Inspection on 11/12/08 for Palmwood Court Care Home

This inspection was carried out on 11th December 2008.

CSCI 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Palmwood Court Care Home 06/02/07

Palmwood Court Care Home 08/12/05

Palmwood Court Care Home 20/06/05

Palmwood Court Care Home 22/02/05

Palmwood Court Care Home 27/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Palmwood Court Care Home 14/17 Palmwood Court, Highbury Vale Bulwell Nottingham NG6 9BZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Linda Hirst     Date: 1 1 1 2 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Palmwood Court Care Home 14/17 Palmwood Court, Highbury Vale Bulwell Nottingham NG6 9BZ 01158443679 Telephone number: Fax number: Email address: Provider web address: myvonneh@ncha.org.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Yvonne Hughes Type of registration: Number of places registered: Nottingham Community Housing Association care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users shall be within category MD To allow one named service user of 67 years of age to reside at Palmwood Court Date of last inspection Brief description of the care home 14 / 17 Palmwood Court is a purpose built care home for up to twelve adults with a mental health needs. There are three bungalows, each one accommodating four people, with one bungalow being just for females and another being just for males. There is another bungalow for the admininstration, office and staffroom and there is a communal lounge for everyone to come together. Each bungalow has its own kitchen and bathroom facilities as well as a private garden that people living at the service are actively encouraged to maintain. The home is located in a quiet cul-de-sac in the residential area of Bulwell and is close to local amenities and bus routes into Nottingham City Centre. The fees for accommodation and support are per week. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 12 Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people Care Homes for Adults (18-65 years) Page 6 of 36 who live there and how they can and intend to improve their service. We did not receive this back from the manager but she gave us a copy during our visit. We were not able to use it to plan our inspection. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the service users living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke with three members of staff and two people who live at the service, one of whom is from a minority ethnic communities to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we began to find evidence a continued breach of regulations concerning the staff files, an issue which has been outstanding since January 2006. We issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to take evidence of this breach with a view to assessing the findings in relation to enforcement action. What the care home does well: What has improved since the last inspection? There have been improvements to some areas of the home. A bedroom doorway has been widened and a walk in shower has been installed. Staff have had updated medication training since our last visit to the home so they know how to perform their role safely. Supervision and staff meetings now take place regularly so people are supported and guided about their role and performance. Care Homes for Adults (18-65 years) Page 8 of 36 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 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. People who want to live at the service have their needs properly assessed before admission and can be assured these will be met at the service. Evidence: The manager told us in her Annual Quality Assurance Assessment that all documentation and assessments are reviewed before admission, including comprehensive Care Programme Approach documents. People can come and visit and stay at the project and they are assessed by people who work at the service using a formalised assessment tool to decide on their suitability to live there. She states that they support people to visit, ask questions and to look at previous reports on the service. We looked at the documents held at the service for someone who is in the process of deciding whether the service is suitable for their needs. We found the service have obtained comprehensive information about the persons needs and have started their own assessment during introductory visits. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: The people we spoke with told us they were given information about the service and came to visit and stay at the project before making a firm decision to stay, they gave me lots of information, but to be honest I went on my own impressions from visiting. I like it here and I have settled very well. Someone from here came and assessed me as well. Another person told us, I wanted to live in my own place, but I couldnt, they assessed me and I looked here. I think things are getting better and I am settling. Staff we spoke with confirmed, We get referrals all the time from the Continuing Health Panel. The manager or one of the nurses assesses people and sometimes we get information before they even come to visit, we also get feedback from the manager or the nurse and their assessment. I feel we get good information, we talk a lot and have full discussions on everything that is going on. If people have cultural needs we get information on that too. Care Homes for Adults (18-65 years) Page 12 of 36 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. Individuals are involved in decisions about their lives, but they do not all play an active role in planning the care and support they receive. Evidence: The manager told us in her Annual Quality Assurance Assessment that people who live at the service have copies of their personal support plans and they are encouraged to participate in planning their care through individual key worker sessions and Care Programme Approach reviews. She states that positive risk taking is promoted to maximise independent living and people are encouraged to make decisions about their own lives. She said they could improve by offering staff the chance to work in other services with people with more complex or challenging needs. They have improved by holding more regular and structured residents meetings. We looked at the plans of care for three people who live at the service and we found that although there are plans in place for people and these are kept under regular Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: review, some are not very detailed, person centred and there is no consistent approach to them, some people have plans and information about their mental health needs, others do not. Key information from the Care Programme Approach documents and the risk assessments (HONOS) about peoples risk history and the symptoms of worsening mental health are missing from some of the care plans we saw. That said people told us they receive care which meets their needs and it is clear that the staff know people living at the service really well. The people we spoke with told us, I have not really seen a care plan and I dont need much help, I look after myself really, and I havent seen a care plan yet but I am looking forward to seeing