Inspection on 22/06/10 for Langdon Park 18

This inspection was carried out on 22nd June 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Langdon Park 18 11/08/09

Langdon Park 18 13/02/09

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Langdon Park 18 18 Langdon Park Teddington Middlesex TW11 9PS     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: Sandy Patrick     Date: 2 2 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 41 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 41 Information about the care home Name of care home: Address: Langdon Park 18 18 Langdon Park Teddington Middlesex TW11 9PS 02089432255 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.mst-online.org.uk Metropolitan Support Trust Name of registered manager (if applicable) Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who may be accommodated is: 7 The Registered Person may provide the following categories of care only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Langdon Park is a purpose built care home that provides care and accommodation for a maximum of seven adults with learning disabilities. Staffing is available to residents 24 hours a day. The service is managed by Metropolitan Support Trust. The home is situated in a quiet residential area close to local shops and public transport links. Each person has a single room with en-suite bathroom. 1 1 0 8 2 0 0 9 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The rating for this service is 0 stars. This means that people who live at the home experience poor quality outcomes. As part of the inspection we made an unannounced visit to the home on 22nd June 2010. We met the people who lived there, staff on duty and the acting manager. We looked at the environment, records and observed how people were being cared for and supported. We wrote to the acting manager and asked him to complete a quality self assessment (AQAA). We wrote to people who live at the home, their representatives and staff to complete surveys about their experiences. Care Homes for Adults (18-65 years) Page 5 of 41 We looked at all the other information we had received since the last inspection, including notifications of changes and incidents. We spoke to the local authority who have a contract with the home and who undertake regular monitoring of the contract. The Commission is taking enforcement action to secure compliance and achieve better outcomes for people who live at the home. Care Homes for Adults (18-65 years) Page 6 of 41 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 7 of 41 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 8 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one has moved to the service since the last inspection. Evidence: No one has moved to the home since the last inspection. The acting manager has updated the guide to the home and this was on display in the entrance hall. The acting manager has reviewed and updated the assessment of needs for all the people who live at the home. Care Homes for Adults (18-65 years) Page 9 of 41 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. People do not have all their needs assessed, recorded or met. Although there has been some improvement to recording, people still have needs which have not been addressed and this puts them at risk. People who live at the home do not have the information they need to make informed choices. Evidence: Everyone who lives at the home has a support plan which is designed to record their strengths and needs and the action the staff should take to meet these needs. The acting manager has started to review and improve these plans and some of them give detailed information on personal care needs. However, the support plans did not show how peoples social needs would be met and information on some personal care and health care needs was basic. These plans need to be further improved so that they give clearer information on all areas of need. The staff also need to consider how they can create plans which are meaningful for and accessible to the people they are about. The staff have started to improve the way they record how they have supported Care Homes for Adults (18-65 years) Page 10 of 41 Evidence: people to meet their needs each day. The acting manager has created some useful documents which help show how each person has been supported. The acting manager has also introduced a system where staff review this information each month and monitor peoples health and wellbeing. The system is well designed but the quality of the information recorded by staff was not always clear. For example on several occasions the staff failed to describe what someone did during the day. The staff also used terms such as good and well behaved to describe someone. These terms do not adequately describe how the person was. There is a very basic record which shows some of the risks that people experience and how they can be supported to reduce the likelihood of harm. These had been reviewed shortly before our inspection. However, these assessments were very basic and tended to consider the same selection of risks for each person. The staff need to think about each individual and the risks that they face in their everyday lives. They also need to think about how people can be supported to take risks and face challenges without being harmed. The acting manager told us that risk assessment training had been organised for all staff for September 2010. This training needs to equip staff with the skills to assess the risks and restrictions people face and also to value the importance of risk taking and support people to make informed choices about the risks they wish to take. The people who live at the home are supported to help plan a menu. They are invited to regular meetings. We saw records of these meetings. We saw