Inspection on 07/07/09 for Karistos

This inspection was carried out on 7th July 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 7 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 10/12/09

Karistos 12/11/09

Karistos 09/11/09

Karistos 22/10/09

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: 0 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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 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 our inspections 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. The visit to the home was undertaken by one inspector over eight and a half hours. A second inspector completed a Short Observational Framework for Inspection (SOFI) of five people over two hours. We were assisted throughout by the Registered Manager and lead nurse. The home did not know that we were visiting that day. There were 16 people living at the home and one person was receiving hospital care. The last inspection at the home was on the 25th July 2008. 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 Care Homes for Adults (18-65 years) Page 6 of 33 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. 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 also looked at staff files, training records and health and safety files. Before the visit we sent random surveys to ten people who live at the home and to staff. We received surveys from four people who live at the home and eleven staff. Three people who live at the home, two relatives and six staff were spoken to. Prior to the inspection the manager had completed the Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about how well the home think they are performing. It tells us about the home, staff and people who live there, what the home do well and what they need to improve. Reports of any complaints or incidents reported to us were reviewed in the planning of the visit to the home. Following our visit we contacted West Midlands Fire Service as we had concerns about training and staff knowledge about what to do in the event of a fire. The fire service have since visited the home and issued a Statutory Requirement Notice to ensure that staff will have the knowledge about how to keep people safe in the event of a fire. 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: People should be given choices and be supported to make decisions about their lives. Risk assessments need to be reviewed so that people are safe from harm. People must have a choice of activities so that they experience a meaningful lifestyle. One person said I get bored quite a lot, I like to read the newspaper but there are none in the home. People must be offered a choice of meals that meet their dietary, religious needs and preferences. One person said there is no taste to the food. Care plans must be reflective of current care needs so that staff know how to assist people. People need to know that complaints are taken seriously and that they are listened to. The cleanliness and decoration of some parts of the home should be reviewed so that people live in a clean and homely environment. Staff should receive training so that they know how to meet all the needs of people living in the home. Care Homes for Adults (18-65 years) Page 8 of 33 The providers need to regularly review the quality of service being provided. Staff need to know how to protect people from harm in the event of a fire. 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. People have information to enable them to make an informed decision about whether they would like to live at the home. Pre admission assessments ensure people know their needs can be met prior to moving in. Evidence: The service user guide and statement of purpose give people information about the home. They are available in the reception area and are in each persons room 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 information had been reviewed in January this year to ensure that it was up to date. The certificate of registration and a copy of the last inspection report are displayed in reception so that people can read these if they chose to. Records sampled showed that peoples needs are assessed before they move in to ensure that their individual needs can be met. Following assessment the manager sends a confirmation letter that the home can meet their needs. This ensures that Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: people are confident that their needs can be met when they move into the home. One person who had recently moved into the home said Its good, its like hospital but a bit better. 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 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 always supported to make 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. Some of the plans had good information for staff to follow but this was not consistent and some plans did not have enough information. There is a key worker system in place and one member of staff told us that this meant they kept the persons room tidy and that they had personal things. One person told us that he could go to bed when he wanted to and that he had a choice of meals but it was usually the same sort of thing. People who were unable to communicate were not given choices for example, on the day of our visit the cook told us that those who could speak would be asked what they wanted to eat but people who could not communicate were given meat and rice. This does not ensure that people are given the opportunity to make their own decisions. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Care plans seen made reference to people having a bath or shower on a particular day such as shower on a Friday or shower every Thursday. There was a notice board in the corridor that told staff what day to shower each person, this indicates that the home appears to be run to a routine rather than a person centred approach where people make their own decisions. People were unable to have the choice of a bath on the day of our visit as the bath was not working. Risk assessments are undertaken each month for skin soreness, nutrition and risk of falls. People had risk assessments in place for use of bed rails but one of these had not been reviewed since August 2006. This does not ensure that the assessment is current and relevant to the person in order to keep them safe. Consideration had not been given to the possibility of people getting sore skin on a recent day trip and this had resulted in one person getting a sore. Residents and relatives meetings are held at the home and minutes of the meeting held in April were seen. These meetings give people the opportunity to share ideas or concerns about the home. One resident asked the manager when the next meeting would be and told us that she liked to attend these. A social committee meeting had been held in May 2009 where people discussed plans for the day trip in June. A relative told us that the relatives meetings are helpful and you can put your point across. Staff interaction with people was poor and some appeared to have limited understanding about how to communicate with people who were not able to communicate verbally. During our short observational framework inspection (SOFI) staff did not acknowledge or speak to people when they came into the room. We saw that one person living at the home became distressed and was not approached by staff to find out what was wrong. This does not ensure that peoples needs are met. