Inspection on 16/06/09 for Nine Elms Lane

This inspection was carried out on 16th June 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nine Elms Lane 08/08/07

Nine Elms Lane 23/08/06

Nine Elms Lane 26/01/06

Nine Elms Lane 27/09/05

Nine Elms Lane 08/10/04

Nine Elms Lane 30/06/04

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: Nine Elms Lane 87-89 Nine Elms Lane Park Village Wolverhampton West Midlands WV10 9AN     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: Dawn Evans     Date: 1 6 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 33 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 33 Information about the care home Name of care home: Address: Nine Elms Lane 87-89 Nine Elms Lane Park Village Wolverhampton West Midlands WV10 9AN 01902833730 01902833731 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Learning disability who may also have physical disability. The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 7 Physical disability (PD) 7 Date of last inspection Brief description of the care home This service was last inspected on 08 August 2007. Nine Elms Lane provides a service for younger adults who have a learning and physical Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 7 7 Brief description of the care home disability and who may require nursing care due to their physical health needs. The home is situated in a residential area and there are a range of community facilities nearby, including shops and pubs. The bus route is within walking distance and the train station is approximately 2.5 miles from the home. There is limited off road car parking to the front of the property. Located on the ground floor are two lounges, separate dining room, kitchen, laundry and toilet. Seven single bedrooms are situated on the first floor. There are no en suite facilities provided but all bedrooms have a washbasin. Situated on the first floor is a shower room and bathroom. Equipment and adaptations are in place which, include passenger lift, raised toilet seat, grab rails, hoist, assisted bath and ramp access to the garden. The staff team consist of both male and female and are available on a 24 hour basis, a trained nurse is always on duty. Previous inspection reports are available in the home for people to read if they wish enabling them to establish the quality of the service and peoples experience of living there. Information about the fees charged for the service was not made available; the reader is advised to contact the home directly for this information. Care Homes for Adults (18-65 years) Page 5 of 33 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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. We looked at all the information that we have received, or asked for, since the last key inspection . This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by Care Homes for Adults (18-65 years) Page 6 of 33 law, and an Annual Quality Assurance Assessment. (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive , discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps we understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Due to the communication needs of people living here we were only able to ask one person their views on the home, so time was spent observing care practices and staff interaction. We received five out of six Have your Say surveys sent to people who use the service and one out of six sent to staff members. These views have been included in this report. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Documents such as the statement of purpose, service user guide and complaints procedure need to be in a format people can understand. Care plans need to reflect peoples cultural and religious needs so people can be assured this will be respected. A falls risk assessment needs to be in place for people with restricted mobility to support their independence and safety. A risk assessment for people with complex dietary needs should be in place so staff have the information needed to ensure peoples nutritional needs are met safely. Menus should reflect peoples special dietary needs so they can be confident their choice and preferences will be assured. A written protocol should be in place for the use of when required medicines, so staff know how to administer them safely. To ensure people are given the relevant support to pursue social activities of their choice so they can live a fulfilled lifestyle. To ensure care plans identify peoples preference and style of dress and are supported to reflect their choice. Care Homes for Adults (18-65 years) Page 8 of 33 To ensure all staff have contact details of the relevant agencies to report any allegations of abuse so people are assured immediate protection. To ensure the property and furnishings are maintained to a reasonable standard to ensure peoples comfort. Staff personnel files need to contain evidence of appropriate safety checks to show they are suitable to work with vulnerable people. Large furnishings needs to be secured to the wall or a detailed risk assessment put in place to ensure peoples safety. To ensure all chemicals that could place people at risk of harm are securely stored. 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 33 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 33 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 do not have access to information they can understand to enable them to establish the homes suitability to meet their needs. However, the undertaking of a needs assessment ensures staff will know how to support them. Evidence: The statement of purpose and service user guide provided information about the service and facilities available. Staff told us that people who use the service would not be able to understand them. We looked at the services quality assurance assessment tool. This is where the service looks at the quality of the service provided to people. This also showed the need to provide these documents in a format people can understand. This means that not all people would have access to information needed to find out if the service would be suitable to meet their assessed care and social needs. The manager also acknowledged that some information contained in these documents need to be updated to reflect the current management and staff team. