Inspection on 21/10/09 for Oak House Residential Care Home

This inspection was carried out on 21st October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak House Residential Care Home 03/05/07

Oak House Residential Care Home 16/08/06

Oak House Residential Care Home 27/09/05

Oak House Residential Care Home 22/04/05

Oak House Residential Care Home 22/11/04

Oak House Residential Care Home 05/05/04

Oak House Residential Care Home 23/07/02

Similar services:

Southfields

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Insight - Eastchurch

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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: Oak House Residential Care Home 56 Surrenden Road Brighton East Sussex BN1 6PS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gwyneth Bryant     Date: 2 1 1 0 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 38 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 38 Information about the care home Name of care home: Address: Oak House Residential Care Home 56 Surrenden Road Brighton East Sussex BN1 6PS 01273500785 01273500785 manager.jan@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Anthony David Sargent care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 14 The registered person may provide the following category of service only: Care home only ( PC) ot service users of the following gender: Either whose primary care needs on admission to the service are within the following category: Learning disability(LD) Date of last inspection Brief description of the care home Oak House is a privately owned, three storey Victorian semi-detached house providing residential care for up to fourteen adults who have mild to moderate learning disabilities. The providers have owned the home for 24 years. The home is located in a residential area on the outskirts of Brighton, close to Preston Park, local amenities and bus routes into Brighton. Placements are generally long term, with most residents having lived at the home for many years. The home works closely with the Grace Eyre Foundation and accesses many of the services offered by them including day care provision. Accommodation is provided over three floors and consists of eleven single and one shared bedroom, therefore the home can accommodate up to thirteen service users. Care Homes for Adults (18-65 years) Page 4 of 38 14 Over 65 0 Brief description of the care home Communal facilities include a sitting room, lounge/diner and rear garden. There are two bathrooms located on the first and second floor and two shower facilities on the ground and first floor. Stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. The home provides personal care and support to service users who are funded by Social Services. The homes fees as of 03 May 2007 range between £622.00 - £705.00 per person per week. Additional costs are charged for hairdressing, chiropody, toiletries, holidays and transport. Prospective service users and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Oak House will be referred to as residents. This was an unannounced inspection which began at 10:15 and ended at 15:45 and was carried out by two Inspectors. The purpose of the inspection was to check compliance with key standards and other standards. There were thirteen people in residence on the day of which four were involved in the inspection. The Registered Manager, senior carer and one visitor were also involved in the inspection. A number of documents and records were viewed; including personnel files, medication charts and care plans. Seven bedrooms were visited as were two communal bathrooms, two communal toilets and the communal lounge and dining areas. Care Homes for Adults (18-65 years) Page 6 of 38 Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Although this was provided when we asked for it some of the responses were limited to a single sentence rather than giving detailed information, however the information is included in this report as necessary. Care Homes for Adults (18-65 years) Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 38 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 9 of 38 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. Pre-admission processes are satisfactory but documents relating to the services offered need to accurately reflect the current services offered. Evidence: Although the AQAA sent to us in March 2009 indicated that the homes Statement of Purpose and Service Users Guide were up to date, on the day this was not the case. A copy of both documents were in the homes hallway and were viewed. The documents had been signed and dated as being reviewed but changes had been made using correction fluid and some information was out of date. For example, the Service Users Guide stated that smoking was allowed in communal rooms and the senior carer on duty confirmed that this had not been the case for over a year. The personal finances of one resident showed that they purchased their own cream and yoghurts but information in the service users guide indicated that the home provides all food, including food supplements. It is essential that these documents accurately reflect current services offered. No one has been admitted in the last twelve months but information in the AQAA Care Homes for Adults (18-65 years) Page 10 of 38 Evidence: stated that a thorough assessment of new residents takes place and a three month trial offered to all new residents. Pre admission assessments were not included with care plans as a number of residents have been at Oak House for many years and