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people using the service experience a lifestyle that is meaningful and meets their needs or expectations. People do not always receive a choice of meals which meet their cultural needs or preferences. Evidence: The home has an activity coordinator who is also a senior carer. She works as an activity coordinator for four days of the week but still has some carer responsibilities during this time. On the day of our visit the activity coordinator had escorted someone to a hospital appointment and therefore was not able to provide activities. There was a weekly activity programme which included board games, music and movies. A church service is held once a month for people who wish to continue with their religious beliefs and one person told us that they go out to their own church with a friend once a month. One person attends a day centre twice a week. One person said I get bored quite a lot, I like to read the newspaper but there are none in the home. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: The activity coordinator told us that external entertainers were booked for birthdays and Christmas but there was nothing planned at present. There had been a recent day trip to Drayton Manor Park and some people go out shopping. One person had been on holiday but no one else had any holidays arranged and one relative said I would like them to do something with holidays for them. Receipts for peoples personal money showed that people spent their money on hairdressing and a recent day trip. This shows that people may not be accessing other leisure activities. We completed a two hour observation, this started mid morning and continued over lunchtime. It was concerning that people were mostly sleeping and those who were awake were not engaged in any meaningful activity for the duration of the observation. Two people had a 100 negative staff interaction during the two hours. One person had 67 negative, another 50 and one person had 40 negative interactions. Overall the five people only had positive staff interaction of 17 over the two hours. Staff made little attempt to engage with people and engagement was usually as a result of a task being carried out. One person told us that when they went to the lounge, some of the other residents would tell her to go back upstairs. Although this person prefers to spend most of their time in their room, the management of this situation does not ensure that she is able to go to the lounge if she chooses to. There is an open visiting policy, which means that people can see their friends and relatives as they chose and can continue with relationships that are meaningful to them. A relative told us that they could visit at anytime. The home has a four week rolling menu in place. We looked at the menus and these showed that cereals or cooked breakfast were offered. The menus didnt always show that there were a choice of foods, for example scampi, chips and peas was the only meal on the menu on Friday lunchtime on two weeks. Where two choices were offered consideration needs to be given to the choices, for example on one evening the choice was a sausage sandwich or sausage and mash. The menus didnt tell people what alternatives they could have if they didnt want sausage. Some people have their meals pureed because they have swallowing difficulties and it was disappointing to see that the food was all mixed together in the bowl as this does not ensure that people can experience the texture and taste of different foods. One person was feeding someone breakfast and was standing up to do this, the manager intervened and asked the staff member to sit down with the person. One member of Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: staff at lunchtime was feeding a resident and during this time did not speak to the person about their meal or tell them what they were eating. This does not make mealtimes an enjoyable time for people living in the home. One person in the home requires a Halal diet in order to maintain their religious needs. The manager told us that this person refused to eat at the home and that family brought in food. The person living at the home told us that there was no taste to the food and that she was only offered chicken or fish. The person told us that on one occasion when the family were unable to visit, the home could only offer them chips. We looked at the food stock and found that there was one piece of fish identified as being halal, however you cannot purchase halal fish. There was no halal meat for this person. The home were unable to produce any receipts as proof that halal meat was purchased so that this person could have a choice of halal meals. Food records showed that this person had ice cream, fish and bread or chips. Did not eat was recorded on a number of occasions but there was no evidence of what foods had been offered. This does not ensure that people are receiving meals that they like and that meet religious needs. 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. Arrangements do not always ensure that peoples health needs and dignity are met, which could impact on their well being. 