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: The assistant manager and staff were not sure if people or their representative were given this information before they moved into the home. People who used the service had limited verbal skills and were not able to tell us if they had receive this information and we did not have the opportunity to speak to their representative. Staff told us they were able to communicate with some people using pictures and acknowledged that some people would be able to understand these documents if produced in a pictorial format. The manager told us people have a needs assessment before moving into the home. This assessment enables the service to find out the persons care and social needs and the support needed to ensure their health and best interests. We looked at three care records, which showed detailed assessments had been carried out. Information obtained from this assessment is used to develop a care plan. A care plan tells staff about the persons care needs and how to support them in a way they prefer. The AQAA told us people are able to visit the home on a number of occasions before making a decision to move in. Staff spoken to also confirmed this practice. This enables people to make an informed decision of whether they wish to live there. Care Homes for Adults (18-65 years) Page 12 of 33 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 have written information on how to meet peoples needs but the absence of detail about peoples culture and religion does not ensure these will be met the way they prefer. Evidence: The three people we case tracked, we looked at their care plans. A care plan tells staff about peoples assessed needs and how to support them to ensure their health and independence. Care plans were detailed and provided staff with information about peoples health conditions and how to assist them. For example, one care plan told staff about a persons restricted mobility, the equipment required to assist them and the need for the person to have rest periods when walking. Discussions with two staff members confirmed their knowledge of the persons needs. This person can be assured staff will know how to meet their needs and ensure their Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: wellbeing. Another care plan told staff about a persons health condition and the assistance needed relating to their complex dietary needs to ensure their health. Staff spoken to were also aware of this persons care needs. We observed the person being offered meals as shown in their care plan. Staff said where possible people were involved in planning and reviewing their care. We did not see any evidence of this on their care plan. Two staff members told us people would not be able to understand their care plan. Consideration should be given in producing care plans in a pictorial format so people can understand them. We observed that staff were able to communicate with people in a way they understood. Staff said meetings were not undertaken with people who live at the home. Meetings would enable people to be actively involved in the running of the home and assist them to make decisions. One staff member said they have Talk Time, asking people about their choice of social activities. However, these discussions were not recorded. Information about these sessions was also shown in the AQAA. This should enable people to have a say in how they receive their care. Staff told us people had access to a self advocacy service. This is a service that provides independent support to people. We heard the manager arranging a self advocate to provide additional support for a person, to enable them to access suitable equipment to assist with their mobility. Due to peoples lack of mental capacity staff said they were not able to manage their financial affairs. This was managed by Social Services or the persons family. The home held a small amount of cash in safekeeping for people. We saw account sheets showing all financial transactions and receipts were maintained. We looked at two account sheets and funds. One was correct and there was a small discrepancy with the other, showing a surplus of funds. A financial risk assessment was also in place. These practices should ensure people are protected from potential financial abuse. We saw other risk assessments in place to support peoples independence and ensure their safety whilst doing so. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: We looked at three risk assessments and saw they were written in the same standard format for everybody. This did not reflect the persons individual needs. For example, one person had a health condition and restricted mobility and was at risk of falls. We did not see a falls risk assessment and the assistant manager said they did not have one. However, we spoke to two care staff who had an awareness of this persons needs and the assistance required to maintain their safety. This person was unable to tell us about the support they received. We observed this persons mobility was restricted and required the use of a walking appliance and passenger lift to moblise and access facilities within the home. The lack of written information to tell staff how to ensure this persons safety may place them at risk of harm. Some people had complex health and dietary needs. Information contained within one care plan and discussions with the manager showed that if this person was given the wrong food it could place them at risk of harm. The manager also told us they did not have a risk assessment for this person to ensure their safety. A written risk assessment should ensure all staff are aware of the importance of this persons special dietary needs to ensure their wellbeing. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not have the support needed to pursue social activities of their choice to ensure they live a stimulating and fulfilled lifestyle. Evidence: Staff told us people were supported to access leisure services within their local community including, shops, walks in the park, going to the local pub and the theatre. Staff said people displayed behaviours that challenged the service and required one to one support when in the community. They said insufficient staffing levels meant social activities were limited. The AQAA told us the home needs to increase social activities and there were plans to recruit an additional member of staff to enable this to happen. We observed one staff member taking a person out for a walk to the local park. One Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: person requested to go to their bedroom and we saw staff assisting them to do so, respecting the persons choice. Three people attended day care services, three days a week. Staff told us it was peoples choice and they enjoyed going. The