Inspection on 10/06/09 for Mappleton House

This inspection was carried out on 10th June 2009.

CQC found this care home to be providing an Adequate 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mappleton House 21/01/09

Mappleton House 23/05/07

Mappleton House 17/01/07

Mappleton House 11/08/06

Mappleton House 23/08/05

Mappleton House 21/02/05

Mappleton House 05/04/04

Similar services:

Hillside

Applegarth

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Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Mappleton House Mappleton House 9B Chestnut Grove Mapperley Park Nottingham NG3 5AD     The quality rating for this care home is:   one star adequate 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: Meryl Bailey     Date: 1 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 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 34 Information about the care home Name of care home: Address: Mappleton House Mappleton House 9B Chestnut Grove Mapperley Park Nottingham NG3 5AD 01159623714 01159623714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mappleton House Care Homes Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Mappleton House Care Homes Limited is registered to provide accommodation and personal care for persons of both sexes whose primary care needs fall within the following category :- Learning Disability (LD) 10 Date of last inspection Brief description of the care home Mappleton House Care Homes is a care home providing long-term personal care and accommodation for a maximum of 10 younger adults who have a learning disability. The home is located in a residential area, north of Nottingham city centre and close to shops, pubs, the post office and other amenities. Mappleton House Care Homes comprises of two houses and a bungalow each with single bedrooms, bathrooms, kitchen, and shared sitting rooms. Unrestricted parking is available on the road. Information about the service is provided on request at Mappleton House. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 10 2 1 0 1 2 0 0 9 Brief description of the care home The fees for the service range from £900 - £3,200 per week depending on needs. There are additional charges for hairdressing, chiropody and toiletries. Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate 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 focus of inspections undertaken by the Commission for Social Care Inspection is on outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection in January 2009. Managers of homes are now required to complete a form called an Annual Quality Assurance Assessment (AQAA) to identify from their own quality monitoring what the service does well and what they need to improve. The AQAA was returned in May 2009 and was used to plan the visit and to support judgements made in this report. We did the inspection visit with two inspectors. One of these was a specialist pharmacy inspector, who concentrated on the handling and administration of medicines in the Care Homes for Adults (18-65 years) Page 6 of 34 home. The visit was unannounced and took place on one day during the daytime. The main method of inspection we use is called case tracking which involves us choosing a sample of people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at three peoples care records and two peoples medication in detail. The people living at the home have needs relating to communication and our assessment of their views has been through observations in addition to some direct responses. We had discussions with staff working there as well as a senior manager. A partial tour of the premises was made and this included some of the bedrooms as well as communal areas and facilities. We also looked at a sample of staff records to find out if checks were carried out before they started working at the home and if they were appropriately supervised and trained. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Complete all care planning within the home, storing information securely in one place, so that staff can access and follow clear support plans. Make use of the sensory equipment in the home and provide training for staff to use this as needed to meet individual needs. Include clear directions in support plans so that staff encourage individuals to make choices at all times. Ensure staff follow support plans to guide people to pursue their interests and provide appropriate activities at all times. This is so that people are appropriately occupied. Provide an annual holiday or equivalent day trips for each person living in the home. Ensure information about people living in the home is held securely on the premises and available for staff at all times. This is so that staff have the information they require to meet each persons needs safely. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. In particular the action in the following four paragraphs is required concerning medication: Storage arrangements must be secure and dedicated for the purposes of safe handling of medicines. This includes adequate secure storage for all medicines, nutritional supplements and returned medicines awaiting collection. This is to safeguard the health and welfare of all people living in the home. Staff must transport medicines throughout the home in a safe manner and securely Care Homes for Adults (18-65 years) Page 8 of 34 held in a locked facility. This is to ensure medicines are secure in the event of an emergency and to safeguard the health and welfare of all people living in the home. A system must be installed to check the prescriptions prior to dispensing by the pharmacy and then to check the dispensed medications and charts against the prescription for accuracy. All stocks of medicines and discrepancies must be addressed with the healthcare professional before each cycle of medication is received into the home. This is to ensure people always receive medicines as prescribed by a doctor and to safeguard their health and welfare. All staff responsible for medicines administration must have the necessary skills and training that includes invasive techniques and external preparations from trainers that have a body of up to date knowledge in the subject of medicines. This is to ensure that staff at the home administer all medicines safely at the times they are required. Provide training in Safeguarding Adults to all staff working in the home. This is so that all staff are fully aware of how to keep people safe. Display the Complaints Procedure in a format appropriate to the needs of people living in the home to give everyone an opportunity to understand how to make a complaint. Ensure there is a clear system and that staff follow