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 had good information for staff to follow but this was not consistent and some plans did not have enough information so that staff would know how to meet peoples needs. When we spoke to staff most of them were able to tell us about individual peoples needs. People had been supported to wear clothing appropriate for the time of year and which reflected cultural, gender and personal preferences. We observed that people were not always supported to maintain their dignity; examples of this include one persons catheter bag which was full of urine showing beneath their trousers and one person using their hand to wipe away saliva as they were not offered a tissue. Records sampled showed that where appropriate other health professionals were Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: involved in peoples care. This included General Practitioners, nurse specialists in tissue viability (sore skin) and Multiple Sclerosis, opticians, dentists and chiropodists. There was evidence that people are supported to attend appointments at various clinics and hospitals and this means that people receive the specialist care they need. One person had three different care plans relating to their continence care and it was confusing which plan was to be followed. A short term care plan had been written when someone had been on a course of antibiotics but there was no evaluation of the plan to show if the treatment had been effective or not. One person was using a hoist for transfers and staff were able to tell us this, but there was no care plan in place to tell people what equipment they should use. Daily records for one person talked about sore skin and that heel protectors were being used. When looking at the care plans they made no reference to the use of heel protectors and the skin care plan had not been updated to include the information about skin being sore. Another person had developed a skin sore following a day trip as there was no planning by the home before the trip about how they would change people to ensure they were dry, and no review about how long people would sit in one position. Daily records gave details about the sore but a care plan was not written for five days after the sore developed. This does not ensure that staff will know what to do or that the skin can be monitored. There had previously been concerns raised around tissue viability within the home as the home had not sought advice from the relevant people. The home were working with the Primary Care Trust (PCT) and had referred this person to the tissue viability nurse specialist. The management of medication was reviewed and people received their medication as prescribed. Medication was signed into the home upon receipt and copies of prescriptions were kept so that staff could check the medication. Controlled drugs were stored safely and records were correct. One persons eye drops had not been dated when opened, so that staff would know when to discard them to prevent cross infection. All of the audits completed were correct with the exception of one tablet where there were four unaccounted for. The lead nurse told us that this person went home at the weekend and they didnt always know what tablets had been taken while he had been at home. It is recommended that tablets are signed back into the home on return from leave so that the home has an accurate audit trail. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not ensure that people can be confident that their concerns are listened to and acted upon. There are some systems in place to protect people 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. There is a suggestion box in reception where people can write down their comments and suggestions however the manager confirmed that this was not used. The home had received two complaints since our last visit. The complaints were recorded, including how the complaint had been investigated, actions taken and the outcome. We had received a complaint about the management of the home and we asked the provider to investigate. The provider sent us a response to the complaint but it was disappointing that when we tried to speak to the provider regarding further information, he did not return our calls. We have since written to the provider again, however we have not received a response and this does not give us confidence that the provider wants to listen to concerns and improve the service. We had received some concerns regarding odours and lack of equipment in the home and these concerns were reviewed throughout our visit. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: In the surveys returned to us from people living at the home, they told us that they knew how to make a complaint. One relative said there are no problems here, and a resident said I would speak to the manager if I was unhappy. One resident said that they didnt know who to go to if they had a complaint but they didnt have any. The home has a copy of the local Multi Agency Guidelines for staff to follow in the event of an allegation being made. Four staff spoken to were able to tell us what they would do if an allegation was made or witnessed in order to protect the person from harm. There has been one adult protection case since our last visit to the home regarding tissue viability (sore skin) and the case is now closed. In the staff surveys received one person said that they did not know what to do if someone had concerns about the home. One member of staff spoken to did not know what the whistle blowing procedure was and this may prevent people raising their concerns in order to protect people from harm. Staff had received training in the protection of vulnerable adults in May 2008. The manager told us and the training matrix showed that all staff had received training in the Mental Capacity Act; however two staff spoken to said they had not received training. One said that they had been given a booklet and one said they were due to have training. This does not ensure that staff understand the new legislation and how it may affect people who live in the home. We looked at three peoples money and found records and balances to be correct. Each person has their own individual record and receipts were kept. 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 the people living in the home. Evidence: The home is a three storey property. Access to the home is via steps but a platform lift enables people who use wheelchairs to access the building safely. There is a passenger lift inside the home to enable access to all floors. We saw records that the lift had broken down on a number of occasions and engineers had to be called to repair it. Staff said the lift is always breaking down and the lift breaks down often, I would change this. The manager told us that quotes were being obtained for a new lift but no dates were confirmed for work to take place. Consideration should be given to replacing the lift as it has potential to breakdown again. If it could not be repaired then a number of people would not be able to come down from their rooms and may be at risk of isolation. If people were downstairs then they would not be able to access their rooms as they would be unable to use the stairs. The dining room and lounge are not big enough to accomodate all of the people who live in the home at the same time. The communal area was observed to be overcrowded and not big enough for all of the people in the home due to the various equipment that they needed. