Inspection on 02/10/08 for Onkar Care Home

This inspection was carried out on 2nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Onkar Care Home 03/12/08

Onkar Care Home 08/10/08

Onkar Care Home 24/04/07

Onkar Care Home 27/04/06

Onkar Care Home 14/11/05

Onkar Care Home 28/04/05

Onkar Care Home 10/12/04

Onkar Care Home 17/06/04

Similar services:

Hillside

Applegarth

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Jubilee Villa Care Home

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Beech Lodge

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Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Onkar Care Home Name: Address: 15 Portman Street Leicester Leicestershire LE4 6NZ Zero star poor service The quality rating for this care home is: 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: Ruth Wood Date: 0 2 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Onkar Care Home 15 Portman Street Leicester Leicestershire LE4 6NZ 01162516443 01162246952 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harjap Singh Riyat Name of registered manager (if applicable) Mr Jaspal Singh Riyat Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 10 3 0 0 0 care home 10 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: Service user numbers: No one falling within category LD may be admitted into Onkar Care Home where there are 10 persons of category LD already accommodated within this home. Service user numbers: No one falling within category PD may be admitted into Onkar Care Home where there are 3 persons of category PD already accommodated within this home. Service user category: No person falling within category PD may be admitted to Onkar care home unless that person also falls within category LD - ie dual disability. To specify suitable facilities: The service users admitted to Onkar Care Home who fall within category PD may only be accommodated on the ground floor. Service user numbers: No one falling within category MD may be admitted into Onkar Care Home where there are 10 persons of category MD already accommodated within this home. Service user category: No person falling within category MD may be admitted to Onkar care home unless that person also falls within category LD - ie dual disability. No person to be admitted to Onkar Care Home in categories LD, PD or MD when 10 persons in total of these categories/combined categories are already accommodated in this home. A bit about the care home Onkar Care Home is registered to provide care for 10 adults with learning disabilities, all of who may have additional mental health problems and three of who may have a physical disability. The home is located in a residential area with easy access to public transport and the city of Leicester. The property consists of two floors and has ten single bedrooms all with en-suite facilities. There are some aids and adaptations in the home, based on residents assessed care needs. At the time of the inspection, fees ranged from approximately £329 to £751 per week. 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: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Zero star poor service How we did our inspection: This is what the inspector did when they were at the care home The last key inspection of this service took place on 24/04/07. This key inspection took place on 02/10/08 between 13:20 and 18:00. The date of the key inspection was brought forward as the Commission had received two complaints about certain aspects of the service provided at Onkar Care Home. We looked at three peoples individual plans and spoke to the acting manager about how she and the staff support people. We examined how peoples social, health and medication needs are met. We looked at staff training and recruitment records and examined the rota to see how many staff worked at the home at various times of the day. We looked at how medication was managed and how people were helped to manage their money. We looked at all the communal areas of the home and the majority of bedrooms. We spoke to all the people who live in the home and some of the staff members, about what it is like to live and work there. We could not look at the Annual Quality Assurance Assessment, as the registered person had not completed this. This is a document sent to each care home to complete which tells us how the provider of the service ensures and improves the ongoing quality of service. This document should have been returned to us on the 27/10/08 but it has not been returned to the Commission. What the care home does well Most of the people living in the home seem happy and relaxed and appear to enjoy a very positive relationship with the acting manager. Peoples cultural and religious needs are well met, with the majority of staff being able to speak both Gujarati and English, depending on the individual needs of the person. One person is supported to attend a local temple regularly and receives culturally appropriate food. A variety of festivals are celebrated and peoples family and friends are invited to take part in these celebrations. Good systems are in place to ensure that peoples medication is administered safely and that people are supported to manage their finances. All staff have received training in moving and handling and in food hygiene. What has got better from the last inspection What the care home could do better The registered manager has not been actively involved in the home for approximately nine months and an acting manager started work at the home in March. The person who owns the home (the registered provider) did not tell us about this change and must send us a letter about this. They must also send back the AQAA to the Commission. Staffing levels in the home must be improved so that people can have all their needs met and are looked after safely. More staff need to be employed so that those already working there can have time off. This should also give the acting manager more time to manage the home. The information about the home, given out by the registered person, must be accurate and be able to be easily understood by the people living there and