Inspection on 08/10/09 for Kernou

This inspection was carried out on 8th October 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

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Kernou Westcliff Porthtowan Truro Cornwall TR4 8AE Lead Inspector Diana Penrose Key Unannounced Inspection 8th October 2009 09:00 Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Kernou Address Westcliff Porthtowan Truro Cornwall TR4 8AE 01209 890386 01209 891798 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cornwallis Care Services Limited Mrs Sandra Bygraves Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 8. Date of last inspection N/A New Service Brief Description of the Service: Kernou is registered to provide care to eight adults with a learning disability. At present seven people are accommodated. The home is located on the coast, in the village of Porthtowan, near Redruth. It is situated on the cliff top and has impressive views of the sea and beach below. The care home is accessed by the car park at the side of the building that provides access by a gentle slope. The boundary on the Cliffside has been fenced and two patios have been provided. The home was previously a hotel and internally has limitation given the size and layout of the bedrooms and width of corridors. Single accommodation is provided for residents but not all rooms have en-suite facilities, or facilities that are in use. There is a large dining room and a lounge on the upper ground floor. The lower ground floor is private accommodation used for staff sleeping in overnight. The people currently living in the home attend weekday activities and work placements. They are given opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a statement of purpose / service users’ guide, which can be supplied to enquirers on request. A copy of the most recent inspection report is available in the home. The manager told us that the fees range from 265 to 315 pounds per week, with one exception of 600 pounds. Private healthcare provision, hairdressing and personal items such as confectionary and toiletries are not included in the fees. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. A Regulatory Inspector visited Kernou Care Home on 08 October 2009 and spent seven hours at the home. This was a key inspection and an unannounced visit. The focus was on ensuring that residents placements in the home result in good outcomes for them. All of the key standards were inspected plus a few others. Although this home has changed ownership there have been no changes to the running of the home or the policies and procedures in place. On the day of inspection seven people were living in the home, some of them were out at work placements and returned later in the day. The methods used to undertake the inspection were to meet with the registered manager, staff and residents to gain their views and information on the services offered by the home. The manager was on annual leave but wished to attend this inspection. Records, policies and procedures were examined and the inspector toured the building. The manager returned an Annual Quality Assurance Assessment (AQAA) which was used to inform this inspection. We received completed surveys from five residents, three staff and one healthcare professional which were also used to inform this inspection. In addition information was received from the Operations Director of the Company following this inspection. This report summarises the findings of this key inspection. The registered manager is aware that there have been breaches of the Care Home Regulations 2001 and these were discussed during the inspection. She has agreed to address the shortfalls however requirements and recommendations have been set. What the service does well: The home provides a relaxed and friendly environment for the people using the service. The home is clean and there were no offensive odours during this inspection. Care plans are in place for residents which show they have had input into them, although not recently. People using the service attend work placements and clubs of their choice and outings are arranged by the home with the use of their mini bus. Relationships with the neighbours and local community are good. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 6 A varied and nutritional diet is on offer and people using the service can access drinks and snacks from the kitchen between meals. Personal and healthcare needs appear to be met and people’s privacy and dignity are respected. People told us they are treated well in the home by staff who listen to them. The medicines system in the home is appropriate and records are well maintained. Four of the six care staff are qualified to at least NVQ2 in care. In addition there is one person awaiting certification and another awaiting final verification. What has improved since the last inspection? What they could do better: Keep the statement of purpose up to date to ensure appropriate information about the home is available for prospective residents and enquirers. Review the care files and ensure that the care plans are updated and reviewed regularly with the resident, relatives and professionals as appropriate. The actions required by care staff must be specific to inform and direct them on the care to be provided. Ensure that the weekly records are more detailed and that agency staff make written records to account for the care they provide. Ensure that people using the service are assessed on their capability to handle money. They need also ensure that the policy for managing residents is adhered to and that the accounts held for resident’s monies are up to date and accurate. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 7 Provide suitable activities for people using the service including entertainment of their choice and the opportunity to go on holidays. Provide more written evidence as to the choices made by people using the service on how they spend their time. Review and update the medicines policy and obtain a copy of the guidelines for the handling of medicines in social care for staff to refer to. Ensure that all staff who administer medicines attend appropriate medicines training courses. Review and update the complaints and adult protection policies and ensure staff and residents are aware of them as relevant. All of the home’s policies should be reviewed and kept up to date. Ensure that the manager and all staff attend safeguarding training that is appropriate to them. Make sure that the building is repaired, maintained and refurbished so that people can live and work in a safe, homely environment. A full environmental audit should be undertaken with an improvement plan compiled that includes timescales for the work to be undertaken. Ensure that issues in respect of the electrical wiring are addressed and purchase a cooker that is suitable for the home. Staffing must be reviewed to ensure that there are sufficient staff, with the relevant knowledge and skills, on duty at all times to meet peoples needs. Staff told us about their concerns regarding staffing in the home and the large amount of extra hours they work to cover any absences. The recruitment system must be reviewed to ensure that POVA and CRB disclosures are undertaken appropriately and that supervision arrangements are in place as necessary. There must be two satisfactory references for all new employees held in the home prior to their commencement of work. There must be photographs of all employees on file, evidence of their fitness to work and relevant job descriptions must be provided to all staff and the registered manager. Records of interviews should be maintained. Although the provision of training for staff has improved there needs to be a plan in place for staff training and development, this must include training relevant to the client group. Ensure the registered manager receives appropriate support, guidance and training to enable her to fulfil her role effectively; formal supervision with written records will provide evidence of the support she is receiving. A quality assurance system needs to be in place to help to ensure continual improvement of the service to benefit the residents. Ensure that the emergency lighting tests are kept up to date. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 8 Ensure that the entrance to the home is secure for the safety of residents and staff. 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. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available about the home is not up to date so would not give prospective residents the information they need to make an informed choice. There have been no new people admitted to the home since the new ownership, or for several years, for us to be able to assess standard two. EVIDENCE: The manager showed us the homes statement of purpose. It was a copy that was in use when the previous owners were running the home. It did not state the new ownership or the current management arrangements; it also referred to the National Care Standards Commission. A different copy was later found but was dated January 2007; this did not contain the information required by legislation or the current ownership and management arrangements. The manager stated that there was a new statement of purpose but she could not find it. The statement of purpose must be updated to ensure that any prospective residents and enquirers receive detailed and correct information. This does not impact on the current people using the service. We were told by the registered manager and staff that no new residents have moved to the care home for six years, therefore there was no recent pre Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 11 admission assessment documentation to inspect. The home is currently operating at a maximum occupancy of 7 residents. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have handwritten care plans that have not been reviewed or updated regularly; they do not fully detail the actions to be taken by staff to ensure appropriate care is provided. There is a system in place for managing residents money but the record keeping is poor and does not safeguard the people using the service. EVIDENCE: The manager told us that each person using the service has a written care plan and showed us where they were stored. We examined three care files, the files were disorganised and some sheets for individuals did not hold their name. Each file contained a hand written care plan and one contained pictures, they were the care plans that were in place prior to the new ownership and needed updating then. Some new information had been added to the care plans but it was not evident when this was added or by whom. Some information was out Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 13 of date, for example they referred to the previous registered providers. Some risk assessments were seen mainly for safety issues, some were updated in February 2009. The care plans do not refer to these risk assessments. Interventions required by the staff were not in sufficient detail to inform and direct them on the specific care to be provided. An example was blood sugar monitoring, which had not been included in the person’s care plan, this was discussed with the manager. Some residents exhibit aggressive or challenging behaviors but the care plans do not detail how to deal with these. One care plan had a review date of August 2008 but there was no evidence of multidisciplinary reviews or reviews with the resident or their relatives. The manager told us she has encountered problems getting relevant professionals to undertake reviews. She told us that she reviews the care plans every 6 months but this was not evident. Weekly records were seen for each resident and these varied in content, they included outings and activities but there was nothing about what the person gained from the activity, whether they joined in or whether there was any emotional reaction and so on. We were told that there were no records maintained by agency staff working in the home, the manager said she would get a book for this rather than use the sheets in the files. The weekly records contain some evidence