as placing authorities had not carried out annual assessments for the people whose care plans were viewed, it was difficult to ascertain whether or not the admission process is effective. There were issues raised in respect of the compatibility of residents as two were very dependent and the others less so. Therefore it is essential to arrange for reassessments for the more dependent residents to ensure the home remains an appropriate placement and to ensure other residents can maintain a good quality life. Following the site visit the registered provider confirmed that both the statement of purpose and service users guide have now been updated. Care Homes for Adults (18-65 years) Page 11 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are basic and fail to be compiled in a person centred manner, nor are they reviewed to reflect an individuals changing needs or circumstances. There are also shortfalls in the information provided and service users do not currently benefit from opportunities to develop and fulfil their goals and aspirations. Evidence: Five care plans were viewed in depth and one briefly to check healthcare needs. Although the AQAA stated that Person Centred Care plans were in place the registered manager explained that to date, the home has the templates, none of which had been started. Generally care planning documents were poorly completed and had not been updated. There was little evidence of residents being involved in compiling the plans or subsequent reviews. One plan was last signed by the resident in 2005. Some parts of two plans included simple images to facilitate residents understanding but these were out of date and did not accurately reflect the residents current needs. Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: There was no evidence of input from relatives, advocates or other relevant agencies in any of the care plans. However, one resident confirmed they had an advocate and the registered manager said that residents can access advocates via the day centres and that an Advocacy group, Speakout, had arranged to visit the home in November. The home does have a key worker system but the latest reviews were carried out by a senior carer rather than the key worker and there was no evidence to show that key workers were consulted or had input during the review process. There was little consistent evidence to demonstrate that residents preferred daily routines had been identified such as times to get up and favourite foods/drinks. The opportunities for residents to make decisions were limited and although there was some information stating that residents helped to lay tables, only one person did this on the day and staff appeared to do everything else for residents, including making drinks and meals. Care plans were often inconsistent with one part stating that the individual was of low dependency then another part stating that they needed total support with personal care, including assistance to dress. From the information in the plans and discussion with the registered manager none of the residents were supported to manage their own finances although there were good records relating to the registered managers handling of residents day to day expenditure. There was no evidence to demonstrate that residents are involved in developing and reviewing documents relating to the running of the home such as the Service Users Guide and Statement of Purpose. Daily notes were variable with a number just having the letters NTR to denote nothing to report. It is crucial that daily notes are sufficiently informative to ensure they give a good overview of how the individual spent their day and that any issues arising are acted upon to provide evidence that care has been delivered in line with information in the care plans. Risk assessments had been carried out but they were poorly done as risks were not clearly identified nor were there clear directions to staff in reducing the risk. This is of great concern particularly as one resident has left the day centre, unescorted, on a number of occasions and has recently been found taking a bus ride. Given that this individual is noted to have become confused and is at risk of abuse due to their affectionate nature, it is crucial that a comprehensive risk assessment with appropriate safeguards be created and implemented. Risk assessments had been carried out for manual handling but again, the information was limited and did not clearly direct staff in the delivery of consistent care. Care Homes for Adults (18-65 years) Page 13 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users opportunities to access the local community and participate in meaningful social activities are restricted by staffing levels and inadequate resources. They are not involved in many decision making processes and choices available to them are limited. Evidence: Care plans showed that some residents go to local day centres but it was of concern that one plan stated that due to dementia the person is no longer able to do the listed activities but no alternative activities were identified. Each plan included a weekly activity timetable but this was limited to just stating where the individual would be on a particular day, for example certain days at a day centre and the other days in the home. These records did not detail what activities residents chose to participate in whilst in the home. Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: One resident said they always have a home day but is often unable to go out as there is not enough staff. Another resident used to have a job and discussion with the registered manager found that she has been trying to find them another job but could not state which establishments she had tried or the outcomes. It is important to record all actions taken on behalf of residents and how they were involved in the process. Following the site visit the registered provider has confirmed that the registered manager has consulted with an appropriate agency in respect of finding this resident a job and that they have also discussed this with their social worker on a number of occasions. There was no information in the care plans to demonstrate that staff had attempted to help residents understand political issues or have the opportunity to exercise their right to vote. It was good to note that care plans did include preferred terms of address and that they were adhered to by care staff. The AQAA stated that residents are supported to lead a varied and fulfilling lifestyle with the development of life skills, however there was little information in care plans to demonstrate this happens in practice. The home does not have a planned programme of activities based on residents preferences and on the day residents were left to colour in books or sort jigsaw puzzles with little staff interaction. Residents spoken with said that they did lots of things at the day centres such as Karaoke and having manicures but did not say what was available in the home. There was evidence that visitors were made welcome at all reasonable times and two individual activity timetables showed that residents were taken to visit family. However, daily notes did not reflect that these visits had actually taken place. The senior carer said that the home has a 7-seater minibus but this had been out of action for 5 weeks. It is difficult to see how residents can be taken shopping and on outings without appropriate transport. The visitor spoken with confirmed they were made welcome and were able to visit whenever they wished. On viewing residents finance records and discussion with the registered manager, residents all had an annual holiday. It was good to note that residents are given keys to their own bedrooms, especially as one resident now enters others rooms without permission, therefore residents are able to protect their privacy. Staff said that residents are able to access all parts of the home, however all residents spoken with said that they were not allowed into the kitchen. There was no information in any of the care plans viewed to demonstrate that residents were assisted to prepare meals and drinks. In addition, one person who had Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: a cold was asked not to be in the same lounge as another resident who is very vulnerable. This was also recorded in the daily notes and these notes indicated that they were encouraged to remain in their own room to avoid cross infection. Good practice suggests that a more subtle means of reducing cross infection be identified and implemented to ensure individual residents are not isolated. Only one care plan viewed included a photograph of the individual and this appeared to be taken some years ago. It is important to ensure plans include an up to date photograph of the resident to facilitate identification by new staff and visiting professionals. Care plans did not include clear and up to date information on residents responsibilities for housekeeping tasks such as cooking and cleaning rooms, from observation of the homes routines it appears that staff take full responsibility for most household tasks, although one person did lay the table at lunchtime and two residents said they also lay tables and are asked what they would like for dinner. Following the site visit the registered manager stated that residents do participate in cake making, drying up and helping with other household tasks although there was no evidence to support this. It was disappointing to note that when residents were served cups of tea, milk had been added to the teapot, therefore residents are unable to choose how much milk to have in their tea. This practice is considered to be very institutionalised and not in line with person centred planning. Following the site visit the registered manager confirmed that this practice has now ceased. In addition drinks and snacks were given at set times of mid morning. It was of concern that the person who had a heavy cold was not offered additional drinks or any homely remedies such as hot lemon to alleviate the cold symptoms. The care plans viewed were limited in the information on residents personal issues such as religious needs and sexuality. For example, there was no information to show if female residents like to wear make up or how they prefer to have their hair styled, nor was there information on whether or not male residents like a particular aftershave or hair styling products. The menu looked old and scruffy and had not been written a user friendly format so it is unlikely residents would be able to have a good understanding of what meals are available. The senior carer said the menus had been in use for over a year and one resident said that staff do all the food for us and this same resident did not know Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: where menus were kept. This indicates that residents are not involved in planning or cooking meals and given that the registered manager confirmed all food was ordered online and delivered to the home, it is clear that residents are not involved in shopping for food. Throughout the site visit