that they were used for people to discuss their thoughts and feelings but were not used as a forum to tell the people living at the home about changes or things that were taking place. The record of meetings were not accessible to the people who live there and were not recorded in a format they would understand. The people who live at the home are not involved in its running. They have not participated in the recruitment and selection of staff and have limited information on things that are happening. There is a pictorial menu, which uses photographs to display the meals of the day. However, on the day of our visit the pictorial menu was showing a different meal to the written menu and was different from the meal which was prepared. A notice board in the kitchen displayed a mixture of information for staff and people who live at the home. The board included information on staff training and events. This information should be displayed in staff offices and the board in the kitchen should be used to share accessible information with the people who live there. There is a pictorial rota showing photographs of staff on duty. This is good, however there was no other pictures or accessible information about activities, how to make complaints, what to do in event of a fire or to support people to use the kitchen Care Homes for Adults (18-65 years) Page 11 of 41 Evidence: independently. The staff should think about the needs of the people who live at the home and how they can communicate information more clearly to them so that they can make informed choices. Care Homes for Adults (18-65 years) Page 12 of 41 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. The support people have to take part in different activities and the community has improved however there need to be more emphasis on peoples individual choices and wishes. There needs to be more structure so that people know what they will be doing and can make choices about whether to participate in planned activities. Evidence: In the two months before our visit people who live at the home had started to go out and access the community more regularly. On the day of our visit everyone went out for lunch at Hampton Court. The acting manager told us about other trips to the zoo and places of interest. This is positive and the staff should continue to offer people a variety of opportunities to access the community. The acting manager also told us about planned parties which would involve inviting friends and family to the home. Some people have regular planned events which include visits from therapists and Care Homes for Adults (18-65 years) Page 13 of 41 Evidence: trips to local cafes or the shops. However, apart from a few planned activities, there was very little structure to the things that people who live at the home do each day. Care and support plans did not identify peoples individual needs and interests and people were not given the support they need to pursue these. There was no accessible information for people about what they are going to do each day, or what the planned activities are so that people can make a choice. Whilst some ad hoc activities and free time to allow this are important, there needs to be more structure so that people know what they will be doing and do the things that they like and enjoy. At one point during our visit the staff put a music station on the radio. The music was very loud and modern. Two people were seated in the room where the music was playing and one person was unable to leave the room without support. These people may have liked the music however the staff did not offer them a choice about this and it appeared that the music was the choice of the staff rather than the people who live at the home. Throughout our visit we saw that the staff were kind to people and showed genuine care and affection. However, some of their actions indicated that they did not always respect the choice and rights of people. We saw that the kitchen was well stocked with fresh food, including fruit. All meals are freshly prepared by staff and there is a planned menu, which is varied. The staff told us that they shopped for the house food and prepared the meals. They should consider ways in which the people who live at the home can be more involved with this if they want to be. Care Homes for Adults (18-65 years) Page 14 of 41 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. People do not always have their personal and health care needs met and they are at risk from poor management of medication. Evidence: Everyone is registered with a local GP. The acting manager has created basic health action plans which identify specific health care needs and how these are monitored and met. We saw evidence that some monitoring took place and that people had some input from health professionals. For example, on the day of our inspection one person visited the dentist. However, the information in health care plans was very basic and some of the contact details for health professionals involved in supporting people were incorrect. We also identified that some health care needs were not being met. For example one person has a continence need. This was not fully recorded in their care plan. There was also no evidence that the staff had consulted with an appropriate professional to have this persons needs assessed and for them to have the support they require to manage this need. As people who live at the home are getting older they have developed some conditions associated with older age. There was no evidence that these had been fully Care Homes for Adults (18-65 years) Page 15 of 41 Evidence: assessed and that they were getting the support to manage these conditions. The staff have not had specific training in conditions of older age, including skin care, pressure care, continence