Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Oakmount 68 -70 Westgate Burnley Lancashire BB11 1RY The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pat White
Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home
Name of care home: Address: Oakmount 68 -70 Westgate Burnley Lancashire BB11 1RY 01282458463 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : oakmount68west@msn.com Emmanuel Tendaiwo Dangare,Mrs Eunice Dangare care home 9 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 9 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 9 Date of last inspection Brief description of the care home Oakmount is a care home for 9 adults with a mental illness. The house is of the older type situated close to the town centre. Accommodation consists of kitchen, dining room, 2 lounges, a games/smoke room, utility room, a communal room, 5 single bedrooms and 2 double bedrooms. There was a staff room and office on the upper floor. There was a small yard and patio at the back of the building. The owner of the home is a registered mental health nurse. Mrs Susan Burnett is the registered manager of Oakmount. She has relevant experience and the Registered Managers Award. The fees charged per week depended on the nature of the support required and agreed Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home by social services, with additional charges for some transport and leisure activities. The home had a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. Care Homes for Adults (18-65 years) Page 5 of 32 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: This main key inspection that included a visit to the home was undertaken on the 29th April 2009. The purpose of this inspection was to determine an overall assessment on the quality of the services and care provided by the home, and to determine a quality rating. This included checking all the important areas of life in the home that should be checked against the National Minimum Standards for Adults, and checking the progress made on matters that needed improving from the previous inspection about a year ago and that had been the subject of an Improvement Plan. The inspection included looking round the premises, talking to some residents and staff, looking at residents care records and other documents and discussion with the manager Mrs Susan Burnett. Survey questionnaires from the commission were sent to Care Homes for Adults (18-65 years)
Page 6 of 32 the home for residents and staff to complete. At the time of writing this report 8 residents and 6 members of staff had returned completed questionnaires. Two residents were spoken with at the site visit and gave some views about the home. Some of the views of all the people spoken with, and who completed the questionnaires, are included in the report. In addition the home provided the commission with written information about the residents, staff and the services provided and some of this is also included in the report. What the care home does well: What has improved since the last inspection? Some of the things that we asked the home to improve at the last inspection had been done. The written information about the residents that staff needed to help them understand the residents, and the support they needed, had improved. All the information had been up dated and there was more useful details about mental health matters to help staff understand the residents and offer the right support. There was also more information about why some choices affecting residents health and welfare Care Homes for Adults (18-65 years) Page 8 of 32 were restricted. Some aspects of medication management had been made safer and there was a new method of recording the medication coming into the home so that medication could be traced and accounted for. This should help ensure that there is no mishandling of medicines. The administration of medicines to one of the residents had been made safer and she was more likely to receive the correct medicines. Some further work had been completed on the premises. The landing had been painted and a bathroom had been improved with tiles and painting and there were new lampshades throughout the home (see below). The home was cleaner than at the last inspection making it a more healthy place. What they could do better: The written information about the residents could be further improved. There could be more written information about interests and hobbies and how staff could encourage residents to take part in fulfilling activities, and also about residents skills in money management and what support they needed for this. The written information about the risks associated with some aspects of every day life could be further improved. Any risks to individual residents associated with the hot water supply were still not being properly assessed and it was still not clear whether or not some residents were at risk and whether or not they needed support to protect themselves from water that is too hot. Also there should be comprehensive risk assessments for the administration of medication which clearly show whether or not residents are able to manage some or all of their medication and what support they need. Some further aspects of medication management could be improved. The manager should carry out her own regular recorded checks of medication, and also carry out formal checks on the competence of support workers to administer medication. This will help to prevent mistakes being made and make sure that all medication is given safely. There should also be a review of the use of none prescribed medication in the home for staff and residents. The homes procedures for protecting people from abuse should be improved and updated so that there are written guidelines for all staff including the manager to follow in the event of an allegation or suspicion of abuse. All staff should undertake training in this matter to assit them to understand how to protect people. Some parts of the home were still in urgent need of repair, refurbishment and decoration. There were two areas in the home with ceiling damage, one lounge needed cleaning and decorating, a bathroom and kitchen were in need of refurbishment and a toilet needed repairing. The state of the premises have been of concern for some time, and whilst improvements have been undertaken, these are not progressing as fast as they should. The way staff were recruited to work in the home should be improved. All the Care Homes for Adults (18-65 years) Page 9 of 32 necessary checks should be obtained before staff start work in the home such as the criminal records bureau check and 2 written references. Without these unsuitable staff may be allowed to work in the home. Also the induction training that new members of staff undertake should be written down to show that staff have received the right training, and gained the skills, to work confidently with people in the home. There should be records available in the home to show that all aspects of the home are maintained safely such as the electrical wiring system and the gas and central heating system. Also the staff should have fire training that would help them in the event of a fire. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 32 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 32 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedures helped people to decide whether or not the home was a suitable place for them to live. The needs of people living in the home were reviewed. Evidence: There had been no new admissions to the home since the previous key (main) inspection. This admission had followed thorough procedures including an assessment of need and introductory visits to the home to help decide whether or not the home was the right place for the person, and whether or not their needs could be met. Since the previous inspection, and following a legal requirement, the management had re assessed the needs of all the existing residents and improved on the level of information written, and especially about mental health matters. This should assist staff understand these needs and develop more up to date and accurate care plans. In the questionnaires the people living in the home indicated that their needs were met. Also in the last few years people who were asssessed as being ready, had been
Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: encouraged and supported to move into more independent living arrangements. Whilst residents contracts were not properly assessed it was noted that not all were signed and dated, did not include the fees charged and what the fees included. Care Homes for Adults (18-65 years) Page 13 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans included sufficient details about most areas of support that people needed. Residents were supported in making decisions about their lives. People were supported to take risks associated with independence but these were not always underpinned by a useful risk assessment. Evidence: All residents had care plans that detailed what staff needed to do to support people. Since the previous inspection the care plans had been improved and now included more useful information that told staff what support people needed, and there was more information about mental health matters. There was evidence that these care plans were being reviewed and updated with the residents. There was a key worker sytem that assisted the process of writing and reviewing the care plans. However although the assessment indicated what peoples interests were, there was not a care plan to indicate how these could be used to encourage fulfilling occupations or activities. Neither was there a care plan to guide staff in what support people needed
Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: in managing their personal finances. The risk associated with some activities and some aspects of daily living and behaviour were assessed. There were risk assessments specific to the individual residents. Some were completed satisfactorily and provided useful information for staff, others as last year did not have a management of risk plan, to guide staff. This included the risk assessment underpinning the protection of people from water that is too hot. As at the last inspection these risk assessments were not sufficiently personalised and did not indicate whether or not a personal risk management plan for indiviuals was necessary (see later sections). Residents were assisted to make choices regarding their routines and activities. There were risk assessments that indicated why there were restrictions for some people in such matters as alcohol consumption and smoking, and these indicated why some decisions had been made. There were residents meetings and residents had one to one meetings with their key worker to give residents the opportunity to discuss choices and preferences. There was evidence that residents had made choices about where to go on holiday, and about the meals served. In the completed questionnaires residents indicated that they had sufficient choices in what they were able to do each day. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were encouraged to take part in a range of suitable and fulfilling activities and encouraged to maintain links with their families and the community. The homes terms and conditions promoted independence. The meals served were in accordance with residents preferences and principles of healthy eating. Evidence: Residents were encouraged to take part in fulfilling activities that included visiting social centres and attending supervised work programmes. Those who were younger and interested in moving to more independent accommodation were encouraged and supported to do so. Residents had a plan of weekly activities that showed they were encouraged to excercise, shop and help in the running of the home. All were given the opportunity of going on trips together or with their key worker. A five day holiday was included in the fees and since the last inspection this has been organised differently at
Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: the residents request. Instead of one group holiday there are different options for people. People were supported to maintain existing relationships and to form new ones. They were encouraged to have contact with families and friends, and several residents had regular contact with their families and partners. There was an emphasis on maintaining peoples choices and independence, and as stated above if people were motivated to move into more independent living arrangements the staff at Oakmount worked with the multidisciplinary team to achieve this. Residents were encouraged to take part in activities but could choose not to if they wished. The food served was healthy and suited the service users preferences. Residents helped to plan the menus and there was an emphasis on healthy eating as a way of enhancing peoples physical and emotional well - being. Breakfast and lunch meals were flexible around the service users routines and they were responsible for their own meals at these times. On the day of the site visit we saw people eating meals of their choice. Residents ate the main meal together in the evenings, and usually, in turn, helped staff to prepare and cook it. Care Homes for Adults (18-65 years) Page 17 of 32 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. Appropriate personal support is provided to residents and in such a way as to promote independence. Residents physical and mental health care needs were monitored and addressed and medication practices were satisfactory. Evidence: Residents were provided with the level of support and prompting in personal care and hygiene that they required. They were expected to take some responsibilty for keeping their rooms clean, and for their personal laundry, in order to promote independence and maintain life skills. Continuity of support was assisted through the key worker system. Looking at records and talking to the manager and the residents showed that the residents physical and mental health needs were promoted and that they had the health care they needed. One resident whose records were viewed was was having on going medical attention for a physical illness, and most of the residents had ongoing contact with the mental health services. However ongoing records of residents weights had not been kept, and for at least one resident with low weight this could mean that
Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: further weight loss was not identified. The homes medication practices and procedures were checked and in particular those relating to the previous requirements and recommendations made at the last inspection. Some improvements had been made and the previous requirements had been met. Records of medication received into the home were now being made accurately and the previous practice of taking medication from the containers prior to administration for one resident had ceased. However with respect to the recommendations, there was no evidence that the manager was undertaking regular audits of the medication or formally assessing support workers competence in medication administration. One resident was administering their own medication and this was underpinned by a risk assessment that gave guidance to staff on how to support them and monitor. However for another resident who took pain relief medication there was no written information or guidance as to whether or not he managed this himself. Also for another resident there was insufficient written guidance for staff about when to give some when required medication. This could mean that they did not get the medication at the right time or for the right circumstances. Records and medication of 3 residents were checked and we found the following matters that needed attention. For one resident on one occasion a tablet had been signed as given but had not been given and on another occasion a tablet had been given but not signed for. Not giving medication as prescribed can adversely affect peoples health. In addition there was concern about the use of none prescribed medication in the home for residents and staff and there was a need to review the current practice to ensure that there is no misuse of medication. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had channels to air any concerns and compaliants and knew what to do if they were not happy with anything. The procedures for safeguarding people from abuse available in the home were not adequate in guiding staff how to protect people Evidence: We were informed that no complaints had been made to the home and none had been made directly to the commission. Residents in the questionnaires said they knew what to do if they were not happy about anything and knew how to make a complaint. The records kept and the information provided by the home prior to the site visit showed that no complaints had been but that some minor concerns had been dealt with by the manager. The frequent discussions with the key workers gave residents a chance to air any concerns, as did the residents meetings. There had been no recent reported allegations or suspicions of abuse. However the procedures available in the home at the time of the site visit did not give step by step instructions on what action should be taken. We were informed that these procedures had been reviewed and updated, and a copy would be sent to the commission. This had not been received at the time of writing this report. We were told that some staff, but not all, had undertaken training in Safeguarding adults to help them understand how to protect people. Care Homes for Adults (18-65 years) Page 20 of 32 Care Homes for Adults (18-65 years) Page 21 of 32 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. Oakmount provides a homely environment for the residents and their bedrooms meet their needs and promote independence. Not all areas of the home are maintained and furnished to a satisfactory standard Evidence: After the previous inspection a further action plan for the improvement of some longstanding premises problems had been submitted to the commission. At this site visit we found that some jobs had been undertaken and some areas of the home had been improved. One of the bathrooms had been tiled and painted, the landing had been painted, new lampshades had been fitted in most rooms and areas, one bedroom had a new sink and the radiators had been fitted with new valves. Since the previous inspection a new cleaning regime had been implemented and the home was cleaner in most areas than at the previous inspection and especially the bathrooms. However some jobs had not yet been carried out. The smoke room still had not been refurbished and still had ceiling damage, another area of the home also had unsightly ceiling damage and was badly in need of decorating, some bedding and beds needed replacing, one of the lounges still needed cleaning and decorating, some carpets needed replacing and the kitchen and another bathroom were still in urgent need of refurbishment. In addition one of the toilets was in need of repair and was out of use.
Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: There was a small yard at the back of the house which could be developed to make a more pleasant area for people. Another action plan was requested from the owner. The bedrooms were personalised and regarded as residents private space. Though privacy was compromised in 2 shared rooms this arrangement seemed to meet the needs of the current occupants. As stated above the residents were encouraged to assist in keeping their rooms at an acceptable standard of cleanliness and this was seen as a way of promoting independence. As indicated above there was sufficient communal space and residents made use of the different parts of the home including two lounges with TVs, a small lounge, which is also for staff use, and a smoke/games room. The hot water was still very hot at certain times of the day, and inspite of previous requirements the risk assessments undertaken to help ensure that people were not at risk from this had not been sufficiently developed in accordance with individual personal circumstances. Neither were they clear about whether or not there were any risk factors that needed action. Therefore there was not clear guidance to staff as to whether or not any action was needed (see conduct and management of the home). Care Homes for Adults (18-65 years) Page 23 of 32 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. Most of the staff team had the right qualifications and the right experience to meet the needs of the residents. Staff recruitment procedures were not thorough enough to help protect residents from unsuitable staff. Evidence: We were told that all staff apart from one had either achieved the relevant qualifications for people working in care, or were working towards this (see below). Some people had been on the staff team for some time and were keen to progress and develop and gain further qualifications. They were supported by the homes management to do this. There appeared to be sufficient staff on duty at the time of the inspection to meet the needs of the residents and we were told that this was typical of the staffing levels in the home. There were regular staff meetings, which were often used as in house training sessions. This helped communication between management and support workers and helped staff gain the necessary skills. Staff spoken with and those who completed questionnaires spoke positively about working in the home and the support and training given. Those spoken with indicated
Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: that the National Vocational Qualification courses undertaken included medication, food hygiene and first aid (see below). The records of two recently appointed members of staff were viewed and showed that for one person the procedures followed for staff recruitment were not in accordance with the Care Homes Regulations. This person had commenced work prior to the criminal records bureau and protection of vulnerable adult checks being obtained. There were no references available for viewing for this person and the employment history indicated a gap in employment that hadnt been explained. There was also no record of the Induction training that this person had completed when she started work. Therefore it was not clear whether she had the right skills, and was competent in the range of duties support workers were expected to undertake. For the other person whose records were viewed one of the references obtained was from a friend and neighbour, and not a previous employer, and there was no record of the Induction completed. These recruitment procedures may not help to ensure that only suitable people were employed in the home. Though some certifcates of training were seen on some of the staff files looked at, there were no up todate records of staff training in the home. We were told that these were being updated. Though staff told us in the questionnaires and in discussion that they had relevant training, because there were no up to date records available, it was not clear what training, additional to that mentioned above, staff had undertaken and whether or not the progress made at previous inspections had been maintained. Records of staff supervision were seen on staff files, and those staff who completed questionnaires and those who spoke to us, said that they felt well supported in their work by the manager and the owner. Care Homes for Adults (18-65 years) Page 25 of 32 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. Experienced and qualified people managed the home but some ongoing matters relating to the premises were not being managed and addressed quickly enough. Evidence: The registered manager was experienced and qualified. She had managed the home since 2002 and had completed the the right qualification for people managing a care home. She also had other relevant qualifications. The senior support worker was also undertaking the relevant management qualifications. The owner was a registered nurse, mental health and visited the home regularly and supported the manager and staff. However there were concerns that some of the ongoing issues in the home particularly concerning the premises, were not being addressed quickly enough, and that staff recruitment again was not as thorough as it should be. The home had developed internal quality monitoring systems appropriate to the home, and that involved seeking the views of the residents and some visiting professionals. Residents gave their views in residents meetings and one to one discussions with their
Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: key workers, and the views of social workers were recorded at reviews etc. A report was compiled last year and showed some areas for developement including the holiday arrangements referred to above. In general the home was a safe place for residents and staff, and staff had undertaken some health and safety related training, such as in first aid and food hygiene. However there was insufficient information available at the site visit, or provided to the commission, to indicate whether some of the homes installations and appliances had been satisfactorily tested. There was no certificate of electrical wiring testing available for viewing or gas safety inspection records to indicate that the central heating system had been inspected, though we were told that some work had been undertaken on the gas boiler and the radiators. The fire equipment had been tested appropriately and staff confirmed that the fire alarm was tested regularly. However staff had not recently undertaken external fire training to assist them take appropriate action in the event of a fire. Also in previous sections it has been explained that the action taken by the home to date does not demonstate that residents are not at risk from water that is too hot. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 (4)(a)(c) The risk assessments should 13/06/2008 be completed properly with an assessment of risk and clear strategies for reducing or eliminating the risk, including the risk of falling and the risk associated with water that is too hot. 2 24 23 (2)(b)&(d) All parts of the home must 30/11/2008 be well decorated and maintained and bright, including the areas identified at the inspection, and must inform the CSCI of the progress made Care Homes for Adults (18-65 years) Page 28 of 32 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 All medication should be given as prescribed unless there is an explanation for why this cannot be given and MARs should not be signed as given if not given To maintain the health of the resident. Accurate records should always be kept so that checks can show whether or not medication is being given correctly. 05/06/2009 2 34 19 The staff recruitment 05/06/2009 procedures must be in accordance with the Care Homes Regulations. Staff must not commence work in the home until all the checks have been obtained including the criminal records bureau and protection of vulnerable adults checks and two satisfactory written references from employers or genuine character Care Homes for Adults (18-65 years) Page 29 of 32 referees. Also suitable records of the Induction training must be completed To help protect residents from unsuitable staff and to show that staff have the necessary skills and knowledge to begin work. 3 42 13 All appliances and installations must be appropriately tested and the risk assessment for water that is too hot must help to protect residents. To ensure the health and safety of residents and staff. 30/06/2009 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 5 The contract should be signed and dated by both the resident and the owner and should include all matters listed in the national minimum standard including the fees charged and what the fees cover. The care plans should include sufficient information on all matters related to social care, including leisure activities and other fulfilling occupations. All the risk assessments should be completed properly, be individualised and personal and clearly indicate whether or not there is a risk associated with water that is too hot and what needs to be done to protect individual people. Residents weights should be regularly monitored and recorded and in particular those who are low in weight and at risk from further weight loss. There should be a review of the practice of the use of homeley remedies in the home by residents and staff to reflect good practice. Formal audits of medication and assessments of support
Page 30 of 32 2 6 3 9 4 19 5 20 6 20 Care Homes for Adults (18-65 years) worker competence should be undertaken. 7 20 There should be risk assessments underpinning the administration of medication that clearly demonstrates whether or not people are capable of managing some or all of their medication including homely remedies for pain relief and what support/action is needed from staff. There should be sufficient written guidance to staff on when, and under circumstances, when required medication needs to be administered. The step by step procedures for the protection of people from abuse should be available for staff and reviewed with them on a regular basis. All staff should undertake training on Safeguarding adults from abuse. Suitable up dated records of staff training should be kept. The management should ensure that all the ongoing matters in the home including the premises issues and staff recruitment are addressed. Staff should undertake external fire training. 8 20 9 23 10 11 12 23 35 37 13 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
