Inspection on 12/01/10 for Leabrook House Nursing Home

This inspection was carried out on 12th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leabrook House Nursing Home 16/03/07

Leabrook House Nursing Home 07/03/06

Leabrook House Nursing Home 08/10/05

Leabrook House Nursing Home 15/03/05

Leabrook House Nursing Home 13/10/04

Leabrook House Nursing Home 22/03/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Leabrook House Nursing Home 180/181 Leabrook Road Tipton West Midlands DY4 0DY     The quality rating for this care home is:   two star good 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: Karen Thompson     Date: 1 2 0 1 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 31 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 31 Information about the care home Name of care home: Address: Leabrook House Nursing Home 180/181 Leabrook Road Tipton West Midlands DY4 0DY 01215565685 01215565685 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Leabrook House Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Physical Disability (PD) 31 Date of last inspection Brief description of the care home Leabrook House is situated on the Tipton/Wednesbury border, close to the towns of West Bromwich, Walsall, and Wolverhampton. It is within easy reach of several motorway/main road networks, with good availability of public transport. The Home offers 31 single occupancy rooms, of which fifteen have en-suite with showers and another six have toilet and hand wash basin facilities. There are a range of services and facilities available to people living at the home including:entertainment and recreational activities, various aids and adaptations, complimentary and relaxation therapies, a swimming/hydrotherapy pool and an excellent catering Care Homes for Adults (18-65 years) Page 4 of 31 3 31 Over 65 0 0 Brief description of the care home service. The Home also provides a 10 place day-care facility for younger adults with specific nursing needs. The current scale of charges are £440 to £1400 each week. Care Homes for Adults (18-65 years) Page 5 of 31 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: two star good 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: One Inspector and Local Area Manager carried out this inspection over one day, the home did not know we were going to visit. The focus of inspections we undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The majority of people living at the home have with complex health and nursing needs. We case tracked four peoples care which involves establishing individuals experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Care Homes for Adults (18-65 years) Page 6 of 31 Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. One of the owners and the manager were present for the duration of the inspection. We looked around some parts of the home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the home must tell us about. We sent out surveys to people living in the home we received eight completed surveys back. The majority of surveys were completed by people living in the home with the help of their relatives or representative. Comments received are contained in the main body of the report. We also spoke to a number of visitors during our visit to the home. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The medicine management must improve to safeguard those people that live at the home. All systems must be improved to ensure that all medicines are administered safety to people living at the home. Staff knowledge and awareness about safeguarding, mental capacity and deprivation of liberty needs to improve and be supported by a comprehensive training programme. Documentation such as care plans and service user guides need to be in accessible formates for people living at the home so they it can be demonstrate they are included in the decisions made about their care. Quality assurance systems should be further developed so that the home can demonstrate views have been actively sought and that issues have been identified and are actively addressed. There needs to be a review of training provided to ensure slippage does not occur and that staff have the most up to date knowledge and skills to meet the needs of people Care Homes for Adults (18-65 years) Page 8 of 31 living in the home. Risk assessments of the premises needs to be in place whilst ongoing building work and refurbishment is taking place so that any risks are minimized. Work is required to develop the care planning and risk assessment process further, so that the home can demonstrate all needs have been assessed and are being met appropriately. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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. Peoples needs are not consistently assessed before they move in, so they cannot be confident their needs will be met upon moving into the home. The Service User Guide and Statement of Purpose need to be available in alternative formates which meets the capacity of people living in the home. Evidence: There were twenty-nine people living in the home at the time of our inspection. The files of four people living at the home were looked at in detail. We found all but one to contain a needs assessment either completed by the one or the relevant placing authority. We were told that a funding authority assessment was available for this individual in relation to day care facilties but not permanent nursing care. The home must see the funding assessment so it has all the information it needs to ascertain whether to accept the person for admission to the care home so as to reduce any unnecessary risk of placement breakdown. Surveys returned from people living at the home were completed with the help of either a family member or a representative. They