and dementia. They need to have this training and information so that they can meet the needs of people as they age. Information about peoples personal care needs is recorded in their support plans. And there is evidence that these are monitored and that people are supported to bathe, shower and use the bathroom as needed. The staff told us that they helped people chose the toiletries they wanted and we saw that plans to meet personal care were mostly based around individual choices. However, care plans did not record preferences for gender specific care. On the day of our visit the majority of staff working were female, however a male member of staff attended to the intimate personal care needs of a woman who lives at the home. We saw a member of staff walking around the home wearing disposable gloves and an apron. They told others that they were about to support someone with personal care. The staff should only put on the protective clothing whilst they are actually supporting people and should dispose of this in the same room as the personal care is delivered, immediately after supporting that person. Wearing protective clothing around the home and announcing to a group of people that they are about to support someone with intimate care is not appropriate and does not show respect for that persons privacy and dignity. There is also a risk of cross infection if staff wear protective clothing when they are not in the process of giving support. There was no evidence of staff training or assessment of competency when in administration of medication. Medication is stored securely. Some medication has not been appropriately recorded. person. There were no guidelines to tell staff when they should be administering as required medication. The controlled drugs cabinet was not locked. It was used for storing a number of different items including a bottle of surgical spirit, some olive oil which had expired, unlabeled diuretic for which there was no record and a controlled drug which expired in August 2009. There was no record of this drug on the persons medication profile or administration record. The staff told us that they crushed some peoples medication in a pill crusher and administered this in their food to help them swallow this. There was no record of this method of administration or a risk assessment to state why this was necessary. This method of administration could be covert if staff did not tell the person what they were doing and this needs to be agreed by a multidisciplinary team. The staff told us Care Homes for Adults (18-65 years) Page 16 of 41 Evidence: that the pill crusher was used for two different people. We saw that the device contained dust from medication which had been crushed. The practice of using the same crusher for different people and not cleaning it appropriately puts people at risk. One person has been prescribed a lotion with the instructions to apply daily. There was no record that this had been administered and there were 5 unopened packets of the lotion stored in the cabinet. One persons dose of a medication had been changed. The staff had altered the records in a manner which was unclear and messy. The amount of medication received or carried forward each month in the home had not been recorded anywhere. The Commission is taking enforcement action to secure compliance and achieve better outcomes for people who live at the home. Care Homes for Adults (18-65 years) Page 17 of 41 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. Procedures are in place designed to protect people and keep them safe. However, practices at the home put people at risk of harm and abuse. Evidence: There is a complaints procedure. The organisation should consider developing a complaints procedure in a format which is accessible to the people who live at the home. There were no recorded complaints since the last inspection. The management of the home and staff team have changed a number of times since over the last two years. The organisation needs to make sure people who live at the home know who to speak to if they are unhappy and how to make a complaint. The organisation has its own procedures on abuse and whistle blowing. They also have to work within the safeguarding procedure of the local authority. One member of staff told us that they had undertaken safeguarding training but we did not see a record of this and there was no evidence that the other staff employed at the home had undertaken this training. There was no evidence of criminal record checks for some of the staff working at the home. Some of the practices we saw indicated that staff did not have a good awareness of what constitutes abuse and there were abusive practices taking place, these included mismanagement of peoples finances and medication. The records relating to peoples finances were not well kept. The acting manager Care Homes for Adults (18-65 years) Page 18 of 41 Evidence: referred us to peoples financial files. Some of these had no recent bank statements, others had no financial information in at all. The acting manager has access to some peoples bank accounts through use of a cash card. There was no recorded agreement for this with the next of kin or local authority. There was very limited information on peoples finances and no financial risk assessment for anyone. We were told about practices which constitute financial abuse. For example people who live at the home pays for meals and drink that they have when they go out, even though their food has already been paid for by the local authority. In addition to this people pay for staff food and drinks. The staff told us that one person has limited finances and therefore the other people pay for their food and drink. On the day of our visit everyone went on a trip out and only some people paid for