AQAA shows the service could improve in reflecting peoples cultural background when planning their care. Discussions with the assistant manager and staff confirmed their awareness of peoples cultural needs. They also acknowledged this information was not contained within the care plan so people can be confident all staff will know how to meet their cultural and religious needs. Care records showed and discussions with one person who lived at the home confirmed people were able to maintain contact with their family and friends. One person said they were going out and we observed their relative coming to take them home for a few days. This means people are able to maintain relationships with people important to them. Due to peoples complex care needs and limited verbal skills, we were not able to talk to most of them. We observed staff communicating with people in a way they understood. For example using Makaton. Makaton is a form of sign language. We saw staff using pictures to assist people to make decisions. We saw bedroom doors were fitted with a privacy lock to ensure peoples right to privacy. Staff said people did not have a key because of their lack of capacity. However, we observed staff respecting peoples privacy by knocking on doors before entering rooms. We also observed people being taken to the privacy of their room to be assisted with their personal care needs. Staff said menus were developed on a weekly basis and people were asked what they would like. Information located within the kitchen told staff about peoples dietary needs. Menus did not offer people an alternative choice to reflect their likes or dislikes. Staff said people were offered a choice but this was not recorded. We observed meals offered to people were varied to meet their dietary needs. Two people were from different ethnic backgrounds. Staff said these people enjoyed their cultural meals. However, this information was not included in their care plan or on the menu to reflect their choice or dietary needs. The staff team were from different cultural backgrounds and told us they were able to Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: meet these dietary needs. Two other people required a special diet because of their health condition. Although this information was contained in their care records, it was not identified on the menu and the manager also acknowledged this. The AQAA also showed there was a need to improve the menus. Consideration should be given in providing detailed menus to ensure all staff are of aware of peoples dietary needs so their health and choice can be assured. Care records and discussions with staff confirmed people had access to a dietician supporting them to choice the appropriate foods, to ensure their health. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the support needed to ensure their personal care needs are met. Evidence: Care records showed the support needed to meet peoples personal care needs. One record told us the persons preference about their hair style. We saw this persons hair was the way they wanted it. This practice reflected their choice and individual style. The staff team consisted of both male and female, staff said people can choice what staff assist them with their personal care needs but this information was not written in the care plan to ensure peoples choice was respected. We observed people were dressed smartly but questioned why all the men were dressed similarly. Staff said this was for peoples comfort and they could not be able to manage zips and buttons. It is recommended peoples reference to their style of dress is written in their care plan and the relevant support provided to reflect their choice and individuality. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: Care records showed the equipment and adaptation people required to support their independence and safety. One care record showed what equipment was needed to assist the person to mobilise, so this person independence and safety can be assured. We saw this person using this equipment. The AQAA showed people have access to other healthcare professionals. We looked at three care records, which showed people had access to a general practitioner of their choice, dentist, chiropodist, optican amongst others. Records were maintained of healthcare visits. This should ensure peoples physical and mental health needs are met. We looked at how the home managed peoples prescribed medicines. Medicines were only administered by qualified nurses. We saw medication administration records (MAR) were signed when medicines were given out. A MAR is a record of peoples prescribed medicines. These practices should ensure people receive their medicines regularly and provide an audit trail. Although medicines were stored appropriately, the medication cabinet was not secured to the wall and this may compromise the security of medicines. The assistant manager told us when required medicines were used. These are prescribed medicines only to be used when necessary. We did not see a written protocol for the safe use of these medicines. The assistant manager said there was a generic policy but they did not have individual written protocol for these medicines. Information contained within the homes policy from their training officer, dated February 2008, showed the need to have an individual protocol. This would ensure staff know how to safely administer these medicines to ensure peoples health. Staff said they only used when required medicine occasionally, we looked at a medication administration record that showed these medicines were not used on a regular basis. Care Homes for Adults (18-65 years) Page 20 of 33 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. People do not have access to a complaints procedure they understand so they can share their concerns and be assured their rights will be supported. Evidence: The AQAA stated, There is a robust complaints procedure available to service user, relative and professional. The complaints procedure was a large document and staff told us people were not able to understand it. The AQAA also showed they could improve in making this document more user friendly. Consideration should be given in providing this document in a pictorial format so people can understand it. One survey received from a person who used the service told us they would share their concerns with their social worker. Another survey showed the person would be reliant on their family or staff members to express their concerns. Other people were not able to comment. Discussions with staff and observations proved staff were able to communicate with people and were able to recognise when they were unhappy. We looked at the complaints and compliment book. There were no recorded complaints but a number of compliments about the service provided. The AQAA also showed and staff told us they had not received any complaints since the last inspection visit. We have not received any concerns or complaints about the service. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: The AQAA told us they had not received any safeguarding referrals. This is where an allegation of abuse has been made or where care practices compromise peoples health and safety. Staff said they received safeguarding training to enable them to recognise various forms of abuse. Staff told us if they had any concerns about peoples welfare they would report it to the person in charge. The home had a safeguarding policy that told staff about abuse and what action should be taken to protect people. However, the manager and assistant manager were not aware of contact details of other agencies that should be informed. The assistant manager said, I would telephone the senior member who is on call duty. This may delay action taken and place the person at further risk of harm. Care Homes for Adults (18-65 years) Page 22 of 33 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 property is suitable to meet peoples physical needs but poor maintenance may compromise their comfort. Evidence: Nine Elms Lane is situated in a residential area and is easily accessible. The bus stop is within walking distance making travel to the City Centre easy. The train station is approximately 2.5 miles away. Local shops and pubs are also within walking distance. The property consists of seven single bedrooms located on the first floor. Bedrooms are not equipped with en suite but all have a washbasin. One shower room and bathroom is situated on the first floor. We observed people were able to personalise their bedrooms to reflect their choice and style. One person pointed, showing us their pictures and posters that decorated their room. On the ground floor the home also offered two lounges one of which, had recently been decorated. A separate dining area, kitchen, laundry and toilet. People had access to a garden at the rear of the property. Limited car parking was available at the front of the property. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The property was in need of decorating and refurbishment. We saw a drawer front missing in one persons room. Handles were missing off drawers in the dining room. Window frames needed painting and some were rotten. Old furnishings had also been disposed of in the garden. The manager said arrangements had been made to remove the rubbish. She received a telephone call that day saying the rubbish would be taken away the next day. One bedroom window had an opaque film across it denying the person a view. Staff said this was in place to ensure the persons privacy and dignity. The manager acknowledged this was not appropriate and that alternative methods could be used and arrangements had already been made for it to be removed. The AQAA shows future plans to improve the environment. Equipment and adaptations were in place to support peoples independence and safety. This included a passenger lift, hoist, ramp access to the garden, raised toilet seat and an assisted bath. We observed staff continually cleaning the home. One staff member said, due to some peoples behaviours this was necessary to maintain the cleanliness within the home. The home was clean and tidy. Care Homes for Adults (18-65 years) Page 24 of 33 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. People are supported by suitable, skilled, and dedicated staff but insufficient numbers of staff may compromise the support provided to meet their needs. Evidence: The home had four nurses and eight care staff, the day shift consisted of three care workers and a trained nurse. At nights one care worker and a trained nurse was provided. The home does not have any domestic or catering staff. We observed one staff member spent a lot of time cleaning the home, others having to prepare and cook meals. This detracted staff from their care duties and may compromise the support provided to people. The manager said the nursing team consisted of three Registered General Nurses and one Registered Learning Disability Nurse. Although all the people who used the service had a learning disability she was confident there was a mix of skills to meet peoples mental health and nursing needs. The home was able to accommodate seven people, on the day of our visit six people were living in there. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: The manager said they had created a new deputy managers post and were currently looking to fill this in the near future. There was a 37.5 hour care worker vacant post. The manager said these hours were currently being covered by the existing staff team. The manager told us two people had complex care needs and required one to one support. The home was currently reviewing these peoples care needs to request additional funding to increase staff hours. Two staff members said there were not enough staff on duty to assist people to pursue their social interest. The manager was also not confident adequate staffing hours were provided to meet peoples needs. We observed that staff were extremely busy attending to peoples care needs and were committed in ensuring their wellbeing. The AQAA showed and the manager confirmed seven out of 12 staff members had obtained the National Vocational Qualification Level 2 or above. One staff member told us they had completed this training. This should ensure staff have the appropriate skills to meet peoples assessed needs. The AQAA told us the home had a robust recruitment procedure. We looked at three staff personnel files, which contained evidence of a Criminal Record Bureau disclosure check. The manager said written references were held at the head office, so we were not able to see if appropriate safety checks were being carried out. Two staff members said they did have a CRB check and two written references were requested before they started working at the home. This should ensure their suitability to work with vulnerable people. The AQAA shows two out of four nurses had obtained the Registered Managers Award. We looked at the staff training matrix and discussions with staff members confirmed they had received the following training: Diabetes awareness, infection