staff provided all meals and drinks for residents therefore residents are not supported to make their own drinks, snacks and meals at times of their choosing. One resident said that they could not have a hot meal at lunchtime as they have to wait until the residents are back from the day centre. This practice should be reviewed to provide the main meal of the day at lunchtime if residents prefer this. One resident needs to be fed and it was good to note that this was done very well, with the carer facing the resident and engaging with them while they were being fed. This persons care plan indicated that they had been prescribed food supplements but staff said this was no longer the case and the resident was maintaining weight so as long as normal meals are liquidised there was no need for supplements. The AQAA said that the home carries out nutritional screening and the registered manager said that all residents whose needs have changed had an assessment by a nutritionist. The registered manager added that the nutritionist reports were in individual care plans, but this was not the case as only one report was found. It was of concern that the care plan for one person, who has gained weight, stated they should have low sugar, low fat and low calorie diet but there was no supporting information to show how this would be achieved. Care Homes for Adults (18-65 years) Page 17 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not recieve sufficient support in respect of their personal and health care needs. Medication is appropriately managed, but some service users would benefit from being enabled to take greater control in this area. Evidence: Each resident has a Health Action Plan (HAP) but the information in these plans is limited as not all parts had been completed. In addition it appears that staff do not have a good understanding of what needs to be in these plans. One HAP says the person has dementia which is controlled by medication and the action to maintain health is that staff give the medication and ensure they take it. There were lists of health related appointments in the HAPs but there was little information to state why the appointment was necessary or the outcomes. Where additional information was in the HAPs such as an incontinence assessment, daily notes did not indicate that the advice was followed. One person should be taken to the toilet every 2-3 hours and at 6.30am but there were no records to show this happens. There was no information in respect of the preferred gender of carers, nor were there clear times for having baths, going to bed or meals. Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: One persons plan indicated that they needed to be on a low sugar, low fat and low calorie diet but there was no evidence to show how this is to be achieved and there did not appear to be a variety of low calorie foods in the kitchen such as salads. Following the site visit the registered manager said that the inspection was carried out on a Wednesday and fresh fruit and shopping arrives on a Thursday/Fridays. It was good to note that the HAPs included information on chiropody,hearing and eyesight tests, but there was no information to guide staff on ensuring residents use aids such as spectacles and hearing aids. One plan showed that the last chiropody appointment was in May 2009 but there was no reason given for why the chiropodist no longer visited regularly. One care plan indicated that the resident had epilepsy but there was no guidance for staff such as a description of what their seizures looked like, how often they occur or a risk assessment in place for them to go out on their own. It is of concern that no risk assessment was in place as the resident said that although staff do not take them out, they go out alone if its not raining. Another person has asthma and although a risk assessment was in place, all it stated was when they have an attack, offer their inhaler. There were no preventative measures in place or detail within their care plan about what one of their attacks looks like. None of the HAPs viewed included the outcome of dental appointments, nor if any resident had false teeth. In addition there was no direction to staff in how best to support residents in oral hygiene. One residents health has significantly deteriorated and an assessment by a qualified Occupational Therapist has been carried out and appropriate equipment supplied and staff trained in using it. One person has become confused and now has a diagnosis of dementia but there is limited information as to how this will be managed nor of the effect on other residents. The changing needs of residents with dementia has been raised in earlier reports. There was no evidence that residents have been offered the opportunity to manage their own medication or any other choices in respect of the healthcare they receive. Medication Administration Records were viewed and were clear, accurate and up to date. Although one signature had been scribbled out, it was clear that the wrong sheet had been signed in error and the correct sheet signed afterwards. Medication is stored in line with current legislation and all staff who administer medication has received appropriate training. There were homely remedies in the medication cabinet and the registered manager Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: said there was a homely remedies policy in the home, however this could not be found and the senior carer said she did not think they had one. Care Homes for Adults (18-65 years) Page 20 