that people are encouraged to take reasonable risks. Some risk assessments in respect of safety were seen. There are details on a board of work placements that residents attend during weekdays. Staff said that people using the service are encouraged to be independent and make decisions on their daily life but this was not evident from the records. Residents were seen moving freely about the home making drinks for themselves and so on. One person was watching television and did not wish to talk to the inspector for very long, another was watching a film in his room. Some residents were out at work during the inspection but when they came home they appeared to do as they wished and some were talking about their day. We received 5 surveys from residents, all had been completed with the help of the manager. All of the surveys told us that people using the service make decisions on what they do each day and that they can do as they want all of the time. None of the people using the service manage their own finances. The Operations Director told us he has applied to become appointee for all of the residents. There was no evidence that people using the service have been assessed as to their capability to handle money and the manager said this has not been done. We were shown a hand written policy for the safeguarding of resident’s personal monies. It was out of date and did not explain the process carried out in the home or the storage arrangements. Since this inspection the Operations Director has told us that the resident’s money policy adopted at the Cornwallis Nursing Home has been implemented at the Kernou. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 14 The manager told us that each resident has an account either with the post office or a bank. We were shown the individual plastic wallets that contained people’s money, receipts and an exercise book for recording transactions. We were also shown the post office and bank account statements for people using the service. The records for two people were checked and did not balance; entries in the records had not been calculated correctly. The manager said the records we saw were for the bank accounts as well as the cash held but this was not evident. Since the inspection the Operations Director has told us that he has performed an audit of the accounts with the Accounts and Payroll Controller for the Company and that there are no shortfalls in the resident’s monies. The manager told us that all staff can access the resident’s money held in the wallets and that they all record transactions in the books. She said that she checks them regularly. The manager voiced concerns about money held by the Company for some residents and the payment of some disability allowances. This has been discussed with the Operations Director who has provided an explanation and information to us; he has assured us that these monies will be paid into the resident’s bank accounts forthwith. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the people using the service attend work placements and go on outings according to their ability; however there does not seem to be much activity taking place in the home or opportunities for going on holiday. There is little to show that people’s preferences are respected as part of their daily life. Food provision seems to be good although there was little to show that it reflects people’s preferences and choices. EVIDENCE: Two people were at home during this inspection, we were told the others were at work placements. One resident spent most of the day watching television and the other was in his room. Bedrooms were personalized to varying degrees with personal belongings and pictures and so on, some interests and hobbies were apparent. Some residents have a key to their room and residents were told when they came in that we had looked in their rooms. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 16 We saw the weekly records which show that people participate in activities but they are mainly outside of the home, arranged by clubs, going to the pub or going for walks. The Company owns a mini bus which staff are insured to drive; some records of outings are kept. The records do not detail all activities, the level of participation or what people gained from the activity. There was no evidence that residents clean their own rooms or undertake household tasks in the home although staff said they do this. There was little evidence to support individual choices or flexibility of routines. We were told that no entertainment is brought into the home. We did not see any evidence that residents have the opportunity of an annual holiday. The manager said that the garden had been developed and the residents helped to grow vegetables over the summer months. We did not see any evidence to show this in the records and we did not see any photographs. The manager told us that residents are encouraged to occupy themselves in the home, they were seen watching television and we saw a library of DVDs in the lounge. The manager said that some residents like to draw or do colouring and some are assisted with writing. We were told there are jigsaw puzzles, books and card games in the home and the manager said she has other games that she wishes to purchase. She told us she would like all residents to have allotted one to one time spent with them but there are financial constraints due to the low fees. Staff surveys told us that the lack of funding limits the resident’s social lives. A health professional survey stated that a review is underway with a particular focus on care planning and fees. Staff told us there are not enough staff to spend the time they would like with the residents. The manager said that residents attend day centres and work placements and some have attended educational courses in the past but not now. She said they go out into the local community if they wish. She told us one person does some work locally and another goes on the bus to Truro by himself. She said that one person goes fishing on the beach below the home. Staff said that the visiting arrangements