Inspection on 24/03/10 for Palace Road, 18-18a

This inspection was carried out on 24th March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Palace Road, 18-18a 31/05/07

Palace Road, 18-18a 30/01/06

Palace Road, 18-18a 15/06/05

Palace Road, 18-18a 11/01/05

Palace Road, 18-18a 21/06/04

Palace Road, 18-18a 19/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Palace Road, 18-18a Palace Road, 18-18a Streatham Hill London SW2 3NG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Magee     Date: 3 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Palace Road, 18-18a Palace Road, 18-18a Streatham Hill London SW2 3NG 02086717849 02086839591 nwi@mht.co.uk www.mst-online.org.uk Metropolitan Support Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only (CRH - 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 Date of last inspection Brief description of the care home 18 Palace Road is registered to provide care, support and accommodation for twenty people that have experienced mental health related conditions. The premises are owned and managed by the Metropolitan Housing Trust. The home is located in a quiet residential road between Tulse Hill and Streatham Hill railway stations. Public transport links are good. The majority of the communal rooms are located on the ground floor. There are twenty single occupancy bedrooms located over Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 20 Brief description of the care home the ground, the first and second floors. A passenger lift is provided to enable access to all three floors. Fees range from £514 to £710 per week Care Homes for Adults (18-65 years) Page 5 of 34 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: We undertook this unannounced key inspection over two days. During our visits we met with the operations manager, and five support staff. We examined a range of records held for the service, the service users and for staff. Twelve service users were spoken with over the visits. We also spoke to three professionals from the mental health team. Surveys were completed and returned from ten service users. Prior to the inspection an AQAA was completed by the management team and returned to us. During our visits we toured the premises, we viewed all the communal areas, and five bedrooms. Care Homes for Adults (18-65 years) Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Despite the efforts of staff and management the service is not operating as successfully as it previously did. The shortfalls in the service are identified in the report and are the subject of requirements. The areas of shortfall are linked directly to the management and staffing arrangements in the past twelve months. The service lacked consistent leadership and organisation, due to a number of managerial changes. The home needs a permanent manager in post, the person needs to register with the Care Quality Commission. Staff absences/leave is not always well organised with many permanent staff absent at the same period. As a result sometimes the staff team comprised of all agency staff members. External professionals spoke of this being a barrier to progress in the service and to issues not getting followed up as well as previously encountered. Service users must be provided with more stability, and need the presence of a stable staff team that are permanently employed in the service. Care Homes for Adults (18-65 years) Page 7 of 34 Records were not available to confirm that robust recruitment procedures are operated. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 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. Pre admission arrangements are good. The service makes sure that prospective service users are fully assessed and that their needs are considered before they are offered a place at the home. People using services are supported to develop life skills, and enabled to move on to more appropriate accommodation. Evidence: The service continues to give good attention to pre admission preparations as well as to discharge and moving on arrangements. We examined records for two service users admitted since the restructuring of the service has taken place. The majority of service users were admitted since this change, although a small number of people have lived there prior to the changes in the service and are awaiting relocation. We found evidence to verify that individuals are involved in consultations on planning for moving on. One of the service users responding to our survey has since completing a survey moved to his own flat, he replied that he had progressed well at the service, he said the staff are good at helping service users resolve problems and focus on developing day to day living skills. We spoke to service users during the visits. They told that staff continue to work with them together with the mental health team on Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: finding suitable and appropriate accomodation for people in the service. Service users are referred to Palace Road by the Community Mental Health Teams in Lambeth. and the Placement and Move on Services Team. For the service users we found records of the referral stage, a range of reports, these included community care assessments, risk assessments, occupational health assessments, CPA reports, social circumstance reports. With this information on support needs and the risks associated a decision is made as to whether the service is suitable. Applicants are expected to work closely with prospective support worker on improving their independent living skills and engaging the support service being provided. This motivation aspect is looked at when assessing potential service users. There is a specific referrals team that is made up of 2 support workers and the manager. All referrals must be approved by the mental health and social care funding panel. We found that the information viewed on the pre admission assessment for both service users was comprehensive, it gave staff sound knowledge on which to make a decision on suitability for admission. We spoke to the service users. The placement for both people they find is appropriate. A keyworker for one of the service users told us that the service user is progressing well and that the pre admission assessment supplied good information. As a result all areas were considered in deciding if it was the most appropriate placement. During our visit we observed that a new service user was welcomed to the home for an overnight stay. She was accompanied by family members. She like other service users that choose to had the opportunity to sample life at the home bfore deciding to move there for rehabilitation. Service users spoken to told us that they