by people who may want to come and live there. People also need to be given clear information about how to make a complaint. A record must also be made of any complaints made and how the person who runs the home has put things right. Peoples individual needs assessments and support plans must be kept up to date and contain enough information so that staff know how they like their needs to be met. If people are prescribed as required medication their support plan must say under what circumstances this can be administered and record the name of the person who prescribed it. A record should be kept of when creams and lotions used on peoples skin are opened so that out of date creams are not used. A record of what people eat in the home must be kept and everyone should be able to eat food that is suitable for their needs. Two written references must be obtained for all staff before they come to work in the home and the date staff start work must be clearly recorded. Staff need to receive training in keeping people living in the home safe and how to deal with any behaviour they may find challenging. They also need training in how to work with people with learning disabilities and with people with mental health conditions. Staff must also receive a structured induction and training in fire prevention. Repairs are needed to some areas of the building and the registered person must make sure that all radiators in the home are working efficiently so that all areas of the home are warm and comfortable to live in. The toilets and sinks in peoples bathrooms must be kept clean so they are pleasant for people to use. Staff should also receive training in infection control. The registered person must make sure that the records of when fire alarms are tested and a fire risk assessment are kept in the home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ruth Wood CSCI Cambridge Capital Business Park Fulbourn Cambridge CB21 5XE 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information in the statement of purpose and service user guide is inaccurate and therefore does not assist people to make an informed decision about whether the service can meet their needs. Peoples needs are not regularly reviewed to make sure that the care they receive continues to be appropriate. Evidence: The registered provider gave us a copy of the service user guide and statement of purpose. These contain many factual errors and do not accurately represent many aspects of the service provided at Onkar Care Home. The statement of purpose appears to be an incomplete proforma for a home for older people. The statement of purpose does not give accurate information about the physical dimensions of the home, the staffing levels, the qualifications and experience of staff, the categories of people for which the home is registered or the name and contact details of the registered persons. It does not give sufficient information to people about how to make a complaint. Neither document would be useful to people wishing to obtain accurate information about the home. The care file of the most recently admitted person contained an assessment from the placing authority but there was no assessment or care plan in place written by the acting manager or the staff. There was no evidence that peoples needs are reviewed by staff to ensure that the care they receive is still appropriate to their needs. 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. Peoples assessed and changing needs are not reflected in their individual plans and not all staff are aware of peoples needs. This can lead to inconsistency in the support that people receive. Evidence: We looked at four peoples files, this included the file of a person who had just come to live at the home. There is no evidence that support plans have been reviewed during the past year and there is no up-to-date support plan in place, compiled by the home. Staff are relying on the care plan produced by individuals placing authorities. These do not give sufficient detail as to how peoples needs should be met. For example it was unclear from the plan how a person with a physical disability should be transferred. The acting manager and staff were unaware of some peoples needs such as their mental health diagnosis and the implications of this and physical health conditions which impacted upon a persons dietary needs. There are no risk assessments in place relating to peoples specific needs and activities such as going out independently. People are given support to manage their own finances and were seen to make some choices in the home regarding food. Choices available to activities and support are limited for some people because of insufficient staffing levels. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples cultural and religious needs are generally well met but poor staffing levels limit the lifestyle of some people who require higher levels of support. Some people living in the home do not receive a diet appropriate to their needs. Evidence: Two people in the home have specific dietary needs. One person who requires a soft diet receives this. One person requires a diet suitable for a person with diabetes but there is no evidence that they are receiving this and not all staff members responsible for preparing food are aware that the person has diabetes. A requirement was made at the previous inspection that a record be kept of all food served in the home. This allows for the nutritional quality and variety of food to be monitored. This requirement has not been met. People have free access to the kitchen and were observed making hot drinks, with support as required. One person living at the home said that she had made a shepherds pie for everyone the day before, this was confirmed by the acting manager. The manager said that some people like to help with the preparation of main meals and also with the shopping for the home. Some people also do their own laundry with support from staff members. Two people attend formal day care four days a week at social services day centres. As part of this one person undertakes voluntary work. One person