are flexible and there are no barriers to residents maintaining contact with their relatives and friends, however the degree of contact varies. The manager said that residents have free use of the home’s telephone. The individual records show that some contact is made with family and friends. The visitor’s book was seen and shows that people visit the home. The manager told us they get on well with the local community and that a bonfire and barbeque was taking place in November and the local people were invited. The manager told us that she and the care staff prepare and cook all meals. A two week menu was seen and the manager said it was flexible. The menu was varied and we were told there is yogurt or chocolate for pudding. A good stock of fresh fruit and vegetables were seen. We were told that residents who go out to clubs or work placements during the day take a packed lunch but there Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 17 was nothing written as to what this included. We were told that on Saturdays the residents choose what they would like and it maybe a take-away meal or a meal at the pub; again there was little evidence of what actually happens. The manager said that residents are encouraged to help prepare and cook meals; she would like each resident to have the opportunity to choose a meal, shop for ingredients and then cook and serve the meal to the other residents and staff. We saw people making drinks between meals and there was a large bowl of fruit in the dining room. Staff told us the food is good and nutritious. Residents said they like the food that they have in the home. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given to residents according to their needs and they have access to doctors and other professionals as necessary ensuring their healthcare needs are met. There is a system in place for the use of medicines however there needs to be up to date guidance for staff and evidence that relevant training has taken place. EVIDENCE: The manager said that the people using the service are all independent and only one requires assistance with washing. There is one female resident and the manager said she always has a female carer to assist with her bathing and personal care. The staff interaction sheets give information on the support needed. We did not see details of when people get up or go to bed but the manager told us that routines are flexible and surveys received from residents support this. There was some information on people’s preferences written in the care plans. The manager said that attention is given to ensuring privacy and dignity when delivering personal care and staff are sensitive to the needs of residents. She said residents are supported to be independent and responsible for their own personal hygiene. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 19 The manager told us that all residents are registered with a GP she said they are assisted as needed with visits to the surgery and so on. She also said they are looking to change to a different surgery and she has been consulting the residents about this. We were told that residents visit an optician in Redruth and go to the dentist regularly. The manager told us that additional support from a physiotherapist had been provided in the past. We were shown a medicines policy that was out of date and needs to be reviewed and updated. Reference books and patient information leaflets were available for staff to read about medicines, the side effects and so on. The guidelines for the handling of medicines in social care were not seen, the manager was not sure if there was a copy in the home. We saw that a monitored dose system was in use and the receipt, administration and return records were in order. Storage arrangements were good, no controlled drugs were in use but an appropriate cupboard was in situ. One person was having their blood sugar levels monitored by staff monthly but there was no specific care plan in place for this. The manager told us that all bar one member of staff have completed medicines training and that she goes through the basics with new employees. She said she had attended medicines training in March 2009 and was awaiting her certificate as were other staff. Open learning packs had been used to update staff on the use of medicines with the previous registered providers the manager said that the completed question papers were never sent away for assessment. There was no apparent reason for this. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s complaint and adult protection policies are out of date and do not ensure that residents or staff know what to do should an incident occur. Some staff have received training in respect of abuse but all staff need to attend appropriate training to ensure people using the service are protected from possible risks of harm, neglect or abuse. EVIDENCE: We were not shown the complaints procedure or the adult protection policy. We were told that the new owners have not provided new policies and the previous policies have not been updated. The manager said there have been no complaints to the home. The alerters guide was seen on the notice board along with a leaflet about abuse. The manager was able to verbalise the correct steps to take should an incident arise. We saw a certificate that showed that the manager had attended POVA/Safeguarding training externally but it was not a course organised by the local council. The home’s procedures for recruitment checks are not robust, see section seven. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 21 As previously stated the home’s system for safeguarding resident’s money needs to be reviewed and an accurate system of accounting put into place in the home. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements have been made to the building and grounds but the home is not a comfortable, homely, safe place to live or work in. EVIDENCE: The inspector toured the building with the registered manager. Some redecoration was seen and we were told that more is underway but we were not given an action plan or timescales. One room had been completed for a resident and he now has a bedroom, sitting area and en-suite toilet and hand washbasin. He said he had chosen the colour for his room and was very happy with it. The manager said there are plans to remove the bar in the lounge and to replace the worn carpet. She told us that the gas fire looks cosy but it doesn’t work. All bedrooms have hand wash basins, some have shower cubicles, and some have en-suite toilets. Many of the shower cubicles are not used. To ensure safety in respect of Legionella the shower heads of these facilities have been Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 23 removed. The manager told us that they would like to remove these showers completely when the planned wet room shower facility has been installed. Following consultation with a CQC registration inspector the Operations Director has been advised not to reduce the existing facilities even though they are out of use. The numbers will be looked at during the future registration of the home. There is one communal bathroom that is partly tiled; the untiled area is not painted and looks very damp. The toilets have no hand washing facilities; these facilities are in the communal bathroom or the kitchen. The stairs are narrow and wooden with a hand rail that goes partway up and a fire door directly at the top. They did not feel safe but the manager said that residents and staff have got used to them and they have not posed a problem. A new floor has been installed in the kitchen which has removed the steps and made it level. Dry food stocks, crockery and cooking utensils are stored on open shelves rather than in cupboards. A new cooker has been purchased as the other one stopped working. Staff said they had to wait a month for the new cooker and that it is too small. One member of staff said “I don’t know how we are expected to cook Christmas dinner on this cooker”. The Operations Director explained that the wiring in the kitchen would not sustain a bigger appliance at the moment. He told us that he intends to have the wiring addressed and install a six burner stove as soon as possible. A fence has been erected around the front of the building making it much safer for residents and staff. Two patio areas have been completed and one has a ramp for easy access. Laundry facilities were seen, there were two industrial washing machines and a tumble drier. The home was generally clean, with no offensive odours. The care staff said they are responsible for the cleaning of the home but residents are encouraged to clean and tidy their rooms. One person said that due to the state of the building it was difficult to make it look clean and respectable; a few coats of paint would be an improvement she said. Surveys from staff told us that the building needs improving and that decorating is needed. We saw that some infection control training had taken place and there were certificates in a file. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are not robust, staff are not provided with training in respect of the client group and staff work long hours to ensure adequate staff are on duty. This does not ensure that the needs of people using the service can be met appropriately or that systems are in place to safeguard them from harm. EVIDENCE: The AQAA told us that there are four full time and one part time care staff employed. The manager told us that one member of staff is new and that she is in the process of employing another carer. We were told that all staff are responsible for meeting the care needs of people using the service as well as providing meals and ensuring the home is kept clean and tidy. There is a set duty rota that spans two weeks. It showed that there is one carer on duty in the mornings, two most afternoons and two in the evenings. The manager tends to work mornings and afternoons and said she helps the care staff as required. One person sleeps in overnight, in the lower ground Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 25 floor flat; this is the manager five nights per week. We were told the manager is also permanently on call which was not evident on the rota we saw. The manager was actually on leave on the week of this inspection but this was not recorded on the rota. We were told that any changes to the rota are recorded in the diary on the desk however this had not been completed recently. This method makes it difficult to see who is supposed to be working and who is not; a weekly working rota would be much better. Staff surveys told us that there are not enough staff and staff told us during this inspection that they work very long hours to cover for annual leave and sickness. One member of staff was sleeping in on the night prior to this inspection and was working from 07.30 to 22.00 on the day of this inspection. Staff said they had not signed to opt out of the European Working Time Directive. Following this inspection the Operations Director told us that this is included in the contracts of employment, however there should be a separate opt out agreement. Surveys received from people using the service told us that the staff always treat them well and listen to their needs. One resident told us the staff are good and look after her well. We saw that staff interacted well with the residents in a kind and friendly manner. The manager told us that four members of staff have achieved an NVQ qualification in care to at least level 2, one was awaiting certification. Another member of staff told us she has just completed the NVQ level 2 and is awaiting final verification. None of the staff have a specific qualification or have attended training in respect of learning disabilities. The records show that two staff attended sessions on Autism in 2007 and one did some training on diabetes in 2004. The manager said she does not have a dedicated training budget; the finances are dealt with by the Operations Director. We were told there is no training and development plan for the staff however the manager showed us a sheet that identified training needs for staff. These included coping with