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Some of the corridors in the home were in need of decoration as paint had been scrapped from the walls. The manager told us that the home had been redecorated in April this year and that staff do not pay care and attention when moving around the home. However corridors are narrow and staff would not be able to manoeuvre equipment easily around the home. The corridors do not enable people with mobility problems to move easily around the home as they are so narrow. Three peoples bedrooms were seen and were found to contain personal possessions as they had chosen. One person was in a shared room. We were not confident that the curtains were used to promote peoples privacy as the dividing curtains were tied up around the rail, several times and a carer had to untie them. The AQAA told us that new wardrobes and lockers had been purchased for all rooms. In the three rooms we looked at no one had a lockable facility should they want to lock personal items away. It also told us that a number of new equipment items had been purchased following an Infection Control Audit in February 2009. We looked at the infection control audit report where a score of 74 was achieved. Following the new equipment, a second audit in April showed an improvement in the score to 87 which means that the home was better at reducing the risk of people acquiring infections. An assisted bath had been installed, however it had not been working, the home had received a quote for the repair but a date for work to be completed had not been set. This means that there is only a shower facility at present and means that people do not have the choice of a bath or shower. The bathroom needed re decoration. One person needed a new shower chair as the arm was broken and the manager was made aware of this on the day of the visit, as the equipment was not safe to use. Prior to the visit we had received a concern that there was a strong smell of disinfectant in the home. We did not find this on the day of our visit but two of the chairs smelt very strongly of urine and were not pleasant for people to sit in. We noticed that some tables were sticky and something had been thrown at the TV screen and not cleaned off. This was brought to the manager and providers attention on the day of the visit. A relative said Its always the same, no offensive odours. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that they will be supported by staff who have the skills and knowledge to meet their individual needs. Evidence: During the day there are five care staff and one nurse, and two care staff and one nurse throughout the night. In addition to care and nursing staff the home also has domestic, laundry, maintenance and kitchen staff to meet all the needs of people living at the home. Staff spoken to confirmed there were enough staff on duty to meet the needs of the people living at the home. There are male and female staff working at the home, so that people can choose the gender of staff they wish to help them. One person confirmed that they had female staff out of respect for their religion and male staff spoken to were aware of this request. People told us: Staff are friendly Staff are alright We received concerns about some staff not being able to communicate with people effectively with people living in the home and as a result their needs were not being met. We have also received a complaint about the ethnicity of the staff being Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: employed which we asked the provider to investigate. Some staff who we spoke to had difficulty in understanding what we were asking them and their English was poor. During the short observational framework inspection (SOFI) we saw only one positive interaction with staff, this was a overall score of 17 for five people over two hours. For the five people we observed an overall negative interaction score of 58 . We did not observe staff interacting with people, and even when performing a task there was limited or no interaction with people. This was discussed with the manager and one of the providers on the day of the visit, as the results indicate that staff are not using their knowledge and skills to meet the needs of the people who live in the home. The Annual Quality Assurance Assessment (AQAA) told us that 80 of the staff had completed a National Vocational Qualification (NVQ) level 2. This exceeds the national minimum standards and should mean that staff have the knowledge and skills to care for people individually and collectively. During our observations staff did not demonstrate they were putting what they had learned into practice. We looked at three staff files and these contained all of the required checks to ensure that people were protected from harm. There were two people who had come to work at the home for three days practical experience and were not included in the staffing numbers. Prior to coming to the home they had no previous experience. The manager told us that they worked with someone; however we observed one of these people to be the only person in the lounge for the majority of the two hour observation. The second person did not have a relevant Criminal Records Bureau (CRB) check and was sent home. This places people who live in the home potentially at risk of harm. A training matrix had been devised which indicated that trained staff had received training in dementia care awareness, diabetes and medicine management. The matrix showed all staff had received training in the mental capacity act; however two staff could not confirm this. Two staff said they had had some training last year and one said they had had nothing recently. Staff spoken to could not all demonstrate sufficient knowledge about how to keep people safe. Minutes of a staff meeting were seen where various things were discussed. This should give staff the opportunity to raise any concerns, however in some surveys received from staff they told us that they were not able to raise concerns. 