also likes going to the library. One person said that they would like to go back to college to study cookery. Evidence: The acting manager is looking into this. One person has an additional support worker outside of the home who works with them during the day, ensuring that they have access to activities such as bowling, pub lunches and shopping. Some people who live in the home like to speak in Gujarati and most staff who work at the home are able to converse with them in both Gujarati and English. Provision is made to ensure that one person attends a local temple regularly to ensure that they observe the requirements of their faith. The lounge area was decorated with pictures associated with Halloween and with pictures to celebrate Diwali. The acting manager said that all festivals were celebrated in the home and showed us pictures of recent social events. The people who live in the home invite their friends and families to these events and relatives and friends are encouraged to visit the home at any reasonable time and to play an active role in peoples lives. Some people go to visit members of their family regularly and the home is able to provide transport for them to do this. One person was observed watching Indian music and dancing on the television, which they clearly enjoyed - another person in the room at the same time said that they did not enjoy this music. Some of the walls in the home are decorated with pictures made by people living in the home. There are also framed jigsaw puzzles which one person has completed. Peoples support plans and daily records did not record activities taking place in the home. The staffing levels in place at the time of the key inspection, limit the levels of activity those needing staff support can engage in. This impacts particularly on the level of activity of one person whose placing authority pays for one-to-one support so that they can access outside activities. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to appropriate health professionals and medication is generally well managed. Evidence: People receive a range of support in managing their personal care; some people manage this independently while one person requires total support. The level of support each person requires is not detailed in their support plans. The person who receives full support with care requires two people to safely transfer them. At the time of the inspection there was only one person on duty between 8pm and 7am, which would severely restrict the opportunities for this person to receive appropriate personal care. There is no information on this persons support plan relating to pressure area care although during the inspection the person was transferred from their wheelchair to the sofa to vary their position. An appropriate risk assessment should be completed in relation to this need and any preventative measures to be taken should be detailed in the persons support plan. One persons room smelt of urine. The acting manager said that they had a continence problem. A referral to a continence specialist may be required if this does not resolve. Letters and entries in daily records demonstrate that people have access to doctors, dentists, opticians and other health professionals. A person who has recently come to live at the home had been registered with a local GP, had an appointment for a medication review and an appointment to see the dentist. All staff administering medication have received training and certificates were in place to evidence this. The acting manager showed a good understanding of the medication being taken by the people living in the home. Medication records were completed with no gaps and medication received into the home and returned to the pharmacist was clearly recorded. Evidence: One person who had been experience difficulty sleeping has been prescribed a sedative for occasional use. The acting manager was supporting this person to manage their condition using other methods, such as relaxation tapes; this meant the medication had rarely been required. It is recommended that peoples support plans should contain information about any as required medication they are prescribed including under what circumstances it should be administered and the details of the prescribing physician. Two people are prescribed creams for their skin to us on a regular basis. Opened pots of the creams were found in their rooms, one dated 18/02/05. No record had been made as to when the cream had been opened or when it had been applied. Amendments to Regulations relating to the Misuse of Drugs mean that the home must have separate storage for controlled medication. This should be a metal cupboard of specified gauge with a specified double locking mechanism. It should be fixed to a solid wall or a wall that has a steel plate mounted behind it with Rawl or Rag bolts. No controlled medication is currently stored or administered in the home. 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 absence of a clear and effective complaints procedure means that people living in the home are unaware of how to deal with any concerns they may have. Staffs knowledge of current practice in safeguarding vulnerable adults is insufficient to ensure that people are protected. Evidence: Neither the service users guide or the statement of purpose contains clear information about how people who live at the home can make a complaint. There is no additional guidance anywhere else in the home informing people of how to make a complaint. No record of complaints was available for inspection. People living at the home appear to have an open relationship with the acting manager and one said that they would tell her if they were unhappy with anything in the home. The Commission for Social Care Inspection (CSCI) has received three complaints concerning the home since the previous key inspection. A random visit was made to the home in November 2007 to look at concerns raised. Two complaints were received immediately prior to this key inspection. The acting manager attending training on safeguarding vulnerable adults given by the City Council at the beginning of this year. There is no documentary evidence to indicate that staff members have received training in safeguarding vulnerable adults or in dealing with people whose behaviour may challenge. One staff member did display some knowledge of whistle blowing and their responsibility to report any incidents of abuse to the appropriate authorities. Recruitment procedures in the home are insufficiently robust to ensure that only suitable people work at the home. One person has been employed without written references and the acting manager supplied references for two other staff members. The acting manager started work before her two written references had been received. Good systems are in place to support people to manage their finances. Records are kept of all transactions, together with receipts and the balance of monies held is Evidence: checked regularly. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor hygiene standards and outstanding repairs to the building mean that Onkar Care home is not a clean and comfortable place to live. Evidence: The majority of bedrooms and all communal areas were seen. Bedrooms are personalised and one person had chosen the colour of their bedroom walls. Some bedrooms were cold and the radiators in these rooms should be checked to ensure that they are working efficiently. The toilet bowls and basins in the en-suite areas were dirty and stained, suggesting that they had not been regularly cleaned. One room smelled of urine and the acting manager said that the person had a continence problem and that they intended to change the carpet in this room. There was dried faeces on the floor surrounding one toilet. In two bedrooms call bells had been removed and bare wires had been left hanging from walls. The plaster in the corridor nearest to the laundry is peeling and requires repair and redecoration. There is a large crack in the entrance area, again this requires repair and redecoration. Communal areas of the home, including the kitchen and bathrooms were all clean and fresh smelling and most communal areas of the home were warm and comfortable. However bathrooms and toilets on the ground floor felt cold and again radiators should be checked to ensure that they are working efficiently. A toilet seat is missing from a downstairs bathroom, this should be replaced. There is no written information about how to manage the hygiene needs surrounding a person with MRSA but the acting manager was able to supply this information verbally. Not all staff have received training in infection control and the poor quality of hygiene in en-suite bathrooms suggests this is an area that needs considerable improvement. Evidence: 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. Staffing levels and staff training are insufficient to ensure that the needs of the people living in the home are met. Evidence: Recruitment practices at the home require considerable improvement. A requirement was made at the previous inspection that two written references be obtained for all staff members before they commence work in the home. No written references have been obtained for one staff member working at the home. The acting manager said she believed this to be unnecessary as the person was her daughter. One of the written references for two other staff members had been written by the acting manager. This is not acceptable and an alternative reference must be sought. The acting managers current application form was not fully completed. Start dates were not recorded for the acting manager and another member of staff. All staffs names had been checked against the vulnerable adults register and an enhanced Criminal Records Bureau check had been obtained or applied for. No staff member currently working at the home has received a formal induction, this includes the assistant manager. Staff have also not received training in meeting the needs of the people currently living at the home, that is people with a learning disability and a mental disorder. The acting manager has attended training in mental health and the Mental Capacity Act. Staff have received training in moving and handling and other aspects of health and safety. At the time of the inspection, with the exception of the acting manager, staff did not posses National Vocational Qualifications in the care or support of people, neither had they started these qualifications. At the time of the inspection staffing levels were insufficient to meet the needs of the people living in the home. The rota from 08/09/08 to 05/10/08 was examined; this showed only five people working in the home to cover all shifts, including a waking night duty. This number included the acting manager and the registered provider. The waking night staff member had worked every night of this period without a scheduled Evidence: night off. This staff member was present until 15:00 hours in the home on the day of the inspection. The acting manager confirmed that she sometimes stayed in a spare room in the home as it was difficult for her to get home. No other night staff member is employed by the home. The rota showed that the acting manager had also worked every day of the period; this was disputed by the registered provider. The rota showed that between 8pm and 7am there was only one person on duty in the home. At weekends the time when one person worked alone in the home was longer. One person at the home requires two people to safely transfer them and also should receive one to one support to enable them to access activities throughout the day. The current level of staffing does not allow for this. Neither does it allow for them to be safely taken to the toilet or evacuated from the building between the hours of 8pm and 7am. There is no fire risk assessment in place which states how this is to be managed. A letter of urgent concern was sent with regards to the staffing levels in the home with requirements to be met by the 08th October 2008. These requirements are repeated as part of this report with later timescales, as the requirement is ongoing and the providers response to these will be actively monitored. 