procedures to report any areas that need maintenance or replacement. This is so that people live in fully maintained premises and have full use of facilities. Provide all staff with training appropriate to the work they are to perform. This is so that staff are competent to meet the needs of people who live at the home. Do not employ a person to work at the care home unless the person is fit for such work and checks have been carried out including the receipt of two satisfactory written references. This is to ensure people are supported by staff who are fit and will safeguard them from abuse. The new acting manager must complete a full application to the Commission to be assessed for registration. This is so that she can demonstrate her fitness to manage the home for the benefit of people that live there. The responsible individual for the provider company must ensure visits are made at least once a month by a suitable person within the company in order to inspect and assess the quality of the service provided and prepare a written report on the conduct of the home. This is so that people can be assured the service is monitored and run in the best interests of the people living there. All records, including Medication Administration Records (MAR), care files, accident and complaints records must be held securely on the premises. This is to protect peoples personal information, ensuring it is held confidentially at all times. The filing system should be organised so that all records are maintained and easily accessible when required. Ensure all staff receive up to date training in all safe working topics. Care Homes for Adults (18-65 years) Page 9 of 34 Take advice from the Fire Authority about safe ways to keep doors open with automatic release systems that operate in the event of a fire. Ensure the gas appliances and heating system are regularly serviced. 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 10 of 34 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 11 of 34 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. Clear information is available about the home so that people will know if it is suitable to meet their needs. Evidence: Since the last inspection an additional bedroom has been approved for use so that home can now accommodate a maximum of ten people. Nine people are currently living in the home. The Statement of Purpose and Residents Guide were being revised and updated versions were submitted to the Commission four days after this inspection. Information is now clear about the provider company (Mappleton House Care Homes Limited), which is registered with the Commission, and the parent company (Rushcliffe Care Limited). The Residents Guide is not in a format that all people living in the home can understand. There was a note saying that an alternative format can be obtained from the Manager and we were informed that someone in the company was working on a version using Widgit symbols. The current documents contained useful information for people about the service provided. No new people have moved into the home since December 2007 so there were no new Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: assessments to see. Staff told us that there would full consultation with family and all professionals involved before any new person moved into the vacant room. Care Homes for Adults (18-65 years) Page 13 of 34 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. Support is planned in detail and risks are assessed, but appropriate support may not be provided by staff who cannot easily access the information they need. Individual rights are respected, but choice is not always given. Evidence: Management staff had taken existing plans out of files in order to rewrite them in a new format. Two of the new plans had been completed. Some files had been taken to another home owned by Rushcliffe Care, so that more experienced staff could produce the plans. We requested files for some people and they were brought from Coalville in Leicestershire to Mappleton during the inspection. This showed that previous plans still existed, but important information was not immediately available to staff on the premises. The new format for personal care plans showed that individual needs and choices could be clearly set out. However, in one plan it stated Staff choose my clothes for me as I am unable to do this myself. This was discussed with the senior manager Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: that was present and we suggested that this person should be encouraged to make choices in this area. Otherwise there were sheets stating preferences and choices, such as Foods I really like. We saw in one plan that a person had a specific interest in a particular video and we were able to use this to communicate with the person. Sensory equipment was available, but not used and some staff had never seen it in use. There were detailed risk assessments on some files and these contained clear information about action staff needed to take to reduce risks when people were engaged in particular activities. However, the information was difficult to find amongst papers where they had been removed from original files. This is a temporary situation that will improve once all files have been updated with the new format for care plans. The main gate of the home is kept locked to protect people and one person had been referred to the appropriate authority for an assessment regarding deprivation of liberty under the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 15 of 34 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. Some people take part in appropriate activities and visit local areas, but support is not always available to meet each persons needs to pursue leisure activities. People receive a range of varied food. Evidence: Five people were at home and four were at day centres. Since the last inspection extra staff had been insured to drive the minibus, which had been used to go out to local parks. However, on the day before this inspection a repair was needed and the minibus was still at the garage. Staff told us they had taken one person to the park by taxi on the previous day and a taxi had also been used to accompany someone to day centre and for another person to go to hospital on the day of the inspection. We spoke to one person who was curled up in an arm chair. She told us she had been to Wollaton Park in the past, but was content to stay in her chair. Another person showed us the garden, with her favourite places to stop and sit. She enjoyed watching Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: the birds. Another person was restless throughout our visit and