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 management arrangements do not always ensure that the home is run in the best interests of the people who live there. Evidence: The Registered Manager has been at the home for approximately three and a half years. Since our last visit he has attended training for dementia, end of life care, Mental Capacity Act and Deprivation Of Liberty Safeguarding. This should ensure that he learns new skills in order to lead the staff team. We received a complaint about the manager which we asked the provider to investigate. As discussed in concerns and complaints we do not have confidence that the provider wants to listen to concerns in order to improve the service. The majority of staff spoken to and information in surveys received suggested that people were supported by management, however some people did not feel supported and listened to. People told us: If I need anything he soon gets it for me I would be happy to go the manager and raise concerns Things are not right with the management, the directors Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: tell you different things each day You cant say what you should be able to The Registered Manager told us that he has no budget and does not know the expenditure for the home. This was evidenced when the Registered Manager and cook were unable to tell us about how the home buys its food. Visits from a representative of the provider had not been done since April 2009 to audit how the home is meeting the National Minimum Standards and the needs of the people living there. It is required that the provider makes an unannounced visit to the home each month in order to review the quality of service provided. This has been a previous recommendation that these reports are written to show that the provider is listening to people in the home in order to monitor and improve the service. Prior to our visit the manager had completed an Annual Quality Assurance Assessment (AQAA) which tells us how well the home think they are performing and where they could improve. The AQAA stated that regulation 26 reports are kept, however this was not accurate on the day of our visit. The manager sends out satisfaction questionnaires and had collated an annual report about the quality of the home. This had been sent out to relatives of people living in the home. We looked at fire records in the home and were very concerned that staff had not had any fire training since September 2007. Following the inspection the manager provided training certificates to evidence that some staff had received fire training in June 2008. The last fire drill had been in December 2008 and it was concerning that the home had documented that staff didnt know what to do. There were other comments recorded from previous drills that it was the same staff taking charge as others didnt know what to do and that some staff did not turn up at the assembly point. Some of the staff we spoke to on the day of our visit were not able to demonstrate that they understood what to do in the event of a fire and this does not ensure peoples safety. We contacted West Midlands Fire Service and told them about our concerns. They have told us that they have visited the home and are issuing a Statutory Requirement Notice which the home have to comply with, in order to ensure that staff know what to do to safeguard people in the event of a fire. We have been advised by the manager that staff training has now been booked. This should have been addressed by the home when it was identified that people did not know what to do. Management arrangements do not ensure that people are supervised by knowledgeable staff and satisfactory steps have not been taken so that one person can use the communal areas. The home is not providing meals and activities to meet Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: the individual needs of people living at the home. 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 Risk assessments must be reviewed. To ensure that they are current and give guidance about how to manage potential risks. 14/08/2009 2 14 16 Arrangements for activities must be reviewed. So that people are stimulated and their needs are met. 01/09/2009 3 17 16 People must be offered a 21/08/2009 diet, that meets their needs. So that personal preferences, health and religious needs are met. 4 18 12 People should be suppported 28/08/2009 to meet their needs. So that their dignity is maintained. 5 19 12 Care plans must provide information that is current. 28/08/2009 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 health care needs can be monitored and staff have guidance to follow. 6 32 18 Staff must have the skills and knowledge. To meet peoples individual needs. 7 39 26 Arrangements must be in place so that the provider visits the home and writes a report about the conduct. To ensure that peoples views are listened to and acted upon. 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 18/09/2009 31/08/2009 1 2 7 14 People should be involved in making decisions so that they lead the life they chose to. People should be assisted to make holiday arrangements where they are able so they experience a meaningful lifestyle. Medications should be signed back into the home after leave so there is an accurate audit trail. Eye drops should be dated when opened so that staff know when to discard them. Staff should receive training in policies and new legislation so that they know how to protect people. The home should be decorated to promote a homely environment for people to live in. 3 4 5 6 20 20 23 24 Care Homes for Adults (18-65 years) Page 31 of 33 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 7 8 9 10 11 24 26 27 30 37 Consideration should be given to replacing the lift so that people can access the home freely at all times. People should have a lockable facility so that they can lock items away securely. People should have equipment and facilities to meet their needs and preferences for bathing. The home should provide a clean and odour free environment for people to live in. The manager should have an understanding into the budget for the home so that the home can prioritise in the interests of the people who use the service The home should address the fire service statutory notice so that people are safe from potential harm. 12 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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