Inspection on 21/09/09 for King Edwards House

This inspection was carried out on 21st September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

King Edwards House 17/09/08

King Edwards House 06/09/07

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 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 King Edwards House 18 King Edwards Avenue Gloucester Gloucestershire GL1 5DB Lead Inspector Key Unannounced Inspection 21st September 2009 09:00 King Edwards House DS0000069195.V377857.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. King Edwards House DS0000069195.V377857.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 King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service King Edwards House Address 18 King Edwards Avenue Gloucester Gloucestershire GL1 5DB 01452 381174 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) info@carecommunity.co.uk Care Community Ltd Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places King Edwards House DS0000069195.V377857.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 categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection 17th September 2008 Brief Description of the Service: Accommodation for up to six adults with learning disabilities. It is a detached house, which is located approximately two miles from the centre of Gloucester. There is a small garden area to the rear of the property, where there is also a separate laundry room. One bedroom is on the ground floor and the rest are located upstairs. All have en-suite facilities. The home is situated close to local amenities. The fees for the home are calculated on an individual basis depending on assessed needs. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken on 21/09/09. The Inspector met with care staff, the newly appointed manager, the area manager and both of the people currently living in the home. Records relating to care planning, staff recruitment and training, medication and health and safety were examined. An inspection of the environment was also carried out. The service currently has four vacancies and staffing levels have been reduced to reflect this changing need. The service also shares its registered manager with another registered home owned and run by the same Provider which is situated close by. What the service does well: What has improved since the last inspection? What they could do better: The service needs to provide its Statement of Purpose and Service User Guide in more accessible formats. There is a need for improved daily activities, social opportunities and leisure options for the people living in the home. There is need for an improved and more structured approach to the developing of independence skills. Confidential information needs to be securely stored and the office needs to be properly organised and records kept up to date. The home needs to have designated management hours and consistent leadership and direction be provided to the staff team. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 6 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. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 7 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 King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 8 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): 2. 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 service had an admissions policy that complies with the regulations. New admissions to the home would benefit from up to date and clear information being provided in a more accessible format in the Statement of Purpose and Service User Guide EVIDENCE: The home currently has four vacancies and there have been no admissions since the previous inspection. The service has an admissions policy that complies with the regulations. No pre admission assessments were being undertaken at the time of this visit. There is a need for the service to update and review its Statement of Purpose and Service User Guide King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 9 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): 6, 7, 9 & 10 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. Whilst the care plans are person centred there is scope for these to be improved and developed into more detailed documents that inform practice and improve outcomes for people living in the home. EVIDENCE: At the time of this inspection the care plans were being updated and a new format introduced but this had only been completed for one person so far. Both people living in the home have care plans in place and a document called a Life Plan. The plans give guidance on the support required with daily living within the home and in the community. Records showed that plans were being reviewed on a regular basis. There is much scope for these plans to be improved and be more person centred and better identify short medium and long term goals and objectives. It is also evident that the number of staff changes, including the management changes, had had an effect on the King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 10 consistent implementation of the plans. This was reflected in the small variety of activities being undertaken and the lack of a proper structure or organisation of the day for the people living in the home. This was particularly true for the one person who was not attending college or had any other regular day time activity. There was evidence of regular recording being completed by the staff and a monthly report was also being completed, though this tended to be a summary of the notes from the daily recording. At the time of this inspection all the daily notes and diaries were being kept on the dining room table. This is confidential material and should be stored accordingly. Further reference to the use of the office is made later in the report. The home had a number of basic risk assessments in place and these had been reviewed within the required timescales. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 11 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: 12,13,15,16 & 17 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 living in the home are not being provided with sufficient choice or opportunities to engage in activities in terms of day care or vocational activity. There is limited structured planning towards the development of independence skills or involvement in the daily running of the home. EVIDENCE: The records showed that over the previous few months there had been a limiting of activities and choices for people living in the home and this appeared to mainly due to management changes, staff turnover and the fact that with only two people living in the home there was usually only one member of care staff on duty at a time. At the time of this visit the homes vehicle was awaiting repair, and had been for apparently over a week. There was evidence that some trips had been undertaken but the recently appointed King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 12 manager stated that this was an area that he would be addressing as a matter of urgency. One person had finished their college course in May 2009 and there was a letter on file saying that the Connexions service was to be contacted but no further action had been taken and no steps had been taken to plan any day care for this person, who appeared to have no planned or structured activities for the week. It was hoped they would be attending a college course but no action had been taken to address this. Each person in the home has a document on file called Forward Towards Independence which contains assessments of a range of independence skills. These had not been updated for several months. There also appeared to be no structure or plan to involve the people living in the home in the daily domestic chores and tasks, though the Inspector was told that people did help with the shopping. Whilst it was evident that the people living in the home had limited skills in terms of cooking and food preparation there was scope for them to be involved in some capacity. The menus showed a good variety of food being offered and the kitchen was well stocked at the time of the visit with all produce correctly stored and labelled. One entry in the personal files recorded that a person had experienced bereavement during the previous months but there was no recording to suggest how they had been supported through this King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 13 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): 18,19 & 20 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. People living in the service have their health care and personal care needs met and information is accurately recorded. EVIDENCE: The individual files contain information and guidance for staff on how personal care needs are to be met and the support delivered. There was clear recording of tasks being completed. Files contained records of medical appointments and there was evidence that people’s healthcare needs were being correctly monitored and met. Each person has a Health Action plan in place which included an up to date health assessment. All medication was correctly stored and recorded and only staff who have completed the required training can administer to the people living in the home. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 14 King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 15 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): 22 & 23 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. A safe environment is promoted but this could be enhanced and improved by increased staff training and more thorough recording around staffing records. EVIDENCE: The home has a complaints procedure in place and this is also available and displayed in a pictorial format. It was unclear though how this format could be used by the people living in the home currently. The service has responded positively to some concerns that have been raised, though they have not had to respond to any formal complaints. Questionnaires have been completed by the service users with staff support, as part of the quality assurance process, and one person changed rooms as a result of this. One person spoke with said they felt safe in the home and both people appeared comfortable in their home and responded well to the staff on duty during the inspection visit. Several staff have completed some training in protection issues but it was unclear exactly if everyone had done this training. Reference to the issues around staff training are made under the staffing standards. Concern is also expressed under these standards around some aspects of recording around staffing and recruitment. These procedures need to be followed thoroughly for there to be full confidence that people living in the home are as fully protected. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 16 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): 24 & 30 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. People living in the home enjoy a well decorated and homely environment that is well situated to access the local community. EVIDENCE: The home has been furnished and decorated to a high standard throughout, with all bedrooms having en-suite facilities. The bedrooms are personalised by the service users and staff, and provide comfortable and homely accommodation. Service users expressed satisfaction with their accommodation. Service users can have keys to their rooms if they choose. The home was clean and hygienic throughout at the time of this inspection. The home is well situated for accessing local amenities and facilities. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 17 King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 18 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): 32, 33, 34 & 35 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. Improved supervision of staff and leadership would provide better outcomes for people living in the home and shortfalls in recording could compromise safety and protection. EVIDENCE: Staff spoken with demonstrated a good knowledge of the needs of the people living in the service and were observed interacting in an appropriate manner. There is however limited use of symbols within the home and this is something that could be improved to help communication and promote choice. People living in the home appeared relaxed with the staff on duty and though they have limited communication skills made positive comments about the care and support they receive. There has been a lack of management input in the home over recent months and this has resulted in some shortfalls in terms of recording and storing of information in regards to staff records. Whilst staff have been informally supervised and there has been an acting senior staff member in place the King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 19 newly appointed manager has initially concentrated their time and efforts on the other home for which they are also applying to be registered. It was unclear from the staff files which people were currently employed, which were on the relief bank and which had left. The basic needs of the people living in the home appeared to be being met, but as evidenced in the Lifestyle standards there is a need for some leadership and direction around providing varied opportunities and activities to stimulate and engage the people living in the home. Whilst a considerable amount of training had been completed it was difficult to access accurate information due to the disorganised state of the office and the paperwork. Some staff are being supported to undertake NVQ training. Staff have also not been receiving regular formal supervision and there have not been regular staff meetings. The issues around the office were discussed with the manager and area manager, who explained the background to the present situation and how they were working to improve matters. They undertook to address the issues immediately, and also to audit the staff files to ensure there was an up to date and accurate staffing list in place. The rota for the home, which was displayed on the notice board in the kitchen, included the cover for the other home run by the same Provider and which shares the same manager. This was confusing and inappropriate. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 20 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): 37,39 & 42 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. Improved and consistent management input will provide better leadership for staff and improved outcomes for people living in the home. EVIDENCE: The service has a newly appointed manager which it shares with another service run by the same Provider, which is located close by. Due to certain reasons explained to the Inspector the manager has had to prioritise their time initially to the other home. There has been an acting senior staff member in place but this has resulted in various shortfalls in terms of office administration, staff supervision and general leadership and direction. An adequate standard has been maintained partly due to the fact there are only two people living in the home and this has also resulted in a smaller staff King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 21 team. If the service wishes to register one manager for this home and the sister home then they must ensure that sufficient management cover is provided. The newly appointed manager is appropriately qualified and experienced and has previously been registered. No formal quality assurance has been undertaken in the previous twelve months, though surveys were completed by the two people living in the home. All health and safety checks had been completed and recorded and fire safety recording and servicing had been completed. A safe environment was being maintained. King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 22 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 2 2 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 x 12 2 13 2 14 X 15 3 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 1 X X 3 X Version 5.3 Page 23 King Edwards House DS0000069195.V377857.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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. 2. Standard YA1 YA11 Regulation 4&5 Requirement Timescale for action 31/12/09 31/12/09 3. 4. 5. YA33 YA33 YA34 6. 7. 8. 9. YA34 YA33 YA39 YA10 The home must update and review its Statement of Purpose and Service User Guide 16(2)(m)(n) The service must provide people living in the home with sufficient choice around daily activities 18(2) Staff must receive regular formal supervision 18(2) The home must have regular staff meetings 17 The home must ensure that staff records are up to date and that there is a record of all staff currently employed within the in the home 17 All staff files should contain an up to date photo 18(1)(a) The home must keep an up to date and accurate staffing rota on display 24 The home implement a system of quality assurance 17 The home must ensure that all confidential records and information is securely stored 31/12/09 31/12/09 30/11/09 31/12/09 30/11/09 30/12/09 30/11/09 King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations King Edwards House DS0000069195.V377857.R01.S.doc Version 5.3 Page 25 Care Quality Commission Care Quality Commission South West 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). 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. 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