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place to safeguard service users and ensure their views are actively being listened to and acted upon are not followed and as such service users are not fully valued or safeguarded. Evidence: The AQAA indicated that there are policies and procedures on both complaints and Safeguarding Adults. Discussion with the registered manager found that the home does not have a complaints log or suggestion box for residents. She had a template should a resident wish to make a complaint and said that any issues are resolved on a day to day basis, however there were no records to support this. In addition residents told inspectors that they had made complaints. Although the residents did say that things improved following the complaint it had not been recorded. It is important for all complaints, however minor, to be recorded and include actions taken and outcomes to both facilitate the quality monitoring process and to identify themes. Following the site visit the registered manager pointed out that there is a copy of the homes complaints procedure pinned up in the hall, however, it was not in a user friendly format. The senior carer confirmed that all staff have been trained in Safeguarding Adults and both her and the registered manager have received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. However, one resident left the home Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: unescorted and was found travelling on a bus and the AQAA indicated that another resident presents challenging behaviour. Discussion with the senior carer found that a Best Interests Assessment had not been requested, nor were there detailed information, for staff, on dealing with challenging behaviour in a manner which safeguards the resident. It was of concern to note that one resident was noted to have bruising on their forearm and staff assumed it was due to the resident knocking her arm when placing clothes in the underbed drawer. The action taken to deal with this was inappropriate in that staff did not deal with the matter in line with Safeguarding Adults guidance and the action taken was to change the bed base to one without drawers. There were no follow up records to show that this action had resulted in reduced bruising. The same resident had also locked themselves in their room on at least two occasions and again the action taken was inappropriate as the matter was dealt with by removing the lock on the bedroom door. Staff did not appear to understand that such practices impinge on the privacy and dignity of the individual. Following the site visit the registered manager stated that no further bruising has been identified since the bed has been changed. The lack of a fire evacuation plan for one resident, as required by the placing authority, puts the individual at risk in the event of fire, therefore a Safeguarding Adult alert was made by the Commission following the site visit. Care Homes for Adults (18-65 years) Page 22 of 38 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. Service users benefit from a comfortable and homely environment. However they have little choice in their surroundings and the lack of aids and adaptations indicate their changing needs are not recognised and met. Evidence: Seven bedrooms were inspected in addition to two communal bathrooms, two communal toilets and the lounge and dining areas. The kitchen and laundry were also seen. Generally, bedrooms were clean, tidy and nicely decorated, however there was no information in residents care plans to demonstrate they had been consulted on the decor in their own bedrooms. Only one bedroom was found to be malodorous and the occupant has been assessed by an incontinence nurse but the daily notes did not demonstrate that the incontinence advice was followed in practice which may account for the odour in that room. Screens were evident in shared rooms and call bells seen in all rooms, although one call bell had been fixed with masking tape and this needs to be addressed to ensure the use of tape does not affect its efficiency. It was good to note that one bedroom had been arranged to provide a small area, curtained off, to provide a secluded Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: seating area. There was no evidence to demonstrate service users are supported to maintain and clean their bedrooms and this needs to be addressed to ensure they are involved in homes routines. Communal bathrooms did have bath hoists but the best use of this equipment in line with residents care needs was not included in care plans or risk assessments. Therefore it was not possible to ascertain whether or not the equipment was suitable for the residents who used it. None of the communal bathrooms and toilets had soap in them so residents are at risk of cross infection. In addition one toilet did not have a hand wash basin and this needs to be addressed to reduce the risk of cross infection. This same toilet did not have a toilet roll holder which also needs to be rectified. Although all bedrooms had waste bins, none had a liner and good practice suggests that liners are used in all waste bins to avoid bins becoming tainted with bacteria. Water delivery temperatures were all below 40 degrees and this needs to be addressed to ensure residents can wash in comfort. The home was satisfactorily maintained and information in the AQAA showed that there is a programme of maintenance and renewal. Fire extinguishers were found in each of the communal bathrooms but neither had been fixed to the wall to prevent them being moved and this