all stated that they had received Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: enough information about the home before moving in. We looked at the Service Users Guide and Statement of Purpose which had been reviewed recently . The Service User Guide did not contain the range of fees but during the inspection these documents were changed to incorporate the fees. The Service User Guide was not in a format accessible to all people living in the home. the providers are going to complete information on a website which will be pictorial so that interested parties can have a look at this. Relatives confirmed that they had been able to visit the home prior to admission. The home does not provide intermediate care. Care Homes for Adults (18-65 years) Page 12 of 31 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. Care plans do not demonstrate needs and risks are reassessed in a timely manner or that people living at the home are always actively encouraged to participate fully in making decisions about their care. Evidence: Many of the people living at Leabrook house have complex care and nursing needs. We looked at four care plans. Care plans explain what each persons needs are and the care and support they require to make sure these needs are met. These plans included risk assessments. We found no evidence that people using the service and/or their representatives had been involved in drawing up their care plan. The care plans contained minimal information on the preferred communication style of people livng in the home. Care staff were however able to tell us how they communicate and interact with people living at the home to ascertain their needs, wishes and choices. Care plans were not person centred or written in a format that would enable people living at the home to contribute. It was evident from talking to care staff however that people living at the home are treated as individuals and with respect. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: The provider informed us that all personal care products such as shampoo and soap and also outside services such as hairdressing and chiropody were paid by them for every person living in the home. Relatives spoken to confirmed that there were no restrictions on people living in the home and they were happy with the care provided. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being promoted. Risk assessments consisted of individual and generic risk assessments, including pressure area relief, falls, manual handling, nutrition, bed rails usage and bedroom door locks. The risk assessments contained guidance on what was expected of staff on reducing risk. One person who had recently been admitted to the home had not had a manual handling risk assessment carried out until a month after admission. The instructions on the manual handling risk assessment stated that this needed to be done within twenty four hours of admission. The door key risk assessment was discussed with the management team. The risk assessment was based on the premise that the person had to prove they could have a key as opposed to the premise that everyone was entitled to a key unless issues were identifed and strategies to minimse any concerns proven to be ineffective. People were being weighed regularly. We found however that concerns highlighted by the nutritional risk assessment for one person living at the home which advised the home to seek dietetic advice had not been acted upon at that point. We did however see another example of a nutritional risk assessment highlighting concerns and appropriate action and liason with external professionals had taken place. Care Homes for Adults (18-65 years) Page 14 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are supported to make choices about their lifestyle and are able to develop skills through social and recreational activities Evidence: We looked at care plans and daily records to establish that people were taking part in activities that they enjoyed. Care plans gave very limited information about what people like to do. A number of people attend the day centre attached to the home on a regular basis. We were told by relatives of the activities people living at the home took part in which included; take to Merry Hill and Western and shows, have people come in and do things for them . One set of relatives told us Can visit anytime, visit twice a week, come in anytime, made welcome. This was also confirmed by other relatives spoken to during the inspection visit and the surveys returned to us. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We were informed by the management team that no-one living at the home attended an education establishment or attend work. We were however informed by one set of relatives that they felt since moving to the home their family member had developed both socially and emotionally and this had been due to care staff interaction. We observed staff interaction with people living at the home. Staff addressed people appropriately and they were given choices. We were told that people living at the home are offered a choice. We observed both breakfast and lunch. Breakfast consisted of cereals, egg or bacon sandwiches and a hot option. Lunch also consisted of a range of hot options for both main course and dessert. We observed staff offering drinks to people living at the home on a regular basis. We also observed that staff provided appropriate assistance where required at meal times. Peoples independence at meal times was promoted with specialist crockery and equipment. One person living at the home told us food nice. We sampled the food and found it to be of a good standard. Care Homes for Adults (18-65 years) Page 16 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met appropriately and people