the taxi for their trip. The staff told us that they took it in turns to pay for outings. People who live at the home have not given their permission for this. The systems for using peoples personal money to pay for staff, others and their own food and activities is poorly organsied, is unfair and unmanaged. The cash held on behalf of people who live at the home is counted each change over of staff to make sure records are accurate. The staff told us that any extra money was stored in an envelope which they showed us and this money was used to top up if any balances were wrong. There was no record of this envelope of money or the amount held in it. This system is open to abuse. The Commission is taking enforcement action to secure compliance and achieve better outcomes for people who live at the home. Care Homes for Adults (18-65 years) Page 19 of 41 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well designed environment which is spacious, however this has not been well maintained. Evidence: The building is spacious with a large conservatory, lounge, dining room and kitchen. Each person has their own bedroom with en suite facilities. In general the home was light and well ventilated. A ground floor toilet did not have a window and ventilation in this room was poor. Throughout the home there were signs of wear and tear, including damage to walls and skirting boards. Some walls and ceilings were stained and windows were dirty. We saw that some furniture had been damaged, including a broken chest of drawers and a broken toilet seat. The bedrooms are large, but we saw that majority of these had not been personalised. Some rooms looked rather bare and some contained cardboard boxes and other equipment. The staff need to help people to personalise their bedrooms and make them more attractive. Equipment needs to be stored in a way which does not detract from the comfort and attractiveness of the rooms. We saw that two old mattresses and an old wheelie bin were stored in the garden. These need to be removed. Care Homes for Adults (18-65 years) Page 20 of 41 Evidence: The home was generally clean throughout on the day of our visit. However, some areas smelt strongly of urine and the floor of one communal toilet was stained and smelt. The kitchen waste bin did not have a lid or cover. Care Homes for Adults (18-65 years) Page 21 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have the support of a consistent, permanent staff team. The staff who support them may not have been recruited appropriately and have not had the training and supervision they require to meet the needs of people who live at the home. Evidence: We saw that the staff had good systems of communicating with each other, including regular meetings, message books and a hand over of information between shifts. There are a large number of staff vacancies and the home relies on the use of agency and temporary staff. On the day of our visit only the manager and one other member of staff on duty were employed by the organisation. We looked at staffing rotas and saw that this was the norm. The majority of work is undertaken by temporary staff. Some of these work at the home regularly and this provides a degree of consistency. However, the organisation has not advertised or recruited to the vacant staff posts and therefore there is no planned resolution to to problem. The organisation needs to recruit a permanent stable core staff team who will lead the support of the people who live at the home. The acting manager has asked a temporary member of staff (bank staff) to work as Care Homes for Adults (18-65 years) Page 22 of 41 Evidence: deputy manager. The acting manager has told us that this person has been very supportive and has helped drive improvements at the home. However, we looked at the persons file and there was no evidence of a contract or induction into this role. There was no evidence of training the person had undertaken to give them the skills they need for a management position and the person had not had a supervision meeting since June 2009. We looked at a sample of staff recruitment files. There was no evidence of the recruitment process and we could not locate application forms, interview notes, copies of identification or references for any of the staff. Some staff did not have a recorded criminal records check. There was no evidence of job descriptions or contracts of employment on the staff files. There was no evidence of induction for any of the permanent staff and no training record to evidence the training they had undertaken. We looked at training certificates for 4 members of staff. There was no evidence of safeguarding training, no evidence of medication training, no food hygiene, health and safety or manual handling training - or only evidence of training which needed to be renewed, and no evidence of first aid training. The acting manager told us that he was arranging for training for all the staff and this included first aid training (which some staff were attending on the day of our visit) and risk assessment training. The acting manager needs to make sure all staff have up to date training in areas that affect the safety and wellbeing of people who live at the home. He should also make sure the staff have the training and skills they need to meet other needs, including communication and dementia. Care Homes for Adults (18-65 years) Page 23 of 41 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. People live in a service which is not well managed, where there are few quality measures and where they are put at risk from poor health and safety practices. Evidence: The registered manager has not worked at the service for over a year. There have been three temporary managers employed since this time and periods when the home has been without a manager. The