were provided with a service user guide explaining the purpose of Palace Road and how this can meet their individual support needs. We saw copies of the licence agreement with both service users. This includes details too of the house rules. . Care Homes for Adults (18-65 years) Page 11 of 34 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 service places the service user at the heart of the support arrangements and is outcome focused. Support plans are person centred, setting out the needs goals and aspirations of the service user, and the services to be provided. Individuals can be assured that changing needs and circumstances change are recognised and responded to appropriatly. Evidence: We found that overall service users in this service receive good quality support despite the changes within the staff team. We examined the support plans for two service users, each person has an outcome based support plan in place. . The support plans have improved and are more person centred and outcome based. The plans were both current, we found that the plans are kept updated on the IT system every time there is a change, also following a CPA. Copies are then printed off and placed on service user file. Despite changes to the staff team there are clear signs of stability in the service delivery and outcomes for service users remain the focus. One of the support Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: workers on duty told of the duties of the key worker, that is to work with allocated service user and keep plans under review. A member of staff we heard also attends CPA meetings, and make sure the items discussed are reflected in support plans. The outcome of CPA meetings for service users were not available. The staff team are skilled and experienced and make appropriate arrangements to support service users in the manner required. The team includes regular staff members supplied by an agency. However, only support workers employed by MST are allocated key worker roles. Until the new in house are recruited to vacant post, this can place additional pressure on in house staff if the regular key worker is absent.Service users spoken to and replying to our surveys commented on the constant changes in staffing for the past twelve months, they have found that it has negatively affected their service We found that support plans are person centred and are agreed with the individual service user. Communication with mental health professionals is good, with evidence of good working relationships, also of staff responding appropriately to recommendations made. The plans are are easy to understand, and consider equality and diversity and address any needs identified in a person centred way. A key worker system allows staff to work on a one to one basis and contribute to the support plan development. The plan includes information on risk assessment, how individuals are kept safe, their goals and aspirations, means of communicating, their skills and abilities and how they make choices in their life. The service recognise the areas where further regress is needed and works with other professionals in order to achieve this. We hear in the AQAA how this is considered. The operations manager have recently requested and developed a joint working protocol for the management of incidents and accidents with Lambeths contract management team. The aim of this was to to ensure consistency of response in the management of risk. The support plans seen included information about individuals health. Plans too reflect how the service enables individuals develop their skills, and consider their future aspirations. We found examples of how reviews focus on asking what has worked for the individual, where there is progress and achievements, concerns and identifies action points. Each care plan seen had a comprehensive risk assessment. There is evidence that this is reviewed regularly, also that incidents or behaviour patterns are cross referenced to support plans and linked to these reviews. There are certain limitations on choice and freedom, These are part of the risk management and the support arrangements. Such limitations include the restriction of the use of alcohol in communal areas as part of the rehabilitation process. We heard from the team leader that the majority of service users are supported to take responsibility for managing their own finances. We examined the procedures for two service users that are unable to to manage safely their finances independently. There are records kept of all incoming and outgoing payments. We examined these records of financial transactions Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: and found them to be well managed. The home has policy working groups for service users. Service users are invited to regular inhouse meetings, they are asked to put forward their views. Care Homes for Adults (18-65 years) Page 14 of 34 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. The home values the racial and cultural diversity of service users. Age peer and culturally appropriate activities are available for individuals to take in the home and in the community. The rights of service users are respected and responsibilities are recognised in their lives. Evidence: Service users are very much part of the community. Equality and diversity is fully considered in the service delivery. Cultural events and celebrations are facilitated at the home. We found examples of how a service user recently admitted, had specific religious and cultural needs, these were fully considered by staff prior to admission. Appropriate arrangements have taken place in the service since the persons admission, these are sensitive to the needs of this person, including close location to shower facilities. The service in its attempt to offer a culturally sensitive service Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: ensures that they are aware of service provision across the borough and signpost service users into this provision where appropriate. The service users are Representative of the local community and have specific cultural needs, the staff team reflect the composition of the service user group. Service users use community facilities and attend culturally specific services, including the Afro Carribean days at the local centre in Lambeth. All staff attend diversity training as part of the core training programme. The home has introduced some new activities to the service. We observed a number attending coffee mornings and discussion groups. In the afternoon a service user had a friend come to join him in a game of snooker in the lounge. They both said that the home encourages and welcomes family and friends in