Inspection on 01/12/09 for Millwater

This inspection was carried out on 1st December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Millwater 03/03/10

Millwater 03/02/10

Millwater 14/08/08

Millwater 23/08/07

Millwater 07/03/07

Millwater 25/01/06

Millwater 08/07/05

Millwater 05/01/05

Similar services:

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 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Millwater 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD     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: Sarah Bennett     Date: 0 2 1 2 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 37 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 37 Information about the care home Name of care home: Address: Millwater 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD 01217063707 01217655536 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.schealthcare.co.uk West Regent Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care Home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, of the following age range 18 and 65 years (maximum number of places 18). Date of last inspection Brief description of the care home Millwater Care Home has been registered to provide a learning disability service for up to 18 younger adults. The home is separated into three units Swan, Dove and Wren. Generally people spend their time in the unit in which they live but do from time to time visit people living in other units. Accommodation is in single rooms with en-suite facilities. There is a communal lounge and dining area in each unit and in Swan unit there is an activity room. In Swan unit there is a commercial kitchen and in Dove and Wren units there are small domestic type kitchens. There is a separate laundry in Swan unit. Facilities for laundry are available in the kitchens in Dove and Wren units. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 18 Brief description of the care home The grounds are fully enclosed with access from inside the building only. There is a small area outside the main entrance for off road parking. The home is situated close to major bus routes in and out of Birmingham City Centre.Local shops and amenities are within walking distance and the Swan Shopping Centre is approximately one mile away. The service users guide stated that the last inspection report is available on request from the Manager or in the homes reception area. The service users guide stated that the fees charged depend on individual assessment. These include accommodation, 24 hour staffing, all meals and beverages, laundry except dry cleaning and in - house activities. This information was current at the time of the inspection and the reader may wish to contact the care service for updated information. Care Homes for Adults (18-65 years) Page 5 of 37 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 quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The focus of our inspections 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 regulatory requirements, minimum standards of practice, and focuses on areas that need further development. The inspection was carried out over two days with one inspector, a pharmacy inspector also visited on the first day. The home did not know we were going to visit on the first day. There were sixteen people living there. Prior to the visit taking place, we looked at all of the information we had received, or asked for. This included complaints received, notifications about events that have Care Homes for Adults (18-65 years) Page 6 of 37 occurred in the home and the Annual Quality Assurance Assessment (AQAA). This tells us about the home and how they think it is meeting the regulations. We gave out surveys to people who live at the home and staff on the first day to help us find out their views about the service provided. Five staff and three people living there completed these. Their comments are included in this report. Four people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to staff. We sampled care, staff, health and safety records. We looked around the areas of the home used by the people case tracked to make sure it was warm, clean, and comfortable for them. We were assisted by an Expert by Experience (in this report known as the ex by ex). This is someone with personal experience of using care services who visited with their supporter. Experts by Experience observe what happens in the home and talk to people to obtain their views about what it is like to live there. He produced a report based on his findings and details of this are included in this report. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: There have not been many improvements made since we last visited. However, improvements are and should be being made to benefit the people living there. Before people move in they should be assessed to ensure their needs can be met at the home. Care plans must show staff how to help people to meet their needs and achieve their goals. Risk assessments must show staff how to support people to reduce the risks to their health and safety. People should have planned activities and be supported to do the things they enjoy. Care Homes for Adults (18-65 years) Page 8 of 37 People told the ex by ex they would like to go out more. Menus should include pictures and reflect the choices of the people who live there. Medicines must be managed well to ensure that peoples health needs are met. Peoples weight should be monitored to ensure that they can get help if they have any health needs. The people living there should know how to complain if they are unhappy. People told the ex by ex that they did not know how to do this. The home should be redecorated and new furniture bought so it is homely and comfortable for people to live in. More staff should be recruited to work there so that the people living there have staff working with them who know them well. Staff must have training and supervision so they know how to help the people living there and keep them safe from harm. A manager must be recruited who can run the home well and in the best interests of the people living there. Staff should know what to do if there is a fire to keep them and the people living there safe. 