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. The current management arrangements in the home do not ensure that the service is consistently run in the best interests of the people who live there or that their health and safety is consistently ensured. Evidence: The registered manager has not been actively involved in the home for approximately eight months but the Commission has not been formally notified of this. The current acting manager took up her position in March 2008. She holds a National Vocational Qualification in Care at level 4 and has experience of working in older persons homes at a supervisory level. She has no previous experience of working with people with learning disabilities. The staffing levels in the home have resulted in the acting manager frequently having to undertake a large proportion of direct care and support work. This has left her with insufficient time to address some of the management issues in the home. She has prioritised certain areas, such as medication and the management of peoples finances and has worked hard to establish good systems in these areas. There is no evidence (such as supervision or appraisal records) that the acting manager has received ongoing, structured support from the registered provider in undertaking her role, neither has she received a formal induction. The Annual Quality Assurance Assessment issued by the Commission to each residential care home informs us how each service maintains and improves the quality of care provided and also gives us factual information about the people who live and work in the home. Onkar Care Homes assessment should have been returned by 23/07/08; it has still not been received. It must be returned by 31/10/08 or enforcement action may be taken. Evidence: There is no system in place to allow people in the home to give their opinion on the quality of care they receive and inform the development and running of the service. Other people involved in the home, such as relatives and commissioners of the service, are also not asked for their opinions on the service provided. Record keeping in the home requires improvement. The individual plans of people who live in the home are insufficiently detailed and not updated regularly, some staff recruitment information is incomplete and there was no record of fire practices and maintenance available at the home on the day of the inspection, neither was a fire risk assessment in place. The assessment relating to the control of substances hazardous to health (COSH) was also not available. The laundry where cleaning materials are stored was unlocked and there were potentially poisonous substances found in two peoples unlocked bedrooms. No risk assessments as to the safety of these substances was in place. This matter was brought to the attention of the acting manager and has now been addressed. An Oxford Mini hoist used by one person living in the home had not been serviced since it was obtained in June 2007. This was brought to the attention of the acting manager and the hoist has now been serviced. Staff have received training in moving and handling and in food hygiene but not all staff have received training in fire safety. Are there any outstanding requirements from the last inspection? Yes x 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 1 Standard 17 Regulation 17(2) Requirement Timescale for action A record must be kept of the 24/10/2007 food provided for the people who live at the home in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. 2 24 23 People who live at the home must have access to appropriately maintained grounds. 24/10/2007 3 24 23 The homes premises must be 30/01/2008 well-maintained and meet residents needs in a comfortable and homely way, therefore the threadbare stair carpet must be replaced or repaired. 4 28 23 People who live in the home must have access to appropriately maintained grounds. 30/11/2007 5 34 19 People who live at the home 24/10/2007 must be protected by thorough recruitment practices - two written references must be obtained before employing staff to work in the home. 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 Description 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 1 Standard 1 Regulation 4 Description The statement of purpose must accurately reflect the facilities and services provided at Onkar Care Home. Timescale for action 31/12/2008 To enable people considering living at the home to make an informed decision about whether the service can meet their needs. 2 2 14 The registered person shall ensure that the assessment of a persons needs is kept under review and revised when it is necessary to do so. 30/12/2008 To ensure that peoples changing needs continue to be met. 3 6 15 The registered person must ensure that the persons support plan is kept under regular review 30/11/2008 To ensure that it continues to address the persons changing needs. 4 6 15 The registered person must 30/11/2008 ensure that each person living at the home has an up to date support plan which details their needs and how they should be met. To ensure that peoples needs are met consistently 5 9 13 The Registered Person must 30/11/2009 ensure that where risks to health, safety and welfare of service users are identified, this is managed safely and identified within a risk assessment. This is to ensure that people are appropriately supported to take risks as part of an independent lifestyle. 6 17 17 The registered person must ensure that a record is kept of all food provided for the people living in the home. Previous timescale of 24/10/07 not met. 15/11/2008 This is to allow for the monitoring of the nutritionally quality and suitability of each persons diet. 7 17 16 The registered person must 15/11/2008 ensure that a suitable diet is provided to meet the nutritional needs of each person. This is to ensure the health of each person is maintained. 8 19 12 The registered person must ensure that the identified persons pressure area care needs are appropriately assessed and met. 15/11/2008 This is to ensure the persons ongoing health and welfare. 