the home. A small number of people in the home take part in college courses and work experience. We heard that some service users have been supported by staff to take up part time employment. There are house rules on use of alcohol, smoking, on admission service users receive a copy of these with information on the service. Service users are supported with daily routines and tasks as part of development of the independent living skills. The in house rules promote privacy and dignity, well being and independence. This ensures that service users treat each other with respect, no forms of bullying are accepted. Records show that a small number of incidents have taken place with service users. In the past year staff have become more aware of the implications of some triggers for example service users borrowing and sharing items such as cigarettes. We observed interaction between staff and service users, service users have the opportunity to engage in internal activities. The majority of service users were out into the community during both visits. All have a fob to open their bedroom doors, staff do not enter rooms without permissions, or unless concerned about the welfare of an individual. The service is reviewing current arrangements, so that there is an effective monitoring system in place for monitoring the welfare of service users. A menu committee is in place with service users choosing the food they like and assisting the chef with planning ahead for meals. A daily menu is displayed on the board with the options of two dishes for the main meal in the evening. Service users then select the option by writing the names alongside. We observed the chef prepare a beef curry for service users. A member of staff went to local shop to buy more vegetables as the fresh vegetable supply had run out. The service has experienced some problems with ordering produce from large suppliers. Recently this was not successful. New plans are now in place to use local businesses and markets. Consideration is given to meeting the dietary and cultural needs of service users, this is evident on menus seen. The majority of service users are not in the home at lunch time and have lunch outside the service. Fiev service users ordered sandwiches and pizzas for lunch during our visit. All the service users we spoke to are pleased with the meals served, many complimented Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: the chefs on the quality of meals. Care Homes for Adults (18-65 years) Page 17 of 34 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. Through regular monitoring and encouragement service users are supported and facilitated to manage their own healthcare, including support to access to statutory facilities. Medication procedures are robust, service users are given the prescribed medication, staff ensure that service users assessed to self medicate are supported to do so safely. Evidence: While case tracking the support for two service users we found that the following arrangements are in place. Each service user has a person centred outcome based support plan to identify the strengths the service user has, the areas where support is needed. This details health care needs too, and treatment and therapy recommended. Records confirm appointments with health professionals, also CPA meetings. Generally service users in this home are able to self care and do not require assistance with personal care. One service user has additional physical care needs, an agency carer is supplied to deliver personal care, several calls take place weekly. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: We found that there is a lack of effective working partnership between the support staff at the home and the agency carers. Support workers were unaware of the days and time of visits. No details are recorded in the support plans of this additional assistance required. Staff should work effectively with all others involved in the support arrangements for service users. The support plans are reviewed at least every three months, the service user also has the opportunity to complete a feedback form at each review session to comment on how they feel their planned support is of benefit to them. All support sessions take place in the acivity room and are private and confidential, the service user meets with the allocated keyworker twice a week and also has the opportunity to have support sessions away from the home. The information is recorded on the I.T system. The records seen for both service users demonstrate that the regular key working sessions take place. We observed handover sessions during our visits. We found evidence that good communication is experienced on hand overs, this covers the state of well being and welfare of each service user. The organisation has also introduced some additional procedures at this time in order to improve communication further. There are signs that staff monitor the conditions of service users, if there are concerns these are shared on handovers. Care coordinators spoken to describe the support available at the home as good, support staff establish effective working relationships with service users to enable successful outcomes for individuals. They also share concerns about the frequent changes to the staff team over the past twelve months, communication was not as good as a result of many changes in staffing one care coordinator said. Service users attend independently for check ups and appointments, individual weights are recorded at GP health clinics. The district nurse supports service users with diabetes and requiring insulin. The service has identified some concerns regarding healthcare and how this can be more effectively monitored articularly at night, as they have recognised that there are gaps in the service. We were informed of proposed changes, new procedures aim to assist staff in managing these type of eventualities from a preventative standpoint. These checks are in addition to the monthly and daily checks. A recommendation remains from a previous inspection report. There are plans too to employ a qualified nurse to make better provision for meeting the many complex healthcare conditions that arise. There are currently two service users with mobility support needs. One of these service users has received specialist physiotherapy support. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: All service users have a care co ordinator, and are reviewed by the PAMS team.