needs to be addressed to ensure they are easily accessible in the event of fire. Discussion with the registered manager found that the ground floor had been assessed by a suitably qualified person to ensure it meets the needs of one resident placed by the local authority. However, the rest of the premises has not been assessed and this needs to be addressed as the resident group are ageing and their mobility is impaired. Environmental risk assessments for individuals were not available nor were there similar assessments in respect of hazardous substances. When the registered manager was asked about records relating to water temperature testing she said she had delegated this task to the senior carer. When the records were viewed they showed that some water temperatures had last been tested in March 2009 and although most were below the recommended temperature of 43 degrees no information was available to show action was taken to increase the temperature. The kitchen was very clean and tidy but foodstuffs in the freezer had been opened and not resealed or marked with a date of opening. There was a bowl of butter icing in the fridge which was marked as being made on 12/10/09 and a note requesting that it is Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: not thrown away as I will cut off the hard bits. It is not good practice to store opened packets without a day of opening nor is it acceptable to store made up foods for an unspecified time. Advice needs to be sought from the Environmental Health Agency on storing foods. The laundry room was satisfactory with machines that wash at temperatures that reduce the risk of cross infection. Although two residents were noted need help with continence needs, gloves and aprons were not apparent in one residents room, nor were there gloves and aprons available in the communal bathrooms and toilets. During the site visit staff were observed to wear the same tabards for food preparation as they wore for cleaning duties. It is expected that equipment to protect both staff and residents from cross infection be freely available in rooms where they are to be used. One resident showed an inspector around the garden and two cigarette lighters were found on a chair which staff said belonged to a resident. In addition there was old furniture in the garden. It is crucial to ensure cigarette lighters are always safely stored and that old furniture is quickly removed as it both detracts from the environment and may also pose a health hazard. Care Homes for Adults (18-65 years) Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users in the home are at potential risk from unsatisfactory recruitment practices and their best interests are not served by the inadequate staffing levels. Evidence: On the day of the site visit there were two carers on duty and the registered manager. It was of concern to note that care staff were also doing the cleaning, laundry and making all meals and snacks. There were seven residents in the home on the day, with the other six at day centres. Throughout the site visit residents were left unsupervised for long periods and the resident assessed by the placing authority as needing a range of social activities and 1:1 time was left in the small lounge for long periods of time due to the low staffing levels. Discussion with the manager found that she regards one senior carer as the deputy manager but this is not reflected in the staff rota or job titles. The registered manager has delegated a number of tasks to this senior carer. Although she has been delegated with a number of management tasks there was no evidence that she has been allocated time for these additional tasks. As a result there were shortfalls in record keeping, water temperature logs, risk assessments, updating policies and procedures and time with residents was seriously impaired. Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: Discussion with the registered manager found that the cleaner had left two weeks earlier and she was awaiting a Criminal Records Bureau check for her replacement and the cook had left four years earlier and had never been replaced. When asked the manager said the employment of an agency cleaner had not been considered. Following the site visit the registered manager confirmed that a cleaner has now been employed. Information in the AQAA indicated that of the eight care staff four have already achieved National Vocational Qualifications in care at level 2 and a further 3 are in the process of gaining this qualification. Following the site visit the registered manager confirmed that 2 care staff have NVQ in care at level 3, 1 has NVQ 3 in management, 1 has NVQ 4 and 1 has NVQ 2 and the other 2 care staff are in the process of gaining NVQ in level 2 and 3 respectively. At night there is one waking carer and the registered manager said she is on-call, but one resident has been assessed, by the placing authority, as needing two carers for all transfers, therefore the needs of this resident cannot be met by one carer. Recruitment records were viewed for the last three people to be employed and none had provided a full employment history with a written explanation for any gaps. One person did not have a reference from their last employer and the registered manager said that she telephoned and was told they do not give references. However, there were no records of this in the individuals personnel file. There was no indication that new staff are provided with a handbook or a copy of the code of practices set out by the General Social Care Council. Although both