Inspection on 21/10/09 for Kingstone House

This inspection was carried out on 21st 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingstone House 29/11/07

Kingstone House 31/05/06

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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: Kingstone House 121 - 123 London Road Burgess Hill West Sussex RH15 8LU     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: Annie Taggart     Date: 2 1 1 0 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 32 Information about the care home Name of care home: Address: Kingstone House 121 - 123 London Road Burgess Hill West Sussex RH15 8LU 01444245063 01444258534 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): springmeadow@ilg.co.uk Evesleigh Care Homes Ltd (ILIACE Group) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 20. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability - (LD). Date of last inspection Brief description of the care home Kingstone House is a care home registered to accommodate up to twenty Service Users with learning disabilities. The Registered Provider is Independent Living Group (ILG) and there is no registered manager in post. The home is made up of three detached properties located next door to each other. Kingstone has the capacity to accommodate twelve people and Clevelands comprises of three 2-bed independent apartments, each with their own kitchen, sitting/dining room and bathroom. To the rear of these properties is The Lodge, which houses two self-contained flats. All of the Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 20 Brief description of the care home accommodation is situated a short walk from Burgess Hill town centre, and therefore is accessible to all community facilities, including rail and bus stations. Each service user has their own bedroom complete with en suite toilet facilities, some with showers. In addition there is also a large walk-in shower on the ground floor of Kingstone. Kitchens, dining rooms and lounge areas are well maintained and decorated to a high standard. The home is also in the process of developing an activity room at Kingstone. External grounds are enclosed for security purposes and consist of a tarmac area and a small lawn with seating. Information about the service, including the Statement of Purpose, Service Users Guide and CQC reports is made available to prospective service users or their relatives, on request, as part of the admission process. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: In order to carry out this inspection An Annual Quality Assurance Assessment (AQAA) was sent to the manager for completion and surveys were sent to service user, staff and healthcare professionals involved with the home. We looked at information that we have received since the last key inspection and this included a number of incident and accident forms and details of investigations and meetings undertaken by the West Sussex Safeguarding team. The last key inspection report from 29/11/2007 was also read. The AQAA was returned within the given timescales and it contained clear information about the home. Five service user and three staff surveys were returned and all made some positive comments about the home, no healthcare professionals surveys were returned. Care Homes for Adults (18-65 years) Page 6 of 32 The unannounced inspection was carried out on Wednesday 21st October at 10.30am and the visit lasted for six hours. During that time we spent time with the service users who were in the home both in communal areas and in their private bedrooms and spoke with the staff on duty. We tracked the care plans and health plans for four service users and we also looked at risk assessments, daily records and medication management. We looked at three staff recruitment files and saw that all of the required documentation was in place and staffing training records and supervision files showed us that staff supervision was not being kept up to date. Records for the running of the business were seen, including Regulation 26, registered providers visits reports, Regulation 37, incident and accident reporting, fire safety and staff fire training and service users money management. We spent time with the two deputy managers currently managing the homes and also spoke with a member of the ILG behavioural team who has been assigned to one house. Feedback following the visit was given to the two deputy managers and the area manager. To confirm further evidence of the concerns that we found when carrying out this key inspection, copies of some records were seized under Code B using statutory powers under Part 2 of the Care Standards Act 2000 and a copy was signed and left with the deputy manager. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available about the services on offer in the home but the safety of people is compromised by the the assessment process not ensuring the compatibility of the people living in the home. Evidence: At the last inspection visit we saw that not all people had received a comprehensive assessment of their needs and this had led to issues regarding challenging behaviour in the home. In the AQAA we are told that there is a placement team working out of the head office of the organisation that places people in the homes and that the assessment process has been improved. We were told that at the present time people are being reassessed to ensure the home is currently meeting their needs. From looking at the number of incidents, accidents and safeguarding referrals in the home we saw that there are issues of compatability in both the Kingstone and Clevelands parts of the house and that this has had a detrimental effect on the Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: wellbeing of service users, especially one identified person who is targeted by another. The manager told us that this is being addressed and that alternative accommodation is being considered for one of the people. From looking at records we saw that contracts of terms and conditions of residency are agreed and those that we saw had been signed by service users or their representatives. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are care plans, risk assessments and daily records in place but these are not always kept up to date or followed by the staff team which leads to risks of service users individual needs and wishes not being met. Evidence: For each person living in the home there is a person centred care plans in place in the form of an Essential Lifestyle Plan format. We tracked the care plans of five people over the two houses and saw that the plans contained details such as personal care preferences, challenging behaviour management, healthcare support, food and drink guidelines, and moving and handling assessments. We saw that risk assessments are completed, both personal and environmental, with guidelines for the staff team on how to manage the risks. From looking at risk assessments and guidelines for challenging behaviour we saw in daily records that the staff team had not always followed the guidelines that are in Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: place, leading to both service users and staff being injured, incidents occurring that had an adverse affect on service users, the staff team, the general public and some that have included police involvement. We saw that monthly reviews were not up to date for people, for one person none had been completed since June 2009. When tracking service users records we saw that the ILG behaviour team had assessed one person and had put a plan in place that was designed to place restrictions on their freedoms. The behaviour team had involved the Deprivation of Liberty Team (Dols) to carry out a further assessment and they had agreed to the restrictions on the condition that the person did not have an underlying health condition. From tracking records we saw that the care plans were not up to date for this person therefore the information used to inform the assessment was not correct. Further information about this is detailed in the Lifestyle area of this report. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to their local community and are offered a range of activities and outings. There are risks to the safety of people by food records not being kept up to date. Evidence: From looking at records and speaking to service users and staff we saw that people have access to their local community and that there are a range of activities and outings on offer. In the Clevelands part of the home, the three people living there have their own assigned staff teams and each person has a daily programme of activities that they have agreed to. In the AQAA we are told that one person has paid employment. In the Kingstone house there are programmes of activities and outings, some people have refused to participate in any structured activities and this is recorded in their Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: care plans. People told us that they can see their families and friends, they go on holiday and some people access the local community independently. Records showed that as one person was staying in bed all day and eating at night a restriction was to be put in place where fridges would be locked at night so that the person would not have access. We asked what effect this would have on other people and were told by the deputy manager that other people would ask the staff on duty for access and people had their own snack boxes, we saw these are kept in a cupboard in the kitchen. When tracking the records of the person for whom the restrictions had been agreed, we saw that they were of a low body weight, they were prescribed food supplements and their food records were not up to date. For some days no food at all was recorded and the person was recorded as being in bed for all meal times. From the week commencing 17/10/2009 up to 21/10/2009 no meals were recorded on four days and on some days the records were left blank. The deputy manager said that the person ate cakes and biscuits and went into the fridge at night stealing food, but what was eaten was not being recorded. We spoke to the deputy and the area manager about the safety and appropriateness of putting restrictions on food for a person who was already identified as at risk from not eating. We were told that all of the information had not been given to the team before the programme was designed and that it was not yet put in place as the locks had not arrived for the fridges. We discussed these concerns with the member of the ILG behavioural team who is currently assigned to Clevelands in order to assist with addressing the difficulties in managing behaviours in the home and she agreed that as the service users food records and daily records were not up to date, the correct information was not available when the programme was set up to restrict access to food at night for this person. Care Homes for Adults (18-65 years) Page 15 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are risks to the safety and wellbeing of service users by Health Action Plans not being up to date and errors being made in medication management and recording. Evidence: There are completed Health Action Plans in place for each person living in the home that assess and record the healthcare needs of service users and details the care needed to support their identified needs. In plans we saw that people have access to professionals such as their local doctors, dentists, speech and language therapists and to occupational therapists and that they have support with mental healthcare needs and behaviour management teams. When tracking the records of one person who has been identified by the home as currently needing a high level of support with their health, we saw that their plan was out of date. The Health Action Plan was not dated therefore we could not assess when it had been completed or when it had last been reviewed. The plan consisted of questions about the persons health that in included, are you worried about your weight, is