff could not tell us about peoples needs which were identified from their care plans and medication charts. This does not ensure that staff know about peoples current care needs and have systems in place to monitor healthcare needs. One person was on two different medications for constipation and had also had Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: suppositories prescribed and administered. The person had no care plan for constipation so that staff knew how to monitor this. One staff member told us last month he was in hospital for bowel problems. We asked one staff member why the person was on laxative medication and they said everyone has it. We saw that thickener had been sent to the home for one person (this is a powder which is added to drinks to make it thicker when people have swallowing difficulties). We spoke to four staff and the manager about how much thickener should be used and when. It was of concern that each person gave us different advice. If staff do not use the correct amount of thickener, this places people at risk of choking. One person was prescribed insulin twice a day. There had been a number of occasions when this had not been given due to the persons blood sugar level being too low. Records showed that when the insulin was omitted, the blood sugar levels were not checked again until before the evening dose was to be given. No review of this persons diabetes had taken place and this does not ensure that this condition is being appropriately managed to ensure they stay healthy. We looked at the management of medication and found that some of the Medication Administration Records (MAR) were not signed. One record for suppositories said use as required. An additional handwritten entry said one after 8-10 hours. This was not signed so we did not know where the instruction came from. We saw that these had been administered at various times of day. There was no protocol in place for when one person should not be given insulin. This does not ensure that people receive their medication as prescribed. Medication was stored within the correct temperature and controlled drugs were accurate. Due to the concerns at this visit we have issued the home with a Statutory Requirement Notice around peoples healthcare needs, to make the home improve the service offered to people who live there. We will continue to monitor the service. Care Homes for Adults (18-65 years) Page 18 of 32 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. Systems are in place to listen to people and act upon concerns. 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. The home had not recorded any complaints since our last inspection and we have not received any complaints about the home. In the surveys we received, people indicated that they knew who to talk to if they had any concerns. People told us: Everything here is ok I see the manager everyday During our last inspection one person told us that they were unhappy with the food choices and we brought this to the attention of the manager. We spoke to the person again and they said the cook comes up everyday to see what I want, its improved. This means that people can be confident that their concerns are listened to and acted upon. At our last inspection, we identified a safeguarding concern relating to a persons personal care needs. This was investigated under the safeguarding procedure and the case has been closed. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Staff had been enrolled onto a distance learning course for Safeguarding Of Vulnerable Adults (SOVA). The trainer was at the home and told us that ten members of staff had successfully completed the course. We spoke to staff to determine how they would protect people. It was of concern that a senior member of staff did not think that if people who lived at the home were shouted at, that this should be raised as a safeguarding referral. This may mean that people are not always protected from harm. Some staff had not had appropriate recruitment checks and risk assessments completed when they came back to work at the home. This places people at potential risk of harm. We found that water temperatures were too high and placed some people at risk of being scalded. One persons bedrail was not fitted correctly which meant that they may be at risk of injury. This does not ensure people are safe from harm. We looked at two peoples money and found records and balances to be correct. Each person had individual records and receipts were kept when money was spent. Monthly audits are completed so that any discrepancies would be found to ensure peoples money is kept safely. Care Homes for Adults (18-65 years) Page 20 of 32 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. Offensive odours do not promote a pleasant environment for people to live in. Evidence: There had been some redecoration of the home since our last visit. The reception area and lounge had been redecorated and a new carpet laid in the lounge. A programme of redecoration was in place to decorate peoples bedrooms. This will enhance the environment in which people live. One person who lives at the home told us that they had moved into a new room, they said Its all been decorated and Ive got my own fridge. I chose my own colours, they brought me some colour charts to look at. This means that some people are involved in making decisions about their rooms. New lighting had been installed throughout the home to make it more domestic in style. As commented during previous inspection reports communal space is limited for the number and dependency of the people who live there. This was observed again during the SOFI when people were moved from chair to chair so that wheelchairs could be maneuvered. We looked at three peoples rooms and these were personalised to different tastes and contained personal possessions as people had chosen. Two peoples rooms we saw had offensive odours and we also experienced this in some of the corridors. This does not Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: ensure that people live in a pleasant environment. In December 2009 we found that the emergency call bell in the lift was not working and that people could not call for help. When we visited in March 2010 we found that this had been addressed but had not been met within the timescale given to the home. Further work has been undertaken and the call bell is now very loud to ensure that people can be heard if they are trapped in the lift. The garden area had been tidied up and trees and shrubbery had been cut back so that people could use the garden area if they wanted to. The Primary Care Trust (PCT) had completed an Infection Prevention and Control Audit in April 2010. This resulted in a score of 73 which meant that the home fell within the minimal compliance score range and some urgent action was recommended to address the concerns. One of the owners told us about further improvements that they were working on. This included work in the cellar, which was in progress on the day of the visit. Lever taps had been ordered for sinks in bedrooms and new soap dispensers had been installed in all of the rooms. These improvements were in response to the infection control audit. The manager told us that the Environmental Health Officer had visited the home the previous week. We looked at their report and found that they had told the home about three things they must do to ensure that food was prepared and kept in a safe and hygienic way. Care Homes for Adults (18-65 years) Page 22 of 32 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. People cannot be confident that staff are sufficiently recruited, trained, skilled and knowledgeable to enable them to meet peoples individual and collective needs safely. Evidence: In the morning there are four care staff and one nurse, in the afternoon there are three care staff and one nurse, and during the night there are two care staff and one nurse. There appeared to be sufficient numbers of staff to meet peoples needs. The home also have domestic, kitchen and maintenance staff to assist people to meet all their needs. One person told us the staff are good, they have a laugh and come up and see me. During the two hour observation we saw that staff had some good interactions with people who could verbally communicate, but interaction was limited with people who could not verbally communicate. We saw that staff woke people up but then did not engage with them any further. We saw that some staff still did things to people without explaining what they were doing, for example moving their feet and putting slippers on. The manager interacted well with the people living at the home and people appeared to know him. Overall for the group we saw good interactions of 35 , poor interactions of 30 and neutral interactions of 35 . This means that the interaction was neither good nor bad. Only 1 of the group had a positive state of Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: well being, with the majority of 76 being in a passive state. (This means neither good nor bad). The AQAA stated that 80 of staff have a National vocational Qualification (NVQ) level 2 in care and that the remaining staff are undergoing this training. This should mean that staff have the knowledge and skills to meet the needs of the people living at the home individually and collectively. Some staff do not show this knowledge in practise. We looked at two staff files. One file for a new nurse contained all of the relevant checks with the exception of their Personal Identification Number (PIN) being checked with the Nursing and Midwifery Council (NMC). This was done at the time of our visit and should be checked to ensure that nurses are registered and fit to practise. The second file was of concern. The person had worked at the home previously as a carer but had taken indefinite leave in April last year. The manager told us that they had come back to work in the kitchen, in April this year and that new recruitment records had been completed. We found that the file contained only original recruitment records, references and Criminal Records Bureau Checks. No risk assessment had been completed and there were no records of any discussions taking place about what the person had done for the last year. There was some evidence that the person had completed some training courses in May and June but there were many months unaccounted for. This does not ensure that people are safe. Someone who lives at the home told us I met a new nurse yesterday, I liked her and want her to come here. The manager explained to us that a nurse had come to the home for an interview and the person living at the home had been involved with this. This means that some people are involved in the home and how it is run. Training records showed that some staff have had training in safeguarding, dignity in care homes, managing aggression, care planning and assessment of needs and administration of medicines. These topics are all relevant to the needs of the people living at the home. Epilepsy training had been booked for trained staff however the course had been cancelled and new date had not yet been confirmed. It was of concern that despite this training we were not able to evidence that the training was being consistently put into practise. Care Homes for Adults (18-65 years) Page 24 of 32 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 is not run in the best interests of the people who live there. Evidence: As we have identified at previous inspections to the home, the manager and owners respond well when they are told they need to put something right and make improvements, however this is a reactive approach. We found that the home was providing poor outcomes for people in July 2009 and there have been a number of visits since then to monitor the home. We have found that some things improve but other areas slip and improvements are not always sustained. We are aware that Birmingham City Council have been