the registered manager and senior carer said that staff are provided with an induction programme there was no evidence to support this. In addition the part of the AQAA which asks how many care staff have received induction that meets the Skills for Care guidance was left blank. The senior carer maintains a staff training matrix but pointed out that she has yet to have the time to ensure it is up to date and fully reflects all staff training. The AQAA showed that two staff have been trained in dementia care but other residents have specific conditions such as epilepsy and diabetes and there was no evidence that training in these conditions had been provided, therefore it is not clear if staff have the knowledge to meet residents needs. It was good to note that care staff do have an understanding of residents individual needs, but this system relies on good communication and memory and does not provide a firm foundation for the delivery of good quality and consistently good care. There was no evidence to demonstrate staff have been trained in care planning and risk assessments which may be why these documents had not been well maintained. Care Homes for Adults (18-65 years) Page 27 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are at potential risk as the home lacks a clear and effective management structure. With inadequate quality monitoring systems and unsatisfactory controls in respect of health and safety, the service is not operating in the best interests of the people who live there. Evidence: In the AQAA there was limited focus on equality and diversity issues or promoting human rights and limited understanding of person centred thinking within the service. There is no evidence that the management hierarchy respects residents as individuals. Individual choice and independence is restricted due to insufficient staff and clear management guidance on promoting this within the home. The home holds monies on behalf of residents and although record keeping for transactions were satisfactory there was no evidence to demonstrate that residents are supported to manage their own money and no clear reason why they do not do so. Nor was there evidence to show that individuals have access to their records whenever they wish. It was of concern to note that one resident buys their own cream Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: and yoghurts but none of the information in the statement of purpose or service users guide indicates that residents need to buy their own day to day foodstuffs. The AQAA suggests that the homes financial arrangements are unsatisfactory with lack of finance being given as the reason the service cannot move forward or provide more one to one support for residents. There was a record to show that the registered manager and senior carer have been trained in the Mental Capacity Act and the accompanying Deprivation of Liberty Safeguards, however there were no policies and procedures in this matter. This is of concern given that one person has left both the home and the day centre unescorted on occasions and there was no evidence to demonstrate action had been taken in line with this legislation. The registered manager said she leaves the updating of policies and procedures to the senior carer, however those viewed were either dated 2007 or were not dated at all therefore there was no evidence to show they are reviewed or kept up to date although information in the AQAA claims they were updated in 2009. The manager was able to provide a small number of surveys returned by visiting professionals and these indicated that the service was satisfactory. Information in the AQAA stated that surveys are sent to service users but discussion with the manager found that the home does not give surveys to residents as their views are sought on a day to day basis. The AQAA also stated that regular resident and staff meetings were carried out but the only copy of staff meeting minutes was dated 12/01/09 and only one record of a resident meeting. The lack of information in respect of quality monitoring indicates that quality assurance monitoring is not regarded or implemented as a core management tool. The AQAA was not completed well with some responses consisting of a single sentence and there is minimal evidence to support the claims made within it. This indicates is a lack of understanding of the purpose of the AQAA and its importance as a self assessment tool. A number of fire doors did not close fully and a connection box was broken. An Immediate Requirement was issued in respect of these shortfalls. Following the site visit the registered manager confirmed that these shortfalls had been addressed within 24 hours of the site visit. Discussion with the registered manager during the site visit found that a fire safety risk assessment has not been carried out therefore it is not clear whether or not the building meets the requirements in respect of fire safety. The care assessment for one resident, carried out by the placing authority, stated that a Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: fire evacuation plan needed to be created for the resident. When this was discussed with the registered manager she said she had not created such a plan but said we would carry her out - she is very light. Following the site visit the registered manager said this comment was said in jest. There were records indicating that the registered manager regularly checks the fire alarms but there were no records for the testing of emergency lighting but the manager said she does this with the fire alarms and confirmed that she does not record it. There was limited evidence of fire drills being carried out but the records consisted of a list of people who attended the drills and it should include more details in respect of ensuring fire safety training was followed. Care Homes for Adults (18-65 years) Page 30 of 38 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 38 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 1 5 That the statement of 21/12/2009 purpose and service users guide are accurate and up to date. To ensure prospective service users have accurate information on the services offered. 