conflict, food and nutrition, autism, stroke, diabetes, challenging behaviour and equality and diversity. The manager told us that the open learning packs, referred to in the last inspection report, are no longer in use and the question sheets did not get sent away for assessment. We were told that the one new employee had completed an NVQ course in care and was awaiting a certificate; an induction check sheet was seen in her file that had been signed by a supervisor. There is no evidence that any training regarding learning disabilities was included during her induction period. The skills for care induction standards or knowledge sets have not been introduced by the manager. The staff file for one employee was inspected, not all of the documents required by legislation were included. The records show that the POVA first Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 26 check was received after the person commenced work in the home and the full CRB check has not yet been received. The manager told us that this person is supervised by her or the deputy manager but there was no documentation to support this arrangement. There were no references in the file; the manager said they had been dealt with by the Operations Director along with the CRB. The application form did not include a health check or health declaration and there was no photograph of the employee. The manager stated that she interviewed the applicant but there were no interview records maintained. The manager told us that the job description we saw in the file was not up to date. There was little training information, the manager told us she had been observed doing the medicines and then deemed competent, she had not undertaken a course. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Leadership and robust systems are lacking which means that staff and residents do not have the benefits of a well run home. There is no quality assurance system in place for improvement of the service although systems are in place to ensure the safety of residents, staff and visitors. EVIDENCE: The manager has been in post for a year and has been registered with the Care Quality Commission since 16th April 2009. She has achieved NVQ levels 2, 3 and 4 and the Registered Managers Award. We saw various certificates for training she has undertaken since April 2009, some of which was e-learning. This included Fire Marshal training, safeguarding, Mental Capacity Act, health Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 28 and safety, food safety, first aid and infection control. She told us that she has undertaken medicines training but has not received the certificate as yet. She said that the funding ceased for the diploma in disability awareness that she was doing so this has had to be abandoned. She has a deputy manager to assist her in the home and she told us that the Operations Director visits every two weeks and gives her some support in her role. As part of her registration the Operations Director confirmed that there would be independent management support for Mrs Bygraves, for a year, to allow her to become fully established in her role. We were told he does not keep records of the support given or of any formal supervision. We saw that the manager has terms and conditions of employment but she said she does not have a job description or a set of goals and objectives. Staff told us the manager supports them and has a very good knowledge of the people using the service. They said the Operations Director visits the home regularly and sometimes talks to the staff. Staff surveys told us that the manager supports them regularly or often. The registered manager has not ensured that staff recruitment is robust. The file we saw did not contain references. The POVA first check was dated six weeks after the person commenced work and there was no evidence of the supervision arrangements for this person whilst the CRB disclosure is awaited. The registered manager has not ensured that the system for managing the resident’s personal monies has been safe with accurate accounts maintained. An urgent review has taken place and she needs to ensure the new policy is adhered to and accurate accounts maintained. Although there has been a change in ownership, the home has continued to run as before and most of the issues identified in the previous inspection report have remained unchanged. The manager states she now has a computer but still no internet access. The Operations Director has explained the issues to us regarding the inability to get this access and is hoping it will be resolved forthwith. We were told there is no annual development programme for the home. We were also told that the quality assurance questionnaires were on the computer and were to be sent out in December 2009. The manager showed us a draft form that she had in a file. She said that no audits take place at the moment. She told us that staff meetings take place every five months but she could not find the notes of the last meeting which she said was in July 2009. We saw the notes of a meeting held in November 2008 when the previous owners were running the home. One member of staff said there was a meeting in February 2009 when the hours worked and staffing was discussed. We were told that there were no resident’s meetings but the manager said she talks to them all every day. The manager said that the Operations Director visits the home every month to undertake an inspection and write a report in accordance with Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 29 Regulation 26. She said the file of reports was not in the home as the Operations Director had taken them away to type them up. Since this inspection we have received copies of the reports for May and September 2009. The manager completed an Annual Quality Assurance Assessment (AQAA) prior to this inspection and returned it to the Commission. It was in reasonable detail but was the format for an Older Persons service rather than a Younger Adults service. The manager told us that all of the homes policies and procedures require reviewing and those we saw verified