monitoring the homes performance and working with them to improve the standards. In addition the Primary Care Trust (PCT) have also been monitoring the home and have devised an action plan to improve standards. At the end of last year West Midlands Fire service were working with the home to improve fire safety. The manager told us that the fire officer had visited the home the previous week and they were happy with the progress the home had made. We confirmed this with the fire officer in a telephone call the day after our Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: visit. There has been a recent visit from the Environmental Health Officer and this resulted in three requirements on the home to improve. We are concerned that the home is unable to identify and act upon these concerns without continuous input from external agencies. We are now considering what further action to take to improve the service offered to people. The manager has completed a three day course in tissue viability (prevention and treatment of sore skin), Safeguarding Of Vulnerable Adults training and adult literacy. This means that he keeps his knowledge up to date. The owners visit the home regularly and one person who lives at the home said The directors always pop in to say hello, they are a friendly crew. Reports about the quality of the service are written each month and a number of audits are in place. This should assist the owners and manager to identify any areas for improvements before external agencies have to tell them. It is of concern that these visits have not identified many of the failings during this and previous inspections. On the day of our visit records showed that water temperatures were very high in peoples bedrooms, and meant that some people could be at risk of being scalded. Whilst the owners had contacted an external company to rectify this, no immediate actions had been taken to minimise the risk to people. We checked the temperature in three rooms with the manager and these recorded at between 60 and 62 degrees. An immediate requirement was made for this to be made as safe as possible to protect people. At the random inspection in March 2010 we saw that risk assessments for bedrails had been reviewed to ensure that people were still safe to use them. During this visit we saw that one persons bedrail was not safely fitted to the bed, placing the person at risk of injury. The weekly check list suggested that the rail had been checked and was safe for people to use. This does not ensure that people are safe from harm or give people confidence in the robustness of these checks. While there have been some improvements in the decor of the home, we still have concerns about care planning and risk assessments, the protection of people who live there, the overall management of the home and its failure to sustain improvements. Care Homes for Adults (18-65 years) Page 26 of 32 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 27 of 32 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 1 43 13 Arrangements must be in place. To minimise the potential risk of individuals being scalded by hot water in bedrooms. 03/06/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 Care plans must be updated 07/07/2010 when peoples needs change. So that staff know how to support people. 2 9 13 Risk assessments must contain enough information about how to minimise the risks. So that risks are minimised and people are safe. 07/07/2010 3 16 12 Staff must interact with people who live at the home including people who are unable to verbally communicate. So that people lead an interesting and stimulating lifestyle. 05/07/2010 Care Homes for Adults (18-65 years) Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 19 12 Make arrangements to ensure that staff comply with peoples identified healthcare needs. So that peoples needs are met and people are safe. 25/06/2010 5 19 12 Ensure that systems are in place. To promote and make proper provision for the health and welfare of service users. 25/06/2010 6 20 13 Written protocols must be in 07/07/2010 place for medications that may need to be omitted. So that staff have guidance to follow to ensure peoples needs are met and people recieve medication. 7 20 13 Medication must be signed for when administered. To ensure that people receive their medication as prescribed. 07/07/2010 8 23 13 Staff must have the competence to recognise and respond to potential safeguarding concerns. To protect people from harm. 07/07/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 9 32 18 Staff must have the knowledge and skills to interact with people and know their needs. So that peoples needs are met in a way they prefer that is meaningful. 07/07/2010 10 34 19 Robust recruitment systems must in place. To ensure that people are safe from harm. 28/07/2010 11 39 12 Systems must be in place to identify areas of concern and action taken in a proactive way. To ensure that the home is run in the best interests of the people who live there. 30/07/2010 12 43 13 Bed rails must be safely fitted. To ensure poeple are safe from harm. 02/07/2010 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 2 6 14 People should be involved in making decisons so that they are supported to make choices. People should be supported to be seated in a comfortable position to watch the televison as they choose to. Care Homes for Adults (18-65 years) Page 30 of 32 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 3 17 People should be given aids to use that will enable them to maintain their independence and promote their dignity while eating meals. People should be supported and reviewed by healthcare professionals including specialist nurses so that medical conditions are managed. Offensive odours should be addressed so that people have a pleasant environment in which to live. 4 19 5 30 Care Homes for Adults (18-65 years) Page 31 of 32 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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