told us she did not like the home at all. Staff working with her did not give her choices of activities and interests that were indicated in the care and support plan. As referred to in the previous section, within one house, we saw the multi sensory room, but it was being used only to store the equipment, which was not in use at all. In another house a new sensory room had been enclosed on the ground floor, but equipment had not yet been installed there. Sensory equipment, if used, would provide stimulating and relaxing environments for people at the home. One person was supported to visit parents every two weeks and others had some contact with relatives as appropriate. One person would like to go swimming, but this was not made available. There had been no holidays provided since the last inspection. We saw some likes and dislikes about food written down in some care plans, and some records in the daily notes of meals actually eaten. This was not consistent in each house. For some people a nutritional screening tool food chart had been used. Staff told us they were expecting new menus that were in the process of being typed at head office. These were received at the Commission on the next day. The four weeks of menus demonstrated a range of varied food on offer. A choice of lunchtime food was available each day and one main evening meal was suggested each day. The meal planner guidelines directed staff to give choice of food and to specify an alternative in the record when the main meal was not chosen. Care Homes for Adults (18-65 years) Page 17 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate support is given to people with their personal care and with health care appointments. There is an improved system for administering medication to ensure people receive their medicines as prescribed. However, current storage facilities for medicines may compromise the health and safety of the people living at the home. Evidence: There was information, in the individual care plans that were available, about the most effective way to support people with their personal care and this included personal preferences. However, staff could not easily find the plans and relied on information passed from each other. Some relatives told us that personal care appeared to be given appropriately. Some people required two staff to support them and others had one. Information about visits and support from health care specialists such as consultant psychiatrist, GP, Community nurses and Occupational Therapist was written down within the individual files. One person visited the hospital for a review with a consultant on the day of the inspection with the support of two staff. A further review meeting was held at the home during the afternoon. At the last inspection in March 2009, we had serious concerns about the Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: administration of medication by staff and a phamacy inspector made a detailed examination of medication during this current inspection. A new medicines storage cupboard was fixed onto the wall. This cupboard was full and contained medicines from the three houses. Individual containers of medicines for each person living in the service was provided and found in a clean and tidy manner. However, we found a pharmacy delivery bag containing nutritional supplements and another pharmacy delivery bag containg various medicines (awaiting to be returned) on the floor of the office and not securely stored away. We saw that staff transported medicines to and from each home in a open basket. We asked what happens in a emergency and one of the staff stated I got to run back and lock away. We informed the home that any medicines transported during administration must be securely held in a locked facility in the event of an emergency. The Acting Manager had been using an auditing system to ensure that all the medicines were administered as prescribed at all times. We saw documentation of this process, but it did not include how any poor practices were dealt with by management. The sample audits, with respect to two people, undertaken during this inspection indicated that the medicines were administered and staff followed instructions as the doctor prescribed. Sample medication charts were up to date for each person and medicines received and administered were signed. However, the actual date and reason for disposal of medicines was difficult to track. The majority of medicines were returned at the end of the month and a fresh new supply was received instead of ordering what was actually required. There was no controlled drugs on the premises and we were informed that a controlled drugs cabinet had been ordered in preparation. We were informed by the manager that systems were in place to support staff and identify training needs. Some staff that were previously handling medicines told us they had undergone recent in-house medication management induction training. The matrix training sheet indicated that all carers handling medicines received external medication training in March 2009. However, two Staff from aother home had to come and administer medicine as the staff on duty had no training to administer invasive medicines to a person with specific needs. Care Homes for Adults (18-65 years) Page 19 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about how to make a complaint, but not all people living at the home can access it. Recruitment practices and training are not sufficient to safeguard people from abuse. Evidence: The complaints procedure is included at the end of the new Residents Guide, but this had not yet been issued to anyone. The information directed people to write to Rushcliffe Care Ltd, but no name was given. In the new guide submitted to the Commission four days after this inspection, there was more information about who to contact if someone wanted to make a complaint. We did not see the procedure displayed anywhere and it was not in signs and symbols format. Records of formal complaints received were not held at the home and the senior manager told us these were held at head office in Loughborough. Relatives told us they had raised concerns and these had been dealt with. We saw one record of a complaint within accident records and this concerned an allegation that a member of staff had left the premises whilst on duty. There was no record of the outcome of the investigation into this. There was an out of date policy and procedures concerning Adult Protection in the main entrance for staff to access. This was removed during the inspection. Newer local Safeguarding Adults procedures were on a shelf in the office. Some staff told us they had received training in Safeguarding Adults last year, but no such training was recorded on the full staff training record and new staff had not received the training. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Staff we spoke with said they would report any specific concerns to the manager. We have been made aware of safeguarding concerns and these are being investigated by local authority social workers. During the inspection, there was no evidence that appropriate checks had been carried out regarding the fitness of new staff prior to them commencing work. Further information submitted confirmed that the results of full checks had not been received (see staffing section of this report). Care Homes for Adults (18-65 years) Page 21 of 34 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. The accommodation is currently being refurbished and adapted to meet the needs of people living in the home. Evidence: Some areas of the home had been recently redecorated and most areas were clean with new flooring, but other areas were in need of maintenance. There were no doors under one kitchen sink, though we were told they were due later that week. Some lounges had been well decorated, but there were no curtains or blinds in some rooms. All bedrooms had ensuite facilities, but one person had no shower and temporary arrangements were for this person to go to another building to use a shower. In one bathroom there was no toilet seat and the senior manager told us this had not been reported by staff. We found some doors were propped open (see management section of this report). In the Laundry there were sufficient machines and some people used these with support from staff. The only entrance for the bungalow was through the galley kitchen. The senior manager told us of plans to create another entrance in place of a window. This would provide a wide entrance suitable for wheelchair users. Care Homes for Adults (18-65 years) Page 22 of 34 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. Staff are not sufficiently trained to meet the needs of people living in the home and recent recruitment practices have not been sufficient to ensure people at the home are safe. Evidence: During inspection we requested a sample of staffing records, which included one person that had worked at the home for more than a year and two that were recently employed there. However, none of the records for new employees were available on the premises. We received further information by email during the following two days about five of the new care workers at the home. The accumulated evidence showed us that all five people started work at the home prior to applications being made to the Criminal Record Bureau (CRB) for appropriate checks and, also, prior to requests being sent out for written references. A senior manager informed us that other staff were on the premises with new staff, but staff told us they were not present when 1:1 support was given in bedrooms. We saw one of the new staff working alone during the inspection. Another senior manager told us We would assure you that the deficits are being pursued vigorously and With regard to enhanced disclosures we will in future not commence anyones employment with the Company until we have received confirmation of CRB. Since receiving those comments, the senior manager sent us updated information, which confirmed that the awaited CRB checks had since been Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: completed for all people currently working at the home, but some references and other documents were still being pursued. Training information was limited during the inspection as staffing records did not include any individual training and development assessments. There was a chart of the training staff had been given during 2009. An updated one of these was submitted following the inspection and gave information about 23 staff members. Some staff we saw at inspection were not included on this chart. It showed that, since the last inspection, some people had attended training sessions in Health and Safety, Food Hygiene, Medication, Epilepsy Awareness, Person Centred Planning and Challenging Behaviour. However, the chart did not show if any staff needed more of this training or further updates. As already reported, although some training had been given in medication, staff responsible for administering medication had not been trained to use invasive techniques to administer medicines to a person with specific needs. There was a record that one member of staff was given Induction Training and Person Centred Planning training during March 2009, but no other training. There was no record of the other new staff being given specific Induction Training. The chart showed that 9 of the 23 staff had attended training about Challenging Behaviour. During the inspection we observed the way staff dealt with challenging behaviour. Some used confrontational and controlling commands, such as, Stop that! and Say sorry. However, visiting staff from another home demonstrated successful use of distraction techniques. Some people told us they had completed NVQ 2 either in a previous employment or whilst at Mappleton House in the past. There were no records of how many staff had this qualification and information on this was omitted on the Annual Quality Assurance Assessment for completed by the acting manager. Care Homes for Adults (18-65 years) Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are in place, but do not fully promote the best interests of people living in the home. Evidence: A new acting manager commenced in April 2009, but was not available on the day of this inspection. A senior manager was present and assisted with the information we needed. The last Annual Quality Assurance Assessment was completed by the acting manager and received at the Commission in May 2009. It states that the provider company sends out questionnaires to relatives, representatives and professionals, but we did not see any completed questionnaires. We saw previous reports written by a senior manager, but these were not on a monthly basis and, since our inspection in January 2009, there had been one reported visit. All records were stored on open shelves and specific information was difficult to find. As reported earlier case files were not all held within the care home. Records of Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: accidents were not maintained systematically and it was not clear if appropriate actions had been taken following incidents and accidents. During the inspection there were no risk assessments available with respect to risks in the environment. However, the senior manager arranged for samples of these to be sent to the Commission on 15 June 2009. The training information submitted to the Commission did not include all staff and those included had not received training in all safe working topics. For example, of the 23 staff, 11 had received training in Manual Handling and 7 had received fire safety training. In one house we found the lounge and kitchen doors were propped open with no automatic release system. The AQAA form gave us details of when equipment had been tested. All fire alarms and equipment were checked within the last year, but there were no dates for the servicing of the heating system and gas appliances. Care Homes for Adults (18-65 years) Page 26 of 34 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 22 22 Make the Complaints 31/03/2009 Procedure appropriate to the needs of people living in the home. This is to give everyone an opportunity to understand how to make a complaint. 