anyone else worried about your weight? The answer was no and also Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: recorded was my appetite is good at present no changes. The persons weight was recorded as 9st 13lb. Another question in the plan was,are you worried about your mental health or is anyone else worried about your mental health and the answers were recorded as no. When tracking this persons daily records and care plans we saw that on 10/1/2009 their weight had fallen to 6st 13lb and the last time it was recorded, which was on 09/07/2009 it was 7st 2lb. Daily records showed that the person was lying in bed for much of the day, refusing food and they had been referred for counseling and receiving input from mental healthcare specialists and behavioural teams. Daily records said that there had been a deterioration in the persons mental health. We spoke to the deputy manager and the area manager about this and both agreed that there was a lack of current information available to guide the staff team and other professionals about the persons changing healthcare needs. For people with epilepsy there are clear guidelines in place to guide the staff team on how to recognise seizures, what action to take, what medication is needed and at what stage to call for an ambulance. One person in the Clevelands part of the home is prescribed medication that involves an invasive procedure sometimes needing to be carried out and we saw that this had been written up and agreed as a detailed plan and that there were staff training records in the home. There are policies and procedures in place for the recording and administration of medication and staff training records are on file in the home. When tracking the medication system we saw that on regular basis one person refuses to take any of their medication. We saw that this had been discussed with a GP and the outcomes recorded and risk assessments were in place. For another person, a prescribed antibiotic had been missed for seven days due to a mix up by the staff team in ordering repeat medication. On 20/10/2009 a service user had refused to take their medication all day. From looking at Medication Recording Sheets (MAR) we saw that this person was taking a number of medications including medications for serious health needs and behavioural issues but there was no record of a doctor having been contacted to see what affect missing the medication might have had on their wellbeing. The guidelines for one of the missed medications said,take at regular intervals, we asked the deputy manager what this medication was for and she told us that it must be a new one and she did not know. We saw that for one person who self medicates there was a plan and risk assessment Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: in place and that weekly monitoring is carried out. In the Clevelands house there were six gaps in signing in the MAR sheets for one person who is prescribed a cream to be applied daily. Two controlled medications were checked against records and found to be correct. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are risks to service users, staff and members of the public by challenging behaviour in the home not being safely managed and by the staff teams lack of understanding of what constitutes all forms of abuse. Evidence: There is a complaints procedure in place a copy of which is displayed in the home and is available in an accessible format for service users. The system in place is for any complaint to be recorded in the complaints log in the home and then investigated and recorded at the head office of the organisation. During the inspection a service user came to the deputy manager and inspector and repeated several times that they had been upset by a member of staff shouting at them a number of times, they also said that the same staff member had made another service user cry. The person identified the staff member and the shift they had worked on and the deputy manager recorded the complaint and called the area manager who came into the home said that she would make a safeguarding referral. Some of the people living in both Kingstone and Clevelands have difficult behaviours that at times can become aggressive and challenging. The staff team have received training in Strategies for Crisis Intervention and Prevention (SCIP), which is a behaviour management programme and there is also an in - house behavioural team for ILG. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: There have recently been a large number of incidents and accidents recorded in the home that have been referred to the West Sussex Safeguarding team as they have been identified as causing risks to service user, staff and the general public. These have not yet been resolved and investigations are currently underway. In reports referred to the Commission we saw that on some occasions restraint had been used on service users but there was no record of these being agreed or training carried out for staff in the home to carry out restraint. We saw evidence in daily records and incident forms that staff team are not following or responding correctly to the written guidelines for behaviours management and we were told that some staff are undergoing performance management to address this. The deputy manager of Clevelands told us that inconsistency in staff practice and approach had added to the severity of risks in the home. We spoke to the staff on duty about their understanding of safeguarding people from all forms of abuse and when asked what they would do if they heard a staff member shouting at a service user one person replied, I would check on the staff and if there wasnt any good reason for them to be shouting at the service user I would probably go to the deputy or manager if there wasnt a good reason for them to be shouting. We also heard this staff member repeatedly calling service users darling when dealing with them. In the daily records for 2/10/2009 we saw the following entry, today (two service users initials) went up to the shop! upon arrival when we asked if they had purchased anything they both said NO!. We later found a whole packed of biscuits in (initials) room. We explained to both of them that if asked if they had bought anything can they please be honest otherwise they will not be allowed up to the shop together if they cannot be honest with staff. We discussed these issues with the deputy managers in both houses how this shows evidence of service user not being allowed choice and not being treated with respect. We also discussed issues of safety with the area manager and a member of the ILG behaviour team currently working in Clevelands to address the concerns. We were told that they were aware of the seriousness of the issues and of the lack of staff competence in the home and were actively working to improve this. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, homely and well equipped and people have personalised their private space. Evidence: The Kingstone House service is divided into three separate buildings, Kingstone, Clevelands and The Lodge. Kingstone and Clevelands are large detached houses situated next to each other on a residential road with The Lodge a smaller dwelling to the rear. In Clevelands the house is divided into three separate flats all with their own entrance, kitchen, lounge and bathroom and where needed people have the specialist equipment they need. The house is bright, clean and well maintained and peoples private bedrooms have been personalised with their own belongings and equipment. On one entrance the front door was badly marked and we were told that this was because of a service user regularly kicking another persons door. Kingstone is a large detached house with accommodation, lounges and kitchens on each floor and we are told that the floors are staffed separately because of risks of challenging behaviours between the people living on each floor. The home was bright , comfortable and homely and people had personalised their rooms to suit their Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: individual taste. The Lodge is not occupied but we were told that this is being considered as alternative accomodation for one person living in Clevelands whos behaviour is having a negative impact on the lives of the other two people living there. From looking at records and maintenance books we saw that there is a programme of updating and decorating peoples rooms, some areas such as halls and stairways are looking tired and in need of redecoration and we were told that this was planned. There was washing being dried all around the house in Kingstone and we were told that this was because the tumble drier had been broken for two weeks and another one was on order. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a robust recruitment and training programme in place but staff do not have the required skills, competence and supervision they need to safely support people. Evidence: From looking at staffing rotas we saw that the home is being staffed by two distinct staff teams. In Clevelands each service user has their own designated staff team that works with them on a daily basis and each service user has a rota to show who will be supporting them. Staffing is one to one in the home and for some people two to one when out in the community. From the number of incident and accident reports that have led to safeguarding alerts we have seen that the staff teams work under difficult and stressful conditions and the reports have shown evidence that staff not following policies, procedures and written guidelines have lead to escalations in behaviour, staff members being both verbally and physically abused and service users being restrained and the police involved. We discussed this with the area manager who told us that a member of the ILG behavioural team had recently been allocated to Clevelands in order to support the deputy manager, monitor staff practice and put into place consistent approaches to supporting people. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: We asked the deputy manager how staff are currently being supported through supervision and asked to see supervision files. The three that we saw were out of date and some records could not be found at all. The deputy manager told us that some supervisions are delegated to team leaders but were out of date and she said we need to improve 100 on this. A Requirement has been made in respect of staff supervision. When speaking with a service user and the staff member supporting them we found that there was difficulty in understanding the verbal communication of the staff member. We asked the deputy if this might not be contributory in the difficulties of supporting this person and she told us that this was being addressed. In Kingstone the staff on duty work on either the ground or first floor and one person told us that this was very stressful as they were working alone with two people with behaviour difficulties for a whole shift. Two staff members told us that since the manager had left, staff morale was very low and the deputy manager and area manager agreed that this was the case at the present time as the home is being run as two units and there were difficulties with staff refusing to work in both houses. We looked at three supervision files in Kingstone and all were up to date. We tracked the recruitment records for three members of staff and found that they all contained the required documentation, including a current Criminal Bureau Check (CRB) and two references. New staff receive an in house induction and we saw records to show that they undertake the Learning Disability Award (LDQ) and attend mandatory training. A training matrix showed us that there is a training plan in place for each member of staff and courses such as epilepsy awareness, dealing with challenging behaviours and medication management are attended. There was one recently recruited member of staff undergoing their induction in the home, we saw that a POVA first had been gained and the person was being supervised at all times. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no registered manager in place at the home and evidence shows that the home is not being managed in a way that keeps both service users and the staff team safe at all times. Evidence: The registered manager of the home has recently moved to manage another home in the ILG group and the home is currently being managed by a deputy in each house. We are told that the area manager is also supporting Kingstone three days a week and a member of the behavioural team has been assigned to Clevelands. When talking to the staff on duty, two staff members told us that they felt they were not getting the management support that they needed as when the manager left, both the deputy manager and area manager were also on leave and the staff said that this was very stressful and lead to them not having the information they needed to pass on to other professionals when needed. We spoke to the area manager about this and were told that she was only on leave for one day of that week and that the deputy from Clevelands was on call for each house. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: From the records we looked at we saw that Regulation 26, providers visits are carried out monthly, reports are completed and action plans put in place. Regulation 37 reports that detail incidents and accidents in the home are completed and sent to the Commission as required. The ILG group has a quality assurance manual in place but from looking at records we could not evidence that a recent process had been carried out for Kingstone and a requirement has been made to address this. Following a safeguarding incident where a service user living in the home had a large amount of money missing form their bank account ILG have set up a safer system to manage and monitor peoples personal monies. Each person has their own wallet that is sealed using a numbered seal that is recorded and signed by staff every time the wallet is opened. Records are kept of all transactions and receipts are kept on file. We checked the records for one person and they were correct with the money in the wallet. There is a fire risk assessment in place and we saw records to show that staff fire training is up to date. There are identified risks to the people living in the home by the management of the home not ensuring that people receive the support they need to keep them safe at all times. Records are not kept up to date, medication is not being safely managed, the staff team do not follow the procedures and training they have in place to keep people safe, the staff team do not show an awareness of all forms of abuse, staff supervision is not up to date and a quality assurance system has not been carried out. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 14 14 (1) The registered provider must ensure that a thorough assessment is carried out that identifies peoples individual needs and potential risks This is to ensure the compatibility and safety of all service users. 10/12/2009 2 9 15 15 (2) (b)The registered 10/12/2009 provider must ensure that there are up to date care plans, risk assessments and reviews in place that inform the staff team of the current needs and wishes of service users This is to ensure that the staff team have the information they need to safely support the people in their care. 3 17 16 16 (2) (i) The registered provider must liaise with a nutritional expert to ensure 10/12/2009 Care Homes for Adults (18-65 years) Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action that all service user needs are met and food records must be kept up to date. This is to ensure that people receive a nutritional and healthy diet and that there are records available to evidence this. 4 19 12 12 (3) The registered provider must ensure that the changing healthcare needs of service users are recorded and kept under regular review. This is to ensure that people are not being put at risk by their healthcare needs not being met. 5 20 13 13 (2) The registered providers must ensure that medication records are kept up to date and that referrals are made to a doctor when medicines are missed or refused. This is to ensure that people are not being put at risk by them not receiving the medications they need at the times they are prescribed for. 6 23 13 13 (6) The registered provider must ensure that the staff team have further 10/12/2009 10/12/2009 10/12/2009 Care Homes for Adults (18-65 years) Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action training in safeguarding issues and managing challenging behaviours This is to ensure that service users are protected from all forms of abuse and that they are treated with dignity and respect. 7 23 13 13 (7) The registered 10/12/2009 provider must ensure that restraint is not used in the home unless it has been agreed and recorded by multidisciplinary agreement. This is to ensure that service users rights are being addressed 8 36 18 18 (2) The registered provider must ensure that the staff team receive regular supervision and support. This is to ensure that the people living in the home are being supported by a competent and caring staff team who are skilled in caring for people with complex needs 9 39 24 24 (1) (a and b)The registered provider must ensure that a quality assurance process that elicits the views of service 20/12/2009 20/12/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action users, staff and other people involved with the home is carried out. This is to ensure that there is a system in place to monitor the quality of service being provided in the home. 10 42 13 13. (4) The registered provider must ensure that all records in the home are kept up to date and that working procedures are followed by the staff team. This is to ensure that there is a well managed safe environment for people to live and work in. 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 20/12/2009 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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