are treated with respect. The care planning recording systems need to be more robust to demonstrate consistency. Medication systems need to be improved so that people can be sure that they will recieve their medication safely and as prescribed by their doctor. Evidence: There is a mixed group of people living in the home in respect of age, gender and ability. Observations made during the inspection confirmed that peoples privacy and dignity is respected. Survey comments included; the staff are polite and try at all times to maintain the individuals dignity, as a frequent visitor I notice that all residents are treated with the same courtesy and friendliness. Everyone living at the home was registered with a local General Practitioner (GP). There was evidence of visits to/from health and social care professionals such as chiropidists, dentists, opticians, dieticians and specialist nurses. The home employs a physiotherapist. This provides treatment and therapy to support movement, balance and function and to enhance independence with activities of daily living for people living at the home. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Care plans provided some information about the support people required with personal care and health needs. Records of health care appointments indicated when visits occurred and in a majority of cases the outcome of these visits was recorded. We found recommendations suggested by a health care professional a month previously had not been carried out. We also found that short term conditions such as chest infections did not have care planning strategies. We looked at the arrangements in place for medication management. Medication is stored in two trollies in a locked medication room. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. However the original copies are not checked against the Medication Adminstration Record (MAR) charts as these do not arrive in the home untill two weeks later according to the manager. We were unable to audit the medications due to balances from the previous cycle not being included on the current MAR chart . Medication is being administered by Percutaneous Endoscopic Gastrotomy (PEG) lines when it has not been licenced to be administered via this route. PEG routes are made by a surgerical procedure which are put inot the abdomen a line so that some one who is having difficulty swallowing can be receive nutrition via this route. We discussed with the management team how to reduce the risk of complications and risk to people who have medication adminstered by this route. The controlled drugs (CD) balances were correct and the CD register reflected the enteries on the MAR chart. We did find however Temezapam liquid stored in the CD cupboard had been administered two months after it should have been so did not comply with the expiry use details. The manager stated I have never been told this before on us raising concerns about the medication administration systems within the home. We expect staff who administer medication to be aware of how to administer safely. We left an immediate requirement on the day of our inspection visit as we found that secondary dispensing of medication was taking place. The home informed us in writing following our visit that this practice had ceased and we visited the home on 25 February 2010 and did not see this practice taking place and were shown a copy of a letter sent to a member of staff advising them this practice was to cease immediately and outline the action to be taken if this did not occur. Care Homes for Adults (18-65 years) Page 18 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for dealing with complaints and safeguarding but further work is required to ensure that staff have the knowledge and skills to deal with them. Evidence: All surveys returned indicated that people knew who to complain to if they had to make a complaint. Relatives told us they had no complaints, If got any problems will sort it out,. They also told us that they could approach any of the team at Leabrook with concerns if they had any. The home had a complaint book to record details of any complaints though none had been recorded and none have been received by us. The homes policy and procedure in relation to safeguarding people who live at the home met the standard. We talked to staff to ascertain their undertstanding of their duty to safeguard people. Staff knowledge on safeguarding was varied ranging from good to poor. Knowledge deficits were in relation to knowing what to do and the requirement to report. The management team and some of the trained nurses have received training in the Mental Capacity Act and Deprivation of Liberty. The management team informed us that they would be implementing awareness/training for all staff working at the home in the near future. The Mental Capacity Act is an important piece of legislation and it impacts on how care needs to be delivered to ensure people living at the home are not exposed to unlawful restrictions. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: We saw inventories of peoples belongings on their case files. This ensures that peoples personal items are protected. We saw records for managment of peoples personal finances. Care Homes for Adults (18-65 years) Page 20 of 31 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. People live in a clean, safe and comfortable home, which promotes their well being. Evidence: The home consists of two semi detached houses that have been converted and extensively extended. There is off road parking to the front of the property. The home is in the process of completing a ten-bedded extension, which are not at present registered with us. There were several lounge/sitting and dining areas offering a variety of size and outlook. The main building is over two floors and was found to be clean, warm and uncluttered providing a homely atmosphere. Relatives told us; Its always clean and tidyand always clean spotless. The home is in the process of undergoing an extension and refurishment and redecoration we were told will be taking place to enhance the facilities. Bedrooms are located on two floors. There are fifteen room with full ensuite facilities consisting of toiet, shower and hand basin. Another six rooms have ensuites which consist of toiet and hand wash basins. Adaptations were in place to support people living in the home such as handrails, hoists and so forth. There was no evidence to indicate the home was not meeting the physical needs of people residing there. We Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: visited a number of bedrooms, people are encouraged to personalize their bedrooms and can take their own belongings in to their bedrooms to reflect their individual taste, age, gender and culture so meeting their needs and providing a more homely environment. We spoke to some people living at the home and they were happy with their bedroom. The home has a laundry on the ground floor. The tiles in the laundry wall have been in place for a number of years as a result are showing signs of wear and tear we were told that the laundry would be upgraded as part of the extension process. There are only one sink in the laundry when ideally there should be two sinks to promote good infection control practice. Systems were in place to support active infection control which includes, the provision of staff training, the provision of protective equipment, washing machines with sluice facility and red dissolvable laundry bags to minimize staff handling of soiled articles. . Care Homes for Adults (18-65 years) Page 22 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedures in place protect people from risk of harm. Staff receive training and support so people needs are appropriately meet. Evidence: The staffing numbers and skills mix meet the needs of people living at the home. We were told that there were three nurses and twelve carers on duty for the nursing home of a morning and a furthur three staff for the people living on the first floor. We observed a variety of staff working in the home on the day of our visit. We received positive comments from people living at the home or their representatives as to the number of staff available. Comments we did receive included they pay great attention to the hygiene and welfare of the individual..... the staff are polite and try at all times to maintain the individuals dignity , all staff are always helpful and polite and the home provides good care with pleasant and polite staff Staff appeared to interact well with people living in the home, which indicated that good relationships exist between people living there and the staff supporting them. Staff turnover is low which means people living at the home have a consistent workforce to meet their needs. Recruitment records were sampled for four staff and showed that appropriate checks Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Criminal Records Bureau checks and written references had been received before employees began work. These checks are to ensure people living in the home are protected from the risk of having unsuitable staff work in thehome with them. We spoke to four members of staff during this visit who were enthusiastic about their work and keen to learn and develop their skills. Following employment new staff undertake the induction training, which meets the standards of the Social Skills Council. Staff records confrimed this had taken place. There is a rolling programme of basic training that included first aid, manual handling, Control of Substances Harmful to Health (COSHH), fire safety, Safeguarding Vulnerable Adults and palliative care. Such training provides staff with the knowledge and skills to care for people living in the home. There has however been slippage in the training programme for example staff are not receiving a yearly update in manual handling, although we were advised that this had been due to staff sickness. The manager is trained to deliver fire training and whilst slippage had occured in the yearly updates staff interviewed gave a good response to questions about what they would do in the event of a fire. The AQAA stated that 40 of 58 care staff have an National Vocational Qualification (NVQ) 2 or above in care which equals just under 70 percent of staff having this qualification. Also a number of care staff have obtained an NVQ 3 qualification in care which demonstrates a committment of the home to developing their staff group. This training improves staff knowledge and skills and leads to improved outcomes for people living in the home. Staff supervision is being carried out, carers are supervised by senior carers and the supervision is practice based, so acts as monitoring and maintenance of care skills. Care Homes for Adults (18-65 years) Page 24 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place generally promote the health, safety and well being of people. Evidence: One of the owners was present throughout the inspection and we were informed that they visit most days. It was evident from interactions with people living at the home and the owner that there was a good relationship between them. We were informed by relatives that both the owner and the registered manager were approachable and any concerns were dealt with appropriately. The registered manager is an experienced registered nurse with an NVQ 4 management qualification and also acheived the Registered Managers Award. The manager stated that there was no formal quality assurance process in place, where we look things and record these. We do look at things and speak to people nothing formal. The AQAA stated they do on an annual basis distribute surveys to people living at the home and their representatives. The home has an Investors in People award which demonstrates a committment to the quality assurance process. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: All staff working at the home need an awareness/training in the Mental Capacity Act 2005 and the deprivation of liberty safeguards. The AQAA was returned to us in a timely manner and it had been completed to an adequate standard but would benefit from more specific details as some of the comments were rather vague in respect of the developments and future plans. When we looked at people care records it became clear to us that events that had adversely affected the well being of people living at the home had not been reported to us. The home is required to do this so we can monitor the home in between visits. Following our inspection the home has been sending us reports of events that have adversely affected the well being of people living at the home, this allows us to monitor the service in between inspection visits. A sample of health and safety records were checked, including fire and emergency lighting, Portable applicance testing, and calibration of scales. They were all found to be satisfactory ensuring peoples health and safety is promoted. We did however find that no risk assessment had been carried out in relation to the building work which was going on around the home. It was evident that potential for harm could occur in a number of instances such as uneven flooring, accessiblity of white spirit and a hot water dispenser and so forth. Care Homes for Adults (18-65 years) Page 26 of 31 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 31 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 1 20 13 Secondary dispensing of medication must cease with immediate affect. This will ensure the safety and well being of people living in the home. 12/01/2010 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 13 All medicines must be 05/02/2010 administered from a pharmacy labelled container, dated if a short expiry life when opened to ensure that when they are administered they are not out of date. This will ensure medication administered is compliant with its product licence. 2 14 The home should obtain a copy of the funding assessment prior to people moving into the home. This will ensure they have all the information to make an informed decision as to whether they can meet that person needs. 26/02/2010 Care Homes for Adults (18-65 years) Page 28 of 31 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 3 20 13 The quantity of all medicines 05/02/2010 received and any balances carried over from previous cycle must be recorded to enable audits to take place. This will demonstrate that medication is being administered as prescribed. 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 1 The home should produce Service User Guides and Statement of Purposes in suitable alternative formats for people living at the home so that they have information that allows them to make informed decisions. People living at the home should be encouraged to part take in the drawing up of their care plan instructions so that their wishes and preferences are fully explored and meet. Risk assessments should be drawn up in a timely manner and reviewed regularly and when changes have occured to ensure any risk people living at the home are appropriately managed. The bedroom key risk assessment should be reviewed with the emphasis on a right to a bedroom key unless risks can not be minimized or the person actively chooses uptake this facility. Recommendations made by health professionals in relation to monitoring and assessing people care should be incorporated into the care planning process. Care plans should be in place for short term conditions so that staff have clear instructions as to what is required to meet some ones needs and monitoring and evulation of the condition can be documented. Page 29 of 31 2 6 3 9 4 9 5 19 6 19 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 20 Trained staff working at the home should re-familiarise themselves with the NMC Standards of Medicine Management to promote and protect the health and welling being of people living in the home. The home should record the maximum, minimum and current temperatures on a daily basis to ensure that the medicines held in the medication refrigerator are stored in compliance with their product licence to maintain their stability. Handwritten Medication Administeration Records should contain two signatures of staff checking in the medication to demonstrate a second person has checked and found the information to be correct. The home should obtain the NEWT Guidelines ISBN 09552515-0-8 pr ISBN 978-0-9552515-0-4 or contract the drug manufactures medical information department and ascertain what medications can be administered via PEG routes. That staff undertake safeguarding training every three years to ensure their knowledge is kept up to date. It is recommended that the home obtain a copy of the Departments of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training, so that staff are aware of their responsibilities and peoples rights are protected. The home should review the laundry environment and this should include two sinks. The home should carry out a review of training needs and from this implement a following training programme to ensure staff have up to date skill and competences. Formal systems should be put in place to monitor the quality of care provided at the home (quality assurance) 8 20 9 20 10 20 11 12 23 23 13 14 30 35 15 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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