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 37 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 37 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. People have the information they need to make a choice as to whether or not they want to live there. They cannot be confident that their needs can be met at the home, which could impact on their well being. Evidence: The statement of purpose and service users guide had recently been updated. They included pictures making them easier to understand. They included the relevant and required information so that people can make a choice as to whether or not they want to live at the home. People told us that they had enough information about the home before they moved in. Due to recent safeguarding issues at the home the organisation has agreed to a voluntary suspension on people being admitted to the home. There were sixteen people living there when we visited. We looked at the records of four of the people living there, one of whom had moved in since our last visit. Records showed that an assessment was completed before people moved into the home to assess whether or not their needs could be met there. These were not very detailed but included basic Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: information about what the person needed and their likes and dislikes. Care Homes for Adults (18-65 years) Page 12 of 37 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. Staff do not have the information they need to know how to support people to meet their needs and make choices about their lives, which could impact on individuals well being. Evidence: We looked at the records of four of the people living there. These included a care plan that lacked detail as to how staff are to support the person to meet their needs and achieve their goals. One care plan stated that to ensure that the person was safe they needed one to one support from staff at all times. It did not state how staff were to do this so they kept the person safe. One care plan for supporting the person with eating and drinking stated that staff were to sit with the person when they were eating. We observed that staff did not do this at breakfast time which meant that the person wandered around eating their breakfast, which could impact on their well being. One persons care plan stated that to avoid the risk of them choking because of their swallowing difficulties they were not to have foods that were considered to be a high Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: risk. The list of these foods included toast. The persons food records indicated that they had toast for breakfast the previous day, which could impact on their well being. One care plan about supporting the person at night stated that a door sensor was being purchased so that staff could support the person in a more discreet way to reduce the impact on their privacy. Other records indicated that the door sensor had been fitted but their care plan had not been updated so it was not clear how staff were to support the person now. Records showed that the speech and language therapist had worked with one person. Their report showed that to enable the person to communicate staff should use the Total Communication Approach with them. They stated that they would offer support and training in this approach of communicating with a person to help staff understand how this will help the person. Staff said that some staff had received this training. However, this was not clear in the persons care plan which stated that in November the person becomes very frustrated if not understood. If staff are using this approach the persons frustration should be minimal. Training records did not show that staff had received any training in how to communicate with the people living there. Records included a person centred plan that included pictures, making it easier to understand so the person could be more involved. These were not dated and when comparing these to the other records for the person they seemed to be out of date and not reflect the persons current needs and preferences. In each persons file there was a sheet to record when the care plan was audited. These were blank indicating that they are not audited to ensure they meet the persons current needs. We saw minutes of a meeting with seven of the people living there and staff in September this year. This showed that they talked about what to do if there was a fire in the home and menus and choices of food. There were no other minutes of meetings with the people living there. The manager said that another one was planned that week. We saw that changes were being made to the menus as a result of this meeting but more needed to be made to ensure people had more choice in what they ate. Records sampled included a risk assessment. These were not very detailed so it was not clear how staff were to support people to be as independent as possible whilst minimising the risks to their safety. For example, one persons risk assessment stated that their weight was to be monitored as this was identified as a risk to their health but it did not state how staff were to do this or what their weight should be. Another Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: risk assessment for wandering stated that staff should ensure that the person is occupied at all times but not how staff were to do this or what the person liked to do to keep them occupied. Some risk assessments had not been reviewed since March this year but other records indicated that peoples needs had changed during this time so the risks to their safety may be different. Care Homes for Adults (18-65 years) Page 15 of 37 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. Arrangements do not ensure that the people living there experience a meaningful lifestyle, which could impact on their well being. Evidence: Some people living there go to day centres during the week. Staff support is provided at the home for people to do activities if they do not go to day centres. Records sampled showed and it was observed that people did not always do regular activities they enjoy and that would enable them to develop as an individual. The manager had also identified this and during our visit spoke with a member of staff who is going to concentrate on working with people to develop the activities provided. Staff were discussing in