(Placement Assessment Management Team). The service staff work closely with the team. On the team is a Psychiatrist with access to specialist psychology support too. We heard that an optician comes to Palace Road once a year. We examined medication procedures. The medication procedures are more robust with all errors promptly reported. All service users who receive medication are supported to, maintain, collect and administer when possible. This is first agreed with the service user, social worker and GP or Psychiatrist. We examined how service users are supported to self medicate safely. We found that weekly medication spot checks take place to ensure that service users who self medicate are receiving the supported required to do so. We observed medication being administered to service users during our visits. Service users who do not self medicate have flexible times in the morning, afternoon and evening to receive their medication. Actions taken to achieve complaince with medication are good. They come to the office for the medication. Staff ensure that the medication is swallowed before theservice user leaves the office. There are accurate records kept of all medications administered with signatures present. Medicines are supplied in monitored dosset systems. A local pharmacy provides this service and they also collect unused medications. All administration of controlled substances is witnessed by two persons and designated to appropriately trained staff. All medication is stored in a lockable metal cupboard, one staff member is responsible on each shift for securing the keys to same. Weekly stock checks take place, of the support workers is allocated the task of carrying out the monthly medication system audits and produces a report outlining her findings. Any signs of non compliance are dealt with promptly and referred to the mental health team. Blood tests and depots are also monitored so that a service user can be prompted to attend to subsequent appointments. The service is currently looking at reducing the number of pharmacies to simplify and minimise confusion and errors. Care Homes for Adults (18-65 years) Page 20 of 34 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. The service operates an effective complaints sytsem. Safeguarding procedures are robust with staff trained and knowledgable on procedures that protecet vulnerable adults. Service users are offered opportunities to share with keyworkers any concerns, they receive additional help as they are also kept informed on abuse issues and of reporting procedures. Evidence: We spoke to twelve service users. We heard from each of them how the service user is made aware of the complaints procedures. Each service user receives within the service user guide a copy of the complaints policy and procedure and also a complaints form for them to complete. The service has a system in place that records and logs all complaints and feedback received from service users and external agencies or family members. The log demonstrates that the level of complaints is low. The correspondence seen confirms that all issues are responded to within agreed timescales. There is also a notice board in the lobby of the home which has information on how to make complaints. We found signs that the current system is effective. From speaking to service users they speak of issues that are dealt with satisfactorily, and that service users feel comfortable in raising any concerns. The service had an incident in 2009 which led to the disciplinary actions against members of staff. We are confident that since this occurred that procedures are more robust. Areas where service users may have use tactics such as borrowing cigarettes and Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: having control over other service users are not acceptable. Staff are made aware of areas that may be used by service users as a form of control. We spoke with four support staff, all demonstrated a good knowledge of whistleblowing and safeguarding procedures. All staff are aware of the correct reporting procedures of incidents. Proctection from Abuse policies and procedures are in place at the service, and information regarding abuse is available to service users in the service user guide. The service recognises the vulnerability of service users, and ensures that service users are fully aware of what constitues abuse and how this can be reported. Specific protection from abuse issues are discussed at key working sessions and managers surgeries. All information regarding reporting of abuse is recorded and maintained, a whistle blowing policy is in place to protect service users and is discussed during involvement meetings. All staff attend training in relation to protection from abuse and also safeguarding service users from abuse. This is mandatory as part of the staff induction process for inhouse and agency staff, and is outlined within staff members specfic targets. Another area where improvements are found in is how staff are supported. Clinical staff meetings take place monthly, with the attendance of one of the psychologists with the PAMS team. This addresses some of the more challenging areas of support with some service users and how the staff team can understand different behaviours. Care Homes for Adults (18-65 years) Page 22 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a safe and comfortable environment in which service users can live. Communal and individual space is generous and kept clean, a refurbishment plan is needed to confirm the plans for refurbishment of the premises. The premises are warm, and offer good bathing facilities. Evidence: We toured all the communal areas, and five bedrooms. The home is comfortable and homely and there has been some recent decoration of the communal areas. Regular health and safety checks are carried out annually, also monthly audits are done but there are some inconsistencies in the frequencies of these. There are contracts in place for the maintenance of equipment, such as the lift and the fire alarm system. The records showed that equipment was well maintained as records of servicing were up to date. Some equipment in the kitchen is out of order and needs replacing. The home was clean and hygienic as a daily domestic completes these tasks. There is a rota for the service users to clean the communal kitchen and dining room. There are three lounges on the ground floor and a dining room. One of the lounges provides space for private meetings as well as a pool table, there is another lounge with a television and there is a conservatory area providing a space for private meetings or quiet time. The communal gardens offer service users a pleasant outdoor space to relax. The home is a non smoking and there are smoking areas in the front and back Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: gardens. During our tour we found that some service users smoke in bedrooms, we