9 20 13 Secure storage must be put in place for controlled drugs to meet the requirements of the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. 31/01/2009 This is to ensure safe storage of controlled medication 10 22 17 The registered person must 15/11/2008 ensure that a record is kept of all complaints by the people who live at the home, their representatives or staff members together with the action taken to resolve the complaints This is to show that concerns raised are dealt with in a timely and appropriate way. 11 22 22 The registered person must 15/11/2008 ensure that a clear procedure is in place which informs the people who live at the home how they can make a complaint. This procedure must be in a format accessible to the people living in the home. This is to ensure that people living in the home have an effective outlet for their concerns. 12 23 13 The registered person must ensure that staff receive appropriate training in safeguarding vulnerable adults. 31/12/2008 This is to ensure that people living in the home are not placed at risk of abuse. 13 24 23 The registered person must ensure that outstanding repairs to the fabric of the building are completed in a timely fashion. 31/12/2008 This is to ensure that people live in a safe and comfortable environment. 14 30 16 The registered person must 15/11/2008 ensure that all areas of the home are kept clean and free from offensive odours This is to ensure that people live in a safe and comfortable environment. 15 32 18 The Registered Person must 31/12/2008 ensure that staff responsible for the care and welfare of people living in the home, receive training relevant to the needs of the people living in the home with regards to their mental health and learning disability. This is to ensure that staff can meet the needs of the people living in the home 16 33 18 The registered person must 15/11/2008 ensure that sufficient staff are working at the home to enable staff to have a reasonable period of time off duty before they are required to work in the home again. This is to ensure that staffs work in the home is competent and not adversely affected by excessive working hours, such that it places the people who live in the home at risk. 17 33 18 The registered person must 15/11/2008 seek advice to ensure that the hours that staff work do not contravene the European Unions Working Time Directive This is to ensure that the registered person complies with relevant employment legislation, which seeks to protect staff and the people they provide a service for. 18 33 18 The registered person must 15/11/2008 ensure that there are sufficient numbers of staff on duty at all times This is to ensure that the assessed needs of all people living in the home can be met. 19 34 17 The registered person must ensure that an accurate record is kept of when staff 15/11/2008 members started work in their current post in the home. This is to ensure that an accurate record is kept of which staff have supported people at any given time. 20 34 17 The registered person must 15/11/2008 ensure that all people employed at the home have fully completed an application form and that two written references have been obtained in support of their application. This is to ensure that only suitable people work at the home. 21 35 18 The registered person must 15/11/2008 ensure that all staff receive structured induction training. This is to ensure that staff can meet peoples specific needs and are aware of the routines and procedures of the home. 22 38 39 The registered person must 31/10/2008 inform the Commission if any person other that the registered person manages the care home. This is to ensure that the Commission is aware of who to contact about the day to day running of the home. 23 39 24 The registered person must ensure that the annual quality assurance 31/10/2008 assessment is returned to the Commission. This is so that the Commission is aware of the structures in place for the maintenance and improvement of quality in the home. 24 41 17 The registered person must ensure that a record of all fire maintenance tests is available for inspection. 31/10/2008 This is to allow the Commission and other relevant bodies to assess whether fire prevention practise adequate to ensure the safety of the people living and working in the home. 25 42 23 The registered person must make arrangements for all people working in the home to receive training in fire prevention. 30/11/2008 This is to ensure the ongoing safety of the people living and working in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No 1 Refer to Standard 18 Good Practice Recommendations Details of the each persons personal support needs and how they prefer these to be met, should be included in their individual support plan For people prescribed as required medication it should be 2 20 clearly stated under what circumstances this medication is to be administered, together with the name of the prescribing physician. This information should be recorded in the persons support plan and in the medication administration record. 3 20 A record should be kept of when topical creams are opened and when they are applied. This is to ensure they are used regularly as prescribed and that out of date creams are not used. Staff should receive suitable training in how to manage behaviour that may challenge. All radiators should be regularly checked to ensure that they are working efficiently and providing sufficient heat for the comfort of the people living in the home. Staff should undertake training in infection control and an infection control policy should be implemented to ensure that there is no risk of cross contamination within the home. A process should be established to review and improve the quality of service in the home. This should seek the views of those living and working in the home as well as other stakeholders such as such as relatives and commissioners of services. 4 5 23 24 6 30 7 39 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.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 © (2008) 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. 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