the morning what activities they were going to do. There was no structure or plan and it was not clear how staff knew what each person wanted to do and achieve in their lives, as this was not stated in the care plans sampled. People Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: did not start doing activities until at least mid morning, which resulted in the people living there and staff wandering around with no clear direction for the day. It is hoped that this will improve with a member of staff being responsible for developing activities. Some of the people living there have autism and their records stated that they need structure to their day and to know what they are doing so as to reduce their anxieties. Records sampled showed that the lack of this has meant that people have behaved in a way that has resulted in other people living there getting hurt. We observed that one person waited 45 minutes to go out after staff had supported them to get ready. Their records showed that they find it difficult to wait once they know they are going out, which may result in them displaying difficult behaviour. We observed that they did display this behaviour, possibly as a result of staff not supporting them as stated in their guidelines. The ex by ex said, Whilst I was there quite a lot of the residents were at home. In one of the units the women were sitting at the dining table colouring in. This concerned me as they are adults not children, surely they could be doing more meaningful activities. When I went into one of the other units one person had just come back from shopping and had bought a karaoke machine because she loved singing. I thought it was really good that they had been supported to go and buy it. The staff helped them set it up in their bedroom, which was good. Another person was going out to buy an advent calendar with one of the staff, which was good as they had just decided they wanted one so was able to go and get it. Records sampled showed that people went shopping, to the Sealife centre, sensory rooms and to church. These activities were during the day. The ex by ex said, One person told me they would like to go out more. They told me they do not go out in the evening and I observed the person being told that they could not go to the shop as it was dark, it was only 4.30pm. People should have the opportunity to go out in the evenings with support. Given the age of the people living there this does not show that people are being supported to do activities that people of a similar age who do not live in a care home would be doing. Staff told us that people needed to go out more and more activities needed to be provided. During the two days we observed that the people living there tend to come and go from the lounge in Swan unit even if they live in the other units. This is a bigger lounge so is useful as a space for people to meet as a large group. However, it does not respect the privacy of the people who live in Swan unit. The manager said that when new staff are recruited she plans to allocate staff to work on a particular unit so it is hoped that the units will be more independent of each other. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: During the first day a motivation session took place in the lounge of Swan unit. It was obvious that this was a regular session as the people living there knew the person leading it well and what to expect in the session. People seemed to enjoy this and staff sat with them encouraging them to take part. Records sampled showed that people are supported to keep in contact with their family and friends so they can maintain relationships that are important to them. Staff were talking to individuals about what they would like to buy for their family for Christmas and were discussing when they could support them to buy these. We observed that people sometimes helped around the home doing things such as washing up and tidying their bedrooms although this was not very often. This is important as people need to develop daily living skills to enable them to be more independent. The ex by ex said, Staff showed me a big kitchen and told me this is where all of the meals are cooked. They have a chef who cooks for them. This concerned me, so I asked why people are not supported to cook their own meals in their own homes. I was told that people used to cook in their own homes but now it was all done for them. This is not good enough. The people I met were quite able and should be able to cook their own meals with support. I asked one of the people who lived there if they went food shopping. They told me the cook does it. I was shown a list of food that the cook decides and then someone delivers all of the food for the home. It is bad that nobody is involved in shopping for the home or choosing the food that goes on the menu. They should be making the choice about what they eat and should be involved in buying their own food. Records of a meeting with the people living there showed that they talked about menus. As a result of this meeting some things had been taken off the menu as requested. The manager said that staff were going to work with people in developing picture menus and an alternative would be provided to the main menu. We saw several pictures that had been prepared for this. The new chef had started that week. During the two days the manager was heard saying to the chef to ask the people living there what they wanted to eat so to give them a choice. The ex by ex said, I was told that people have a takeaway on a Saturday night. On the menu it said Chinese sweet and sour chicken. I would hope that people get a choice of what takeaway they want and do not just have this every week. We observed staff standing to assist people to eat and drink. When the manager observed this they told staff to sit down so as to support the person appropriately and not stand over them, which impacts on their privacy and dignity. Care Homes for Adults (18-65 years) Page 18 of 37 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. Arrangements do not always ensure that the personal and health care needs of the people living there are met, which could impact on their well being. Evidence: Staff were observed interacting with the people living there and responding to them in a positive way. People