2 35 18 Carry out a full training needs assessment and provide a full training and development plan for the staff team. This is so that all staff receive training appropriate to the work they they perform. 31/03/2009 Care Homes for Adults (18-65 years) Page 27 of 34 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 12 16 Ensure staff follow support plans to guide people to pursue their interests and provide appropriate activities at all times. This is so that people are appropriately occupied. 31/08/2009 2 18 15 Ensure information about people living in the home is held securely on the premises and available for staff at all times. This is so that staff have the information they require to meet each persons needs safely. 31/08/2009 3 20 18 All staff responsible for medicines administration must have the necessary skills and training that includes invasive techniques and external preparations from trainers that have a body of up to date 31/08/2009 Care Homes for Adults (18-65 years) Page 28 of 34 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 knowledge in the subject of medicines. This is to ensure that staff at the home administer all medicines safely at the times they are required. 4 20 13 A system must be installed 31/08/2009 to check the prescriptions prior to dispensing by the pharmacy and then to check the dispensed medications and charts against the prescription for accuracy. All stocks of medicines and discrepancies must be addressed with the healthcare professional before each cycle of medication is received into the home. This is to ensure people receive medicines as prescribed by a doctor and to safeguard their health and welfare. 5 20 13 Staff must transport medicines throughout the home in a safe manner and securely held in a locked facility. This is to ensure medicines are secure in the event of an emergency and to safeguard 31/08/2009 Care Homes for Adults (18-65 years) Page 29 of 34 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 the health and welfare of all people living in the home. 6 20 13 Storage arrangements must be secure and dedicated for the purposes of safe handling of medicines. This includes adequate secure storage for all medicines, nutritional supplements and returned medicines awaiting collection. This is to safeguard the health and welfare of all people living in the home. 7 23 16 Provide training in Safeguarding Adults to all staff working in the home. This is so that all staff are fully aware of how to keep people safe 8 24 23 Ensure there is a clear system and that staff follow procedures to report any areas that need maintenance or replacement. This is so that people live in fully maintained premises and have full use of facilities. 9 32 18 Provide all staff with training 30/10/2009 appropriate to the work they are to perform. 31/08/2009 31/08/2009 31/08/2009 Care Homes for Adults (18-65 years) Page 30 of 34 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 This is so that staff are competent to meet the needs of people who live at the home. 10 34 19 Do not employ a person to work at the care home unless the person is fit for such work and checks have been carried out including the receipt of two satisfactory written references. This is to ensure people are supported by staff who are fit and will safeguard them from abuse. 11 37 9 The new acting manager must complete a full application to the Commission to be assessed for registration. This is so that she can demonstrate her fitness to manage the home for the benefit of people that live there. 12 39 26 The responsible individual 31/08/2009 for the provider company must ensure visits are made at least once a month by a suitable person within the company in order to inspect and assess the quality of the service provided and 31/08/2009 31/07/2009 Care Homes for Adults (18-65 years) Page 31 of 34 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 prepare a written report on the conduct of the home. This is so that people can be assured the service is monitored and run in the best interests of the people living there. 13 41 17 All records, including 31/08/2009 Medication Administration Records (MAR), care files, accident records and records of complaints must be held securely on the premises. This is to protect peoples personal information, ensuring it is held confidentially at all times. 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 6 Make use of the sensory equipment in the home and provide training for staff to use this as needed to meet individual needs. Complete all care planning within the home, storing information securely in one place, so that staff can access and follow clear support plans. Include directions in support plans so that staff encourage individual choices at all times. Provide an annual holiday or equivalent day trips for each person living in the home. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the Page 32 of 34 2 6 3 4 5 7 14 20 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 guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. 6 22 Display the Complaints Procedure in a format appropriate to the needs of people living in the home to give everyone an opportunity to understand how to make a complaint. Complete all refurbishment as planned. Organise the filing system so that all records are maintained and easily accessible when required. Ensure the gas appliances and heating system are regularly serviced. Take advice from the Fire Authority about safe ways to keep doors open with automatic release systems that operate in the event of a fire. Ensure all staff receive up to date training in all safe working topics. 7 8 9 10 24 41 42 42 11 42 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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