current acting manager has been in post for two months. He must apply to be registered with the Care Quality Commission. The acting manager needs to undertake a relevant qualification. The changes in management at the home, along with a lack of a permanent staff team, have had a detrimental impact on the care and support of people living at the home. Care and health needs are not being properly assessed or met, peoples social needs have not been met, the staff have not been supervised or trained, people have not been safeguarded and they have been open to abuse. Although a permanent manager is now in post this person needs to be registered with CQC and the management needs to be stable. Care Homes for Adults (18-65 years) Page 24 of 41 Evidence: The serious concerns identified at this inspection mean that people living at the home are at risk and have poor outcomes. The amount of things that need to improve and be changed mean that these changes will require a high level of skill and resources. We did not see evidence that the organisation was providing this support to help improve the home. The acting manager told us that he felt his line managers offered support. However, we saw no evidence of regular input and support from the organisation. The records of monthly visits which they are required to undertake were poor. These records did not adequately evidence that they had assessed the strengths and needs of the service and they did not provide a clear action plan for improvement. On the day of our visit the local authority who have a contract for all the places at the home met with the manager. The meeting was arranged in advance to discuss their serious concerns with the service and their proposal to cancel the contract. The organisation did not send senior management representation to the meeting and this left the acting manager to meet with them on his own. The organisation has failed to start the process of recruiting to staff vacancies and this has had an impact on the quality of care for people living there. There was no evidence of a formal quality assurance plan for the home. People who live there and their representatives are not consulted about the running of the home and there is no evidence that they have been involved in the development and review of their support plans. The problems and challenges of the home have not been identified by the organisation and there was no evidence of their assurance or commitment to improve the quality of the service. The acting manager has created some new documents to help staff think about the way they record the care and support people received. He has worked hard to make the documents right for the home and has given the staff some support and information on how care plans are developed and how peoples needs are assessed. This is positive. He has also reviewed and updated a lot of the records at the home. However, records used by staff lack organisation and older information which needs to be filed or archived is not stored appropriately. The staff office has a mixture of current records and old out of date records and there is no definition of what is current and relevant and what is not. The staff notice board had messages pinned over important records, such as the fire procedure. Staff records were incomplete, financial records were incomplete, care and support plans need further improvement, medication records and health and safety records were not clear and in some cases not accurate. We saw evidence that staff undertook some checks on health and safety at the home. Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: These included checks on hot water temperatures. A recent check indicated that water temperatures were too high. Records indicated that the core temperature of the boiler had been reduced to resolve this problem. This means that the water system could be at risk of infection. Water temperatures must only be reduced at the point of delivery. We saw a record that portable electrical appliances had been tested in September 2009. However, some of the electrical appliances in the home had not been included in this test. These included electric fans which were being used on the day of the inspection. The test indicated that the refrigerator had failed however there was no evidence of what action had been taken to make this equipment safe. Other records did not evidence how health and safety concerns had been addressed. For example the general health and safety check made in April 2010 by staff identified problems with the fridge, safety signage, food temperature monitoring and information on first aiders. But there was no action plan to show how these concerns had been addressed. We checked the temperatures of the fridge and freezer and found that the freezer was operating at -15.C, a temperature too high for frozen food storage. The record of checks made by staff earlier in the day indicated that the temperature was 5.C colder, in line with other records of checks. The acting manager needs to examine why the recorded temperature was so different from the actual temperature we saw and whether records are being completed accurately. The last recorded fire risk assessment was carried out in June 2008. The assessment identifies a number of risks, some of these serious. There was no evidence that these risks had been addressed and in some cases they clearly had not. For example the assessment requires fire doors to be equipped with intumescent strips which help to contain smoke and fire, the doors had not been appropriately equipped. The assessment also asks for a policy on the use of convector heaters and where possible these heaters to be replaced with safer ones. This had not been actioned. The organisation needs to undertake a new fire risk assessment and take action to address any identified risks. Some of the fire doors in the home did not reach the floor and there was a large gap. These would not appropriately contain fire or smoke and need to be replaced or repaired so that they conform to safety standards. Care Homes for Adults (18-65 years) Page 26 of 41 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 6 15 Improve the standard of 30/10/2009 recording on support plans to demonstrate that service users receive appropriate support to achieve their goals. At the inspection of 22/06/10 there was limitted improvement to the recording in support plans. 