2 6 15 That person centred care plans are in place. They must be accurate, reflect current needs and be regularly reviewed in consultation with service users. To ensure current needs are identified and met. 21/01/2010 3 9 13 That risk assessments be up 21/12/2009 to date and cover all important aspects of service users daily lives. To ensure any activities do not put service users at risk. Care Homes for Adults (18-65 years) Page 32 of 38 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 4 11 15 The Registered Person must ensure that service users are supported to set, monitor and achieve both their long and short term goals and aspirations including chosing from a range of appropriate leisure activities. To identify goals and to support service users to develop skills to achieve maximum independence and fulfilment. 21/12/2009 5 17 16 The Registered Person must provide service users with adequate facilities and opportunities to be involved in the choice and preparation of their own food and have access to drinks and snacks at all times. To ensure service users independence and choice is promoted. 21/12/2009 6 19 12 Where service users have special dietary needs, comprehensive information is provided in respect of meeting such needs. To ensure service users dietary needs are met consistently. 21/12/2009 Care Homes for Adults (18-65 years) Page 33 of 38 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 7 19 13 Health Action plans need to be fully completed and information be accurate and up to date, reflecting changing needs and circumstances. To ensure all service users health care needs are identified and met. 21/12/2009 8 22 22 That all complaints are 21/12/2009 recorded and include actions taken and outcomes. To ensure service users feel listened to. 9 23 18 Staff need to be trained to 21/12/2009 deal with incidents in a sympathic manner that does not impinge on service users privacy. To ensure services users privacy and dignity is protected. 10 23 13 That clear records are maintained to ensure that Deprivation of Liberty Safeguards are in place as required. To ensure service users are not unlawfully deprived for their liberty. 21/12/2009 Care Homes for Adults (18-65 years) Page 34 of 38 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 11 23 13 The Registered Person must make arrangements, by training or other means to ensure service users are safeguarded at all times. To ensure service users are not at risk. 21/12/2009 12 24 23 All parts of the home needs 21/12/2009 to be maintained at a standard that is kept in good repair, clean and decorated. This must include providing hand wash basins in communal toilets and ensuring that the risk cross infection is reduced. To ensure the premises remain comfortable and to promote service users independence. 13 29 23 That a suitably qualified person makes an assessment of the premises and facilities. To ensure the home can meet the needs of all service users regardless of deteriorating mobility. 21/01/2010 14 32 18 That staff training is reviewed to ensure they have the skills to meet service users specialist needs, this must include 21/01/2010 Care Homes for Adults (18-65 years) Page 35 of 38 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 epilepsy, diabetes and dementia. To ensure the needs of all service users are met. 15 33 18 The Registered person must ensure that staffing levels are kept under review to ensure that there are sufficient numbers of competent and qualified staff to meet the needs of service users both during the day and at night. To ensure that service users are safely supported to lead their lives as identified in their individual plans. 16 34 19 That no person is employed to work in the home until all pre-employment checks have been undertaken by the home. To ensure that service users are protected. 17 35 18 That all new staff undertake a thorough induction to the home. Documentary evidence must be available. To ensure that all new staff are aware of good practice issues. 18 39 24 As part of the homes quality assurance system all future 21/12/2009 21/12/2009 21/12/2009 21/12/2009 Care Homes for Adults (18-65 years) Page 36 of 38 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 AQAAs need to be more detailed and the provider must seek the views of the residents on the quality of the care provided in the home. Comments received must be included in the homes service user guide. To ensure service users views are sought and acted upon. 19 42 13 That advice is sought from the local fire service in respect of fire safety and that a suitably qualified person undertakes a fire safety risk assessment of the premises. To ensure service users, staff and visistors are not at risk in the event of fire. 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 21/12/2009 Care Homes for Adults (18-65 years) Page 37 of 38 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. 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