control, safeguarding awareness, fire awareness, understanding challenging behaviours, moving and handling, , food hygiene, amongst others. This should ensure staff have the knowledge and skills to care for people individually and collectively. Care Homes for Adults (18-65 years) Page 26 of 33 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. The home is managed in way that ensures peoples care needs will be met but not necessarily in a way that ensures their health and safety. Evidence: The service has recently appointed a new manager who had been in post three weeks. She told us that she was a trained Registered General Nurse (RGN). To comply with her legal obligation she said she would be sending an application to be registered as the manager for the home. The home had various ways of monitoring the quality of service provided to people. For example, they had a Self Assessment Tool. This focused on the how standards are achieved and what needs to be improved. The manager was not not sure how the information collated was feedback to people so they are aware of what would be done to improve standards within the home. This assessment showed areas that need to be improved some of which, we have identified in this report. This included the need to produce documents in a format Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: people can understand. To ensure care plans are more accessible to people and to provide more social activities. The manager told us they would be sending out pictorial quality assurance surveys within the next few weeks so people can understand the information and enable them to express their views about the service they receive. The area manager undertook regular quality monitoring visits at the home. This is where the quality of the service provided to people is monitored. These practices should ensure peoples health and welfare. The manager acknowledged shortfalls within the service, which included care plans not providing staff with relevant information about choice, culture, religion and the need for detailed risk assessments to ensure peoples safety. She also acknowledged staffing levels need to be reviewed to ensure peoples complex care needs are met. The AQAA provided reasonable information about the service but in some key areas details were missing. For example, there was no information about quality assurance and how the service would ensure good standards are maintained so peoples best interests can be assured. We looked at systems and practices that ensure peoples health and safety. Due to the complex needs of people, some of whom displayed behaviours that challenged the service and others with restricted mobility. We discussed the need to have large furnishings secured to the wall or to have a detailed risk assessment in place to ensure peoples safety. The area manager said they would review this and take the appropriate action. We saw toiletries and cleaning products in the toilet, staff acknowledged that if these products were handled by people who use the service, it could place them at risk of harm. We observed a key left in a cupboard where chemicals were stored. This could also compromise peoples safety. Health and safety maintenance checks had been undertaken to ensure equipment were in safe and full working order. Staff attended fire awareness training to ensure they know how to keep people safe in the event of a fire. Care Homes for Adults (18-65 years) Page 28 of 33 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 29 of 33 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 20 13 The medicine cupboard was not secured to the wall. Action must be taken to ensure the security of medicines held in the home, so people are not placed at risk of harm. 31/07/2009 2 20 13 A written protocol for the safe use of when required medicines was not in place. Measures must be taken to ensure staff have the information they need to safely administer these medicines to ensure peoples health and safety. 31/07/2009 3 33 18 Care staff undertake domestic duties. This detracted them from their care duties. The necessary action must be taken to ensure appropriate levels of care staff are provided in the 01/09/2009 Care Homes for Adults (18-65 years) Page 30 of 33 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 home. This should ensure peoples assessed care and social needs are met. 4 42 13 Chemicals were not securely 31/07/2009 stored and may place people at risk of harm. The appropriate measures must be taken to ensure people do not have access to these chemicals so their health and safety can be assured. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 To ensure people have access to the Statement of Purpose and Service User Guide in a format they understand, this will enable people to establish the services suitability. To ensure where possible people are supported to be involved in their care planning so the service they receive reflects their preferences. To ensure a falls risk assessment is in place to so peoples independence and safety can be assured. A risk assessment should be in place for people who have complex dietary needs to ensure their health. To ensure peoples cultural and religious needs are reflected in their care plan so they are assured staff will know how to meet these needs. To ensure people are provided with the relevant support to take part in social activities of their choice enabling them to live a fulfilled live style. Consideration should be given to ensure menus reflect peoples nutritional needs, likes, dislikes and also offer a Page 31 of 33 2 6 3 4 5 9 9 13 6 13 7 17 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 choice of meals. 8 9 18 22 To ensure care plans identify peoples preference and style of dress and that they are supported to reflect their choice. To ensure people have access to a complaints procedure they can understand so they are able to share their concerns. Consideration should be given to ensure all staff have details for relevant agencies to be contacted to make a safeguarding referral, so not to delay action taken to ensure peoples safety. To ensure the home is maintained to a suitable standard so people are comfortable. To ensure appropriate evidence of staff safety checks are maintained on file, in this instance two written references. To ensure large furnishings are secured to the wall or a risk assessment is put in place to ensure peoples safety. 10 23 11 12 13 24 34 43 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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