2 7 12 Make sure that staff are aware of service users communication needs and are equipped with the skills to meet these needs. At the inspection of 22/06/10 there was no evidence that staff have the skills or information to help them understand individual communication needs. Care plans did not describe individual needs or how these could be met. There was no evidence of training for staff in different communication techniques. 30/10/2009 3 14 16 Make sure that service users 30/10/2009 have the opportunity to take an annual holiday. 22/06/10 There was no evidence that people who live at the home have had a Care Homes for Adults (18-65 years) Page 27 of 41 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 holiday since the last inspection. 4 14 16 Make sure that service users 30/10/2009 have access to a range of activities that reflects individual interests. At the inspection on 22/06/10 we found that peoples individual needs were not recorded and they were not supported to meet these needs. 5 33 18 Recruit to the vacant posts to 30/10/2009 establish an effective team and to provide consistent support to service users. 22/06/10 the organisation has not recruited to establish an effective staff team. 6 36 18 The Registered Person must 30/03/2009 ensure that all staff have supervision at least six times a year. Staff must receive regular supervision and support. We looked at a sample of staff supervision records during our visit on 22/06/10 and found that some staff had only had only had one supervision since June 2009 and some staff had not had any supervision meetings. 7 37 9 Address the situation 30/10/2009 regarding the management of the service and establish a consistent management Page 28 of 41 Care Homes for Adults (18-65 years) 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 team. Care Homes for Adults (18-65 years) Page 29 of 41 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 6 15 The registered person must 23/07/2010 make sure support plans identify all of peoples needs and the support they require to meet these needs. The registered person must make sure the staff record evidence of how they have supported people and that these records are factual and not the opinions of the staff. Because these plans are a guide to tell staff how to care for each person and records need to show that people are having their needs met.. 2 7 12 The registered person must 23/07/2010 make sure information is accessible to the people who live at the home and that it is accurate. Because people need to Care Homes for Adults (18-65 years) Page 30 of 41 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 have accessible information to make informed choices about their care and every day lives. 3 9 13 The registered person must make sure risk assessments are in place and are accurate and personalised. Because the staff need thorough assessments to judge whether people are safe and to help people to make informed choices. 4 12 16 The registered person needs 23/07/2010 to make sure the majority of social activities are planned and advertised so that people can make a choice about whether they wish to participate. Because people need to have time and information to make decisions about what they want to do. 5 12 16 The registered person needs 23/07/2010 to make sure peoples individual wishes and social interests are assessed, recorded and they are supported to meet these. Because people who live at the home have different interests and needs and these should be valued. 23/07/2010 Care Homes for Adults (18-65 years) Page 31 of 41 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 6 14 12 The registered person must make sure people who live at the home are offered choices about music and other entertainment and that the staff value and respect their choices. Because people living at the home should have the entertainment they choose and not the choice of staff. 23/07/2010 7 18 12 The registered person must 23/07/2010 make sure everyones health needs are properly identified, assessed, recorded and met using the support of other professionals where appropriate. Because people may be at risk if they are not given the support they need to stay healthy. 8 18 12 The registered person must 23/07/2010 make sure the staff supporting people have the skills and knowledge to meet their needs. Because people are at risk if the staff do not understand how to keep them healthy. Care Homes for Adults (18-65 years) Page 32 of 41 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 9 19 12 The registered person must make sure the staff treat people with respect for their privacy, dignity and wellbeing at all times. Because people have the right to be treated in this way. 23/07/2010 10 20 13 The registered person must Make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Make arrangements to ensure that medication administration records are accurately maintained. Make arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. Ensure that there are clear guidelines approved by the prescriber for the administration of all medication including as required PRN and crushed medication. Medication must not be covertly administered 23/07/2010 Care Homes for Adults (18-65 