did not see any risk assessments for this. It is recommended that a risk assessment is completed for each resident that smoke in the bedroom areas. There are three bedrooms on the ground floor which can accommodate service users with physical support needs, there is wheelchair access and an accessible shower. Service users bedrooms are inspected on a monthly basis. Where service users need support with keeping their bedroom to a good standard of hygiene, this is recorded in the support plan and support staff assist with room cleaning. Service users are able to personalise their bedrooms and there are relevant records kept. There is a CCTV and door entry system, the door entry system permits access for all service users to all the communal areas and the specific area where their bedroom is located. In the communal areas there are some areas that require attention, for example toilet seats were unattached, some tiles were not unattached in the bathrooms. Curtains were unattached from the rails in some communal areas. The office has exposed flooring where carpet tiles were removed. We need to receive a refurbishment plans to determine if the service has refurbishment plans in place. We heard from staff and from the operations manager that the service has experienced some issues with the repairs system but that these now appear to be more under control. The service should ensure that the refurbishment programme makes provision for renovating the communal areas and any bedrooms that become vacant. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service employs staff that have the right attributes and that understand the importance of good quality support. Service users experience that staff work closely with professionals on focusing and achieving the best outcomes for individuals. Regular agency staff are engaged to suppliment vacant posts, but this is not always successful and resources are stretched. Staff are not effectively supervised and supported due to the management changes. Evidence: We were informed on the AQAA that recruitment of staff is in line with equal opportunities. Also that interviews are competency based. We heard that all new staff are only permitted to start to work in the home following; a CRB check carried out by MST, a satisfactory check with POVA and at least two acceptable references. Staff records were not available at the service to confirm this, Schedule 2 records were incomplete. There was a spreadsheet with information regarding CRB information and relevant numbers, it identified that for three members of staff these records were not available. Two of the staff on the late shift following a request from the area manager brought evidence that a CRB was carried out prior to starting work at the home. The staff members also told of being vetted before they began employment. We are not satisfied that record keeping is in order for staff employed in the service, and await confirmation from the human resource department. The probationary period we heard Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: from staff is six months with a three month review where the targets are reviewed. We observed rotas, also that three support workers are on duty daily, also at weekends. This was increased to reflect the changing needs of service users. There was a review of the staffing levels during the remodeling and the staffing levels were increased. An increase in the number of staff working at the weekends has been introduced and the rota amended to ensure that this happens. The staff team are reflective of the local community and the service users. Agency staff are used from a specific agency, agency workers have worked at the home in the past and have been through the agency induction process. We have some concerns that night time staffing levels may not be appropriate. There is one waking night staff member, and one on sleepover duties. On the first day of this inspection the entire staff team on duty were from the agency. Agency staff do not have access to the IT records. The use of agency staff has maintained consistency, as two of the three were familiar with service users and work regularly at the home. Service users too appeared to have a good relationship with those on duty. Agency support staff spoken to were knowledgeable and experienced. We heard from care coordinators about some difficulties, and how the service supports service users. They find that staff have the general style and attributes needed to work with the client group. All care coordinators complimented staff on the way they work with service users, they find that they cooperate with mental health professionals. We heard from professionals too that the outcomes for service users are generally good, but they expressed concerns regarding staffing levels on occasions also the frequent changes in the past twelve months. They also found that the staff team is frequently stretched due to the high volume of agency staff present, this has a knock on affect on service users. As agency staff are not allocated key worker roles, therefore in house staff are undertaking additional key working roles. Two care coordinators involved with service users at the home confirmed that this has affected stability in the service. The service should make sure that at all times suitably qualified competent and experienced persons are working at the home in such numbers that as are appropriate for the health and welfare of service users. Efforts should be made to ensure that there is always an in house member of staff on every shift. There is a core training programme and reviews of training requirements are discussed at each supervision session. We found that staff experience inconsistent supervision due to the absence of a permanent manager. The core training programme includes all mandatory training for the service.Unfortunately the central training matrix was not up to date. Individual members of staff were spoken to about their development. Each support worker had maintained their training profiles on the IT system. We examined three of these, we found that training provision is good and that staff are provided with all the desired training and development they require. The service should ensure that the central training matrix Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: is kept up to date. There are two team meetings per month, one focuses on the business of the home and the other is a new meeting which focuses on clinical issues and behavioural challenges with service users. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe for service users and staff. The service remains unsettled for service for service users and staff due to the absence of a permanent experienced manager . Record keeping is not good due to the lack of consistent leadership and direction. Evidence: The service has experienced the loss of an experienced registered manager. In the interim agency management staff were engaged. This has not always been successful. The home demonstrates the impact on the outcome of this inspection report as result of the lack of organisation and leadership, organisation . An agency manager in charge was absent from the home during our visits. Both service users and staff commented to us on the inconsistency and the lack of good leadership as they continue to experience further management changes. Professionals from the mental health team also described the impact of this on service users. Since we completed the inspection we were informed that a new manager was successfully recruited and appointed. All sections of the AQAA were completed and the information gives a reasonable Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: picture of the current situation within the service. We received a copy of the action plan developed by the operations manager, this gives details of the plans to address shortfalls that were identified earlier in the year. The evidence to support this is satisfactory. There are areas in the AQAA where more supporting evidence would have been useful to illustrate what the service has done in the last year. The data section of the AQAA was completed, although there are some inconsistencies. The service is due to apply for registration with CQC by October 2010, a condition may be attached if there is no registered manager in control. Examples of the lack of organisation and leadership were seen, there are shortfalls in the filing and record keeping. We found difficulty in accessing records. Individual records and home records were not up to date and in good order. The systems are poorly organised, the records of fire drills, and current fire risk assessments, staff files were not accessible on day one. On day two we received documentation, the records were not well ordered, and did not indicate that attention was given to maintaining up to date records. As a result of this poor record keeping it has the potential to mislead on regular practices such as fire fighting measures. We found the terminology used in some records rather unprofessional. It is recommended that records are maintained in an objective manner. From the records supplied on day two it was confirmed that fire fighting equipment is serviced and maintained. We also saw evidence that fire drills are conducted, the frequency remains an issue, and should reflect the recommendations of risk assessments. Other equipment in the premises is serviced and maintained. more attention is needed to follow up on equipment that needs replacement in the kitchen. The home has experienced some problems with outstanding repairs, staff expressed frustration with these but feel that they are now improving. The operations manager explained that the administrator is now in charge of requesting repairs. We read incident reports and copies of regulation 26 reports. The visit reports are not highlighting and following up on outstanding issues such as outstanding fire drills, repairs responses, and incident reports. A recommendation is made. The service undertakes a form of monitoring to get the views of service users, there are surveys, and service user meetings. We were informed on the AQAA that the service plans to improve this by involving service users in organisational events. Care Homes for Adults (18-65 years) Page 29 of 34 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 37 9 The registered person must 30/08/2007 ensure that the manager submits and application form to register with CSCI. Since the last inspection the registration process has taken place. Since the reregistration of the last manager in 2009 the managers post has been vacated. Care Homes for Adults (18-65 years) Page 30 of 34 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 24 23 The organisation must forward to the Care Quality Commission the refurbishment plans for the service. The premises needs to be kept in good repair both internally and externally 28/05/2010 2 33 18 The home must make sure 30/04/2010 that employment of persons at the home on a temporary basis will not prevent service users receiving continuity of care. The staff team must have a permanent staff member on duty for all shifts to promote continuity 3 34 19 The home must not employ any person to work at the home unless they are fully vetted first. Documents as required by Schedule 2 must be 30/04/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 available for any persons working at the home including agency staff. 4 37 8 The organisation must have a capable and competent manager to manage the service. The manager must be registered with CQC. 5 41 17 The service must ensure that record keeping is improved, records required by regulation must be up to date and well organised. To ensure that service users interests are safeguarded. 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 30/04/2010 30/04/2010 1 2 The service should ensure that for all referrals received, that consideration is given to the needs and challenges of current service users in the home Staff should ensre that copies of CPA meetings are sought and held with support plans. The service should strive to work closely with additional staff engaged to deliver personal care to service users. The service should ensure that the refurbishment programme makes provision for renovating the communal areas and bedrooms that become vacant. Items of furniture needing replacement should be provided as stated in the licence agreement. A copy of this programme should be sent to the Commission. 2 3 4 7 18 24 Care Homes for Adults (18-65 years) Page 32 of 34 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 5 24 Health and safety checks should be carried out at the frequencies recommended in the annual health and safety checks. It is recommended that a risk assessment is completed for any resident that smokes in the bedroom areas. The service should ensure that the central training matrix is kept up to date. All staff should receive regular supervision that enables staff feel valued and supported Reports made in accordance with Regulation 26 should cover all areas outlined in the Regulation, inspection of the premises, records of events, and records of complaints. Fire drills should be completed with the frequency recommended in the fire risk assessment. 6 7 8 9 24 35 36 41 10 42 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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