this. We were told that the new owner has not provided any company policies for the home. Staff told us they do get involved with reviewing policies. The manager showed us the certificates of training for staff and these showed she is making an effort to keep statutory training up to date; however more needs to be done. Basic moving and handling training must be included even though staff do not routinely use handling techniques or equipment for the current people using the service. Training is needed for moving furniture and other objects and for enabling staff to move a resident if required, for example if someone falls and needs help to get up. The manager and deputy manager have attended first aid training but they are not in the home at all times, the manager said she intends to send more staff on the course. We were told there have been no visits by the Environmental Health Officer since the new ownership. We saw the records for the servicing and maintenance of equipment. We saw that the last monthly testing of the emergency lighting was dated in March 2009. There was no certificate in the home for the 5 yearly electrical hardwire test; the Operations Director told us that he could not find this. Since this inspection a further test has been carried out and we have been assured there is nothing detrimental to the safety of the residents. A copy of the test certificate is awaited. Other tests were seen to be up to date, for example the small electrical appliance testing, Legionella and asbestos. The fire enforcement notice was complied with in March 2009. The accident records were seen and there were two incidents in September. There is no doorbell at the entrance to the home and no one heard the inspector knocking when she arrived. She walked into the home and had to call to get the attention of a member of staff. A Social Care professional told us she had the same experience. The entrance to the home needs to be secure to ensure the safety of people using the service and the staff working in the home. Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 N/A 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 1 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 1 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 1 1 1 2 X Version 5.3 Page 31 Kernou DS0000072291.V377624.R01.S.doc Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 YA6 Standard Regulation 15 Requirement All of the people using the service must have a written care plan that details how their individual care needs are to be met. It must be available to them and must be kept under review. This will ensure that staff are informed and directed on how to meet the changing care needs of people using the service. The recruitment system must be reviewed and the vetting and selection of staff made robust, all of the documents required by legislation must be held in the home and appropriate supervision arrangements must be in place for new staff. This will ensure that new staff have been assessed as fit to work in the care home and that steps have been taken to safeguard people using the service. 3 Kernou Timescale for action 29/01/10 2 YA34 19 29/11/09 YA24 23 (2) (b) The care home must be of sound DS0000072291.V377624.R01.S.doc 30/04/10 Page 32 Version 5.3 (d) construction and kept in a good state of repair, reasonably decorated and furnished, and there must be hand wash basins provided in the toilets. To provide a safe, comfortable homely environment for people to live in. The entrance to the home must be made secure and the emergency lighting tests kept up to date. To ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The electrical wiring in the home must be addressed and deemed safe, so that suitable appliances can be installed. To ensure that unnecessary risks to the health or safety and welfare of service users are identified and so far as possible eliminated A review of the management, staffing levels and skill mix of all staff must be conducted with appropriate action taken for any shortfalls or issues arising. To ensure that the care home is able to promote and make proper provision for the health and welfare of people using the service. To include their care, and where appropriate, treatment, education and supervision. All staff must receive training appropriate to the work they perform and the client group DS0000072291.V377624.R01.S.doc 4 YA42 13 29/11/09 5 YA42 13 21/12/09 6 YA33 12 29/01/10 7 YA35 18 30/04/10 Kernou Version 5.3 Page 33 including structured induction training. To ensure that at all times suitably qualified, competent and experienced persons are working at the care home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA1 YA14 YA20 Good Practice Recommendations The statement of purpose and service user guide should be reviewed and updated to ensure that enquirers receive up to date information about the home. Suitable social activities should be provided, with opportunities for annual holidays, taking into consideration the personal preferences of people using the service. The medicines policy should be reviewed and updated and a copy of the guidelines for the handling of medicines in social care should be obtained to ensure that staff have up to date information on the use of medicines in the home and know what is expected of them. There needs to be a full environmental audit with an improvement plan compiled that includes timescales for work to be undertaken. This will ensure that issues are prioritised and improvements to the home take place. The registered manager should receive appropriate support, guidance and training to enable her to fulfil her role effectively. A quality assurance system needs to be in place to help to ensure continual improvement of the service to benefit the residents. All of the homes policies and procedures should be reviewed and kept up to date so that staff are fully informed of what is expected of them. 4 YA24 5 6 7 YA37 YA39 YA40 Kernou DS0000072291.V377624.R01.S.doc Version 5.3 Page 34 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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