years) Page 33 of 41 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 unless this has been agreed by a multi-disciplinary team. Make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. Statutory Requirement Notice 11 22 22 The registered person must make sure people who live at the home know how to make a complaint and who to speak to if they are unhappy about anything. Because people do not have clear accessible information about this and with a high turn over of staff and management they may not know who they should speak to. 12 23 13 The registered person must Make arrangements, by training staff or by other measures, to prevent 23/07/2010 27/08/2010 Care Homes for Adults (18-65 years) Page 34 of 41 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 service users from being placed at risk of suffering financial abuse. Implement a system which ensures that there are clear and accurate records for all of the service users finances that the staff or management have access to or responsibility for, including permission to access this money. Make sure a system is put in place to ensure that service users do not pay for services that have already been paid for no their behalf Make sure a system is put in place to ensure that service, do not pay for staff or other service users food or entertainment, unless they have expressed a wish to do so. Statutory Requirement Notice 13 24 23 The registered person must make sure the environment is well maintained and furnished and decorated appropriately. 30/09/2010 Care Homes for Adults (18-65 years) Page 35 of 41 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 Because people should live in a well maintained environment which they have personalised. 14 24 23 The registered person must make sure equipment and rubbish are stored or disposed of appropriately. Because people should live in a well maintained environment which they have personalised. 15 30 23 The registered person must 23/07/2010 make sure the environment is kept clean, odour free and people are not exposed to risks of infection. Because people may be at risk if their environment is dirty or infected. 16 31 18 The registered person must 30/09/2010 make sure all staff have clearly defined job descriptions, contracts of employment and understand their roles and responsibilities. Because people may not get the support they need if the staff do not have this information. 17 33 18 The registered person must make sure the home has an 30/09/2010 23/07/2010 Care Homes for Adults (18-65 years) Page 36 of 41 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 effective staff team, with sufficient numbers and complementary skills to support peoples assessed needs at all times. Because people may not have their needs met if the staff team is not stable and appropriately skilled. 18 34 19 The registered person must make sure the recruitment practices of the home ensure suitable staff are employed and that there is evidence of these recruitment checks within staff files. Because people may be at risk if unsuitable staff are working at the home. 19 35 18 The registered person must make sure the staff receive the training they need to meet the needs of the people living in the home and to keep them safe. This training must be recorded and updated as necessary. Because people are at risk if supported by untrained staff. 20 36 18 The registered person must make sure all staff (including regularly working 22/07/2010 30/09/2010 23/07/2010 Care Homes for Adults (18-65 years) Page 37 of 41 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 temporary staff) have opportunities for formal, planned supervisions meetings regularly and that these are recorded. Because people may be at risk if staff are not appropriately supervised. 21 37 8 The registered person must make sure the manager applies to be registered with CQC and that management at the home is stabilised. Because the management changes and poor management have had a detrimental impact on the service people receive. 22 38 10 The registered person must make sure the service receives the support, care and skill required to make improvements. Because the improvements needed are so great that the service manager needs additional support, resources and skill to make sure people are safe and their needs are met. 23 39 26 The registered person must make quality monitoring checks at least monthly as described in Regulation 26 23/07/2010 23/07/2010 23/07/2010 Care Homes for Adults (18-65 years) Page 38 of 41 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 and must provide a copy of the report of their findings to CQC. This will provide evidence of the providers monitoring and committment to improving the service. 24 40 17 The registered person must 30/09/2010 make sure all required records are in place, and are accurate and clear. This will evidence the work at the home and the support given to people. 25 42 13 The registered person must make sure all parts of the home are free from hazards and that identified risks are reported and minimised. Because people are at risk if they do not live in a safe environment. 26 43 23 The registered person must 23/07/2010 take appropriate precautions to assess the risks of fire and to detect, contain and extinguish fire. Because people are at risk from hazards in the current environment. 23/07/2010 Care Homes for Adults (18-65 years) Page 39 of 41 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 11 The notice boards in communal areas should be used to provide people who live at the home with information only. The staff should think about ways they can give people who live at the home more opportunities to be involved with the day to day running. Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 41 of 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!