were dressed in individual styles that reflected their age, gender and the activities they were doing. Records showed and it was observed that staff support people to go out and buy their clothes so they can choose these and buy things they like to wear. One person was observed a few times slipping down in their chair and staff supported them appropriately to sit up again so they were comfortable. The manager said that a referral is being made, so that an occupational therapist can assess the person as to the right chair for them, so they are comfortable. Records included an assessment of the risks of staff supporting the person to move. Where these indicated that there was a risk to the person or to staff supporting them it was not clear what needed to be done to reduce this risk. We observed one person Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: being supported to move several times in a way that could hurt them or the staff supporting them. There were no guidelines in this persons records that stated how staff are to support the person safely. Records sampled included a health action plan. This is a personal plan about what support a person needs to meet their health needs. These included pictures, making them easier to understand. They were not dated and other records indicated that some of the information in them was now out of date. One persons records indicated that they were agitated and staff had stated that the person possibly had stomach cramps. The person is unable to communicate their needs and it was not clear from the persons care plan or records how staff would have known this could be the cause of their agitation. Records did not state how a person may communicate that something is wrong with them, which could impact on their well being as staff may make assumptions as to what is wrong. Records showed that other professionals are involved in the care of individuals this involvement has increased since the management of the home has changed helping to meet peoples needs better. Records sampled showed and it was observed that staff identified when a person was unwell and sought medical advice. Weight records sampled showed that people had not been weighed regularly. For some people it had been identified that if they lost weight this was a risk to their health. Records for one person indicated that sometimes they refused to be weighed but their weight record did not indicate that staff had tried to weigh them. The pharmacist inspection lasted three hours. Six peoples medicines were looked at, together with their Medicine Administration Record (MAR) chart and care plans. One member of staff was spoken with and all feedback was given to the manager. The medicines were stored in two medicine trolleys in a dedicated medication room. An air conditioning system was installed to ensure the stability of the medicines. Surplus medicines had been moved out of the trolleys and placed in an open box in the medication room. All medicines should be stored in locked cabinets within the locked room. The medication was promptly returned to the trolleys for safe storage. Medicines no longer required were kept in a large zipped bag in the medication room. This had not been locked in a cabinet so anyone gaining access to the room had access to these medicines also. The home has installed a good system to check the prescriptions before they are dispensed and to check the dispensed medicines and MAR charts received into the Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: home. All the quantities of medicines received and any balances carried over had been recorded enabling audits to take place to demonstrate whether they had been administered as prescribed and records reflected practice. The home had installed a quality assurance system to check the level of medicine management. Whilst improvements were seen, further work is needed to ensure that all staff handle medicines correctly. Audits indicated that not all the medicines had been administered as prescribed and records did not always reflect practice. Currently two staff sign the MAR chart to show that they had administered the medicines. It was not possible to identify which staff actually administered the medicines. Despite two people undertaking the medicine round, mistakes were still seen where staff had signed that they had administered medicines when they had not. The quality assurance system was not refined enough to identify which members of staff were responsible for the errors. One medicine had not been ordered in time so the person went without their prescribed medication for at least five days whilst a new supply was sought. Medicines prescribed to be administered when required only, had supporting protocols. These were very poor in content and lacked important information for staff to follow. One medicine had a protocol detailing its use but was no longer prescribed. Most of the medicines could not be administered without contacting the named manager who is currently not working at the home. Care staff should be trained to understand why they are administering a medicine and have a detailed protocol to follow to safely do so, without contacting the management. This delay may put the people at risk in the home if the management is not to hand. Staff spoken with had a poor knowledge of the medicines they administered so they may not be able to fully support the needs of the people they look after. The care plans did not fully support all the medical conditions the people had. Whilst reviews had taken place they had not been altered despite drug changes. It was difficult to evidence that some medicines had been administered by external health care professionals. Some medicines had been administered late and not at the prescribed intervals, which could be detrimental to people. The day before the inspection staff had forgotten to take one person to the doctor for their fortnightly injection and could not get another appointment for a week. Staff said this would be detrimental to the persons health. Currently the system used to identify when a person is due to attend the doctors is poor as this appointment had been missed. There was no record of when the medicine was due on the MAR chart. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: Therapeutic drug levels had not been taken as advised following a dose change. This is of serious concern as the medicine may not work as intended because the dose was too low or the person may have too high a dose leading to toxicity. The home had an extensive homely remedy policy but no supporting medicines. The manager was keen to address the issues raised during the inspection. Care Homes for Adults (18-65 years) Page 22 of 37 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. Arrangements do not always ensure that the views of the people living there have been listened to and they are safeguarded from harm. Evidence: The complaints procedure was in the statement of purpose and included pictures, making it easier to understand. People told us in the surveys that they knew how to make a complaint. However, the ex by ex said, The staff were telling the people what to write in the surveys. When the residents were asked are you happy here, the staff were saying put yes, of course you are. None of the people who live there knew about complaining and there was no complaints form so I do not know how people say if they are not happy about something. We have received nine complaints about the home since we last visited. This begun with an anonymous complaint made through a staff union representative in May this year that raised concerns about the managers attitude and practices. This was reported to social services and the police and safeguarding procedures followed, resulting in the manager being suspended pending investigation. The investigation recently concluded that the manager could return to work for the organisation but would not return to the home. Subsequent complaints have been investigated and all the people living there continue to be under safeguarding procedures to ensure they are being protected from abuse. There have been several managers in post since the manager was suspended, which has raised concerns about whether the people living Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: there are being protected. The operations manager is currently managing the home, which is providing some stability. The complaints log recorded that seven complaints had been made to the home, one of these raised several issues so was treated as four separate complaints. The log showed that all complaints had been investigated appropriately and action taken to resolve the issues raised. Records included a booklet called Making Decisions which included pictures and was about advocacy, complaints and abuse. The manager said that key workers were going through this with individuals so helping them to understand it. Training records showed that in the last year 25 per cent of staff had received training in safeguarding adults from abuse. This does not ensure that the people living are safeguarded and staff would know what to do if an allegation of abuse was made. The manager said that training for staff in safeguarding has been booked. Incident reports relating to people making allegations that they have been abused by staff or the other people living there show that the procedures for safeguarding had been followed and the appropriate people notified. One person living there has a Deprivation of Liberty Safeguard authorisation. This is placed by the Best Interests team of the local authority to state that where the person is being deprived of their liberty this is in their best interests. We looked at this persons records and found that the recommendations made as part of this authorisation were being met so to safeguard the person from harm. We looked at the personal allowance statements for four people. These showed that people receive their money regularly and spend it on personal items, not on things that should be provided by the home as part of the fees they pay. Peoples money is held securely in the home. When staff spend money on behalf of individuals two staff always sign to say why the persons money is being spent and what on. Receipts are kept of all purchases and these cross referenced with the money spent. Care Homes for Adults (18-65 years) Page 24 of 37 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 environment is safe and clean but not homely and comfortable to meet individuals needs. Evidence: The home is split into three units, Swan, Dove and Wren. As stated earlier in this report the people living there and staff walk through the lounge in Swan unit so it is not always very homely for the people who live there. Some parts of the home had recently been redecorated and new flooring laid to make it more comfortable and homely. Some rooms needed redecoration and the furniture needed replacing, as it looked worn. The manager said that this is planned. In the dining area in Swan unit there is a caricature of a chef and it is known as Swan Bistro. The chairs and tables are metal and cafe style, which does not make it very homely. We spent some time sitting in these, which were cold and not very comfortable. Some people sit at the table in their wheelchairs and the tables were not always high enough for their wheelchair to go under it. The ex by ex said, Generally I did not think the home felt very homely. In the one unit the lounge area was very big and they had a dining area at one end that was made to look like a cafe. I was told that some of the people have their dinner in there. I did not like this as it did not feel like someones home to me. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: The ex by ex said, I asked some of the residents if they had chosen the decor in the home, they told me they had chosen the decor in their bedrooms, which is good, but they had not chosen the decor in the rest of the home. People should get the choice of how their home is decorated. The manager said that people are now being given the opportunity to choose the decor and furnishings of the home. Bedrooms seen were personalised to individual tastes and interests. Each person has their own en suite and these were personalised to their individual tastes. People said they choose the decoration of their bedrooms. One persons toilet seat in their en suite was worn and should be replaced. The ex by ex said, One person showed me their bedroom, which was very childlike. I accept that it is the persons choice to have what they want in their room but staff should work with them and support them to have more age appropriate things as they are an adult. Some people were unable to sit comfortably in the chairs in the lounges. The manager said that referrals had been made to occupational therapists for assessments to be made of suitable chairs for individuals. The home was clean and free from offensive odours. Staff and some people living there were observed several times walking through the lounge of Swan unit carrying plastic bags of washing. The manager said that this should not happen, as there is a washing machine on each unit where the washing should be done. The manager said they would talk to staff about why this was happening. Following our visit the manager told us that the washing was clean and was being brought through to use the dryer in Swan unit. Staff should consider how they can do this without impacting on the privacy of the people who live in Swan unit. Care Homes for Adults (18-65 years) Page 26 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their recruitment, support and development are variable, which could impact on the well being of the people living there. Evidence: Training records indicated that less than twenty per cent of staff had achieved National Vocational Qualification (NVQ) level 2 or above in Care. The standard for this is that at least fifty per cent of staff have achieved this so they have the knowledge and skills to meet the needs of the people living there. The manager said that further staff are enrolled to do this training. Some people need 1 to 1 or 2 to 1 support from staff and this is funded for through their placing authority. Through the safeguarding investigation it was found that extra staffing that had been funded was not being provided. When we visited we found that this is now being provided. Agency staff are being used to cover this while new staff are being recruited. The manager said that where possible they try to use agency staff that have worked at the home before so they know the people living there. Agency staff spoken to said they had worked at the home before and they were observed to know the people living there. However, we saw that care plans did not show staff how to support individuals to meet all their needs. Therefore, it was not possible for agency staff to know how to support individuals. Two support workers, a chef and a Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: handyman had been recruited and started the day before our visit. Some interviews were taking place on the first day of our visit. We saw minutes of staff meetings that showed there had been two in the last year. The manager said that another one was planned for the next week. There should be at least six staff meetings a year so that staff can be updated in the changing needs of the people living there, changes in the organisation and best practice. Staff said they have a handover between each shift so they can pass information on about the needs of the people living there. We looked at the records of four of the staff that work there. These generally included the required recruitment records including a satisfactory Criminal Records Bureau check and evidence that the person is suitable to work with vulnerable adults. One record only included one reference, two should be sought to ensure the person is suitable to work with the people living there. The Operations Director said that through investigating the management of the home they have found that previous training records were not accurate. Current training records showed that staff had received little training so they know how to support the people living there to meet their needs. The manager said that further training is planned and now it is clear what staff have or have not done they are ensuring that staff have the training they need. Visits from the Operations Director had highlighted the need for training. Staff told us in surveys that they get the support they need from the manager. Staff records sampled showed that supervision received from the previous manager was poor. It did not identify their training and development needs but told them what they should not be doing. This does not help to support staff to do their job to improve the lives of the people living there. Records showed that the current manager is ensuring that supervisions help to support and develop staff. The manager said that all staff will have an appraisals by the end of January 2010 so that their training and development needs can be identified. Care Homes for Adults (18-65 years) Page 28 of 37 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 arrangements have not always ensured that the home is well run in the best interests of the people living there, which could affect their safety and well being. Evidence: Since we last visited the manager was suspended pending investigation following an anonymous complaint about her attitude and practices. The deputy manager was also suspended but has returned to working within the organisation, currently based at another home. When we visited the investigation had just been concluded and the Operations Director stated that the manager would be returning to another home within the organisation but not to this home. Since the manager was suspended there have been several changes of managers at the home. Findings of this inspection show that the management arrangements have not ensured that the people living there benefit from a well run home. However, currently the Operations Manager is managing the home with their responsibilities being met by others within the organisation. We found that this was ensuring that improvements are being made. We have agreed that the Operations Manager can remain at the home for a fixed period to stabilise the home before the organisation recruits another manager. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: Regular visits by a Representative of the provider take place and the Operations Director visited to do this on the second day of our visit. This was thorough and a report is made of their visit. This includes an action plan for the manager to complete to show how recommendations made are being met to improve the home. Staff test the water temperatures regularly to ensure that people are not at risk of being scalded. Records showed that these were within the recommended temperatures so that people are not at risk. Fire records showed that staff test the fire equipment regularly to ensure it is working. The last fire drill was in September this year. Records of this showed that the majority of staff did not respond appropriately to this. It stated the need to discuss with staff how they should respond but there was no record that this had happened. The manager said that they would have another fire drill soon as new staff had started. The fire risk assessment had been reviewed in September this year and all recommendations from this had been met so the risks of there being a fire should be minimised. Records showed that the electric and gas equipment in the home had been regularly tested to ensure it was safe to use. Care Homes for Adults (18-65 years) Page 30 of 37 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 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 12 Each person must have a care plan that reflects their needs and preferences. So that staff know how to support individuals to meet their needs and achieve their goals. 31/03/2010 2 9 13 Risk assessments must detail how people are to be supported. To minimise the risks to peoples safety and well being. 31/03/2010 3 18 13 Guidelines must clearly state 31/01/2010 how staff are to support individuals to move. So reducing the risks of the individual and staff getting hurt. 4 19 12 Each person must have a plan that states how their current health needs are to be met. 31/03/2010 Care Homes for Adults (18-65 years) Page 32 of 37 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 So that staff know how to support them. 5 20 13 All medicines must be held in a locked cabinet at all times. This is to ensure the security of all the medicines at all times 6 20 12 All prescribed medicines must be available for administration at all times. To ensure that the people living there are administered prescribed medicines at all times. 7 20 13 All protocols detailing when 01/01/2010 required medicines must be written to reflect the doctors wishes and staff must be trained to adhere to them. To ensure that staff have clear guidelines to follow and are trained to do so. 8 23 13 All staff must receive training in safeguarding. To ensure they know how to safeguard the people living there from abuse. 9 35 12 Staff must have the training they need. 31/05/2010 31/05/2010 01/01/2010 01/01/2010 Care Homes for Adults (18-65 years) Page 33 of 37 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 So they know how to support the people living there to meet their needs. 10 37 8 A manager must be recruited who has the required skills and qualities. So that the people living there benefit from a well run home. 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 31/05/2010 1 2 Assessments before people move into the home should be detailed so it is clear whether or not their needs can be met. Staff should have training in how to communicate effectively with individuals to ensure that their frustration is reduced and they can communicate what they wnat and need. Care plans should be regularly audited to ensure they meet the persons current needs and staff know how to support individuals. Care plans should state what activities the person enjoys and how they need to be supported to do these. Activities should be provided that people enjoy doing and develop their skills so ensuring their well being. People should be supported to do activities that are appropriate to their age and during the evenings if they want to, so they can experience a meaningful lifestyle. People should be given more opportunities to do household tasks to develop their independence and self esteem. 2 6 3 6 4 5 6 12 12 13 7 16 Care Homes for Adults (18-65 years) Page 34 of 37 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 8 9 17 17 Staff should support people appropriately when they are eating or drinking so to respect their dignity. Menus should reflect the choices of individuals so they have the foods that they enjoy helping to ensure their well being. Menus should be provided using pictures to help people understand these better. Staff should weigh people regularly to ensure they are not at risk of being malnourished, which would impact on their well being. All staff that handle medicines should receive training in the indications and side effects of the medicines they administer so they know how these affect peoples health and well being. All the people living there and their family and friends should know how to make a complaint if they are unhappy with the service provided. Furniture should be replaced where needed to ensure that the home is comfortable and homely for people to live in. The home should be redecorated so it is homely and comfortable for people to live in. Toilet seats should be replaced as needed to ensure that the risk of cross infection is minimised. Appropriate furniture should be provided to meet individuals needs so they can sit comfortably. Staff should ensure that the risks of cross infection are minimised as much as possible. At least fifty per cent of staff should achieve NVQ level 2 or above in Care so they have the skills and knowledge to meet the needs of the people living there. There should be at least six staff meetings a year so that staff can be updated with changes to the needs of the people living there, within the organisation and best practice. More staff should be recruited so the people living there are supported by staff that know them well. 10 11 17 19 12 20 13 22 14 15 16 17 18 19 24 24 26 29 30 32 20 33 21 33 Care Homes for Adults (18-65 years) Page 35 of 37 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 22 34 Two references should be sought for each member of staff that is employed to ensure they are suitable to work with the people living there. Staff should have at least six formal supervision sessions with their manager each year so they are supported in their role. Alll staff should be aware of how to respond if there is a fire in the home to ensure their safety and that of the people living there. 23 36 24 42 Care Homes for Adults (18-65 years) Page 36 of 37 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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