one. I dont need much help really. The staff we spoke with could not tell us whether people are involved in drawing up their care plans, I dont know if residents are involved. I know one staff member sits and discusses the plans with the person but I couldnt say whether everyone does. We dont write the care plans, we give feedback if its not working and we discuss it as a team. It is hard if someone is in denial (about their mental health) we try and chip away and we are careful about how we phrase things so we dont offend people. We found that the service is assessing the risks people face and is trying to balance this with their right to make decisions and live independent lifestyles. We found, however that there is no real evidence that the Mental Capacity Act is being considered and incorporated into care planning and risk assessment at the moment. The manager told us in her Annual Quality Assurance Assessment that regular residents meetings are held and that as a result of people expressing their views they have reviewed the main meal times, installed a walk in shower in one bungalow and developed more social activities, such as parties, take away evenings and themed evenings. They intend to provide smoking shelters, provide more day trips and outings and extend meal choices in the coming year in line with peoples wishes and suggestions. People we spoke with told us, I think they are good at letting you make your own decisions and I think they respect those. I go to the residents meetings but not everyone does go. Staff told us, I think people have a lot of say as to their own lives. There are some instances (like smoking rules) which are hard for them but things such as food as so on we will always try. If people want to do something which would make them vulnerable (such as going out alone) we will try and accompany them if they want us to. The staffing levels do affect this a lot though. Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: Care Homes for Adults (18-65 years) Page 15 of 36 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. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, cultural and recreational activities meet individuals expectations. Evidence: The manager told us in her Annual Quality Assurance Assessment that there are a range of individual and group activities (art groups, social club, whispers group, art groups, relaxation sessions) that all residents can access. She states that they promote inclusion, encourage people to maintain relationships and offer a healthy diet to people. The manager told us they have got better at supporting people with their relationships and encouraging empowerment, although she wants to improve the support which is offered to people in terms of their sexual relationships now there is a younger resident group. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: People we spoke with told us, I dont go to college, or day centre and I dont have a job. I spend my day watching TV or washing up. I dont go out, I dont like going out. I feel I have enough to fill my time and I dont get bored. I understand the staff cant always be around to find things for you to do and that we have to entertain ourselves. Im ok. Another person said, I need to start my art work again. I dont go to any day centres or community centres. I go shopping, I get the bus into town and up to the bank. The staff we spoke with told us, Staffing levels affect what we do with people a lot, especially if there are only two people on, its difficult. There is no flexibility in staffing levels, we have the staff we have. If there is an organised trip we will maybe have four people on but people dont really go out that often. We do try and do what they want, one person wanted to see Meatloaf so we took (them), another is going to see the wrestling soon. No one goes to college, day services or has a job, it can be hard to motivate people. There are only limited activities at the moment, but in Summer we go on walks, do gardening, and we arrange trips for them. We had one to the chocolate factory and two people went to Jersey on holiday. We found that there is information about sexuality held at the service, but the plans we saw which look at this area of need were not comprehensive. Those we spoke with told us, I do not have a partner, I did have lots of friends before I came to live here but I dont anymore. My circumstances changed and they couldnt understand it. I have a brother who comes to visit me. He can come when he likes and the staff make him feel welcome. The staff we spoke with told us that they have approached the mental health team about issues about sexuality and contraception. We will talk to (a named person) about sex and sexual health if they speak to us. I think we are better learning as we go along and getting to know people. Family and friends can come when they like, we offer a meal if they want. No one has a partner who comes and stays over. We try and offer male staff to males to talk about issues of sexuality. Things are changing, I do not know of anyone who is openly gay, though there is banter about it. People told us that they do chores around the home to maintain their independence and life skills, I do the pots in my bungalow but I sometimes get annoyed because they just expect me to do it all. I do my laundry but the staff do the cooking and cleaning for us. Staff we spoke with said, Generally we promote independence. We support them with Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: cleaning their room, some do their own laundry and cooking. We looked at the menus which looked varied and people are offered choices and alternatives. People we spoke with told us, I like the food here, we had to fill in a questionnaire a few years ago about what we like to eat. They give me the food I like to eat, I can make my own drinks and get these whenever I need them. Another said, I like to make my own food, I like a curry, my rice and peas and I love a brunch. Staff we spoke with told us, (one person) gets their own food and chooses what (they) want. (The person) goes to Hyson Green to get specialist ingredients. Care Homes for Adults (18-65 years) Page 18 of 36 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. The health and personal care that people receive is based on their individual needs. The storage and auditing of medication is not robust and does not ensure that people are safe and receiving their medication as prescribed by their Doctor. Evidence: The manager told us in her Annual Quality Assurance Assessment that there are individualised support and specialist healthcare services such as Occupational Therapy, Physiotherapists and nurses specialising in Diabetes. Links with the local Health Centre are reported to be excellent. She stated that the medication systems are much more robust and they have recognised that staff have differing relationships with each resident so they are able to meet diverse needs. The people we case tracked do not need help with personal care, they told us, I dont need help, I manage myself. Another said, I use oils to keep my skin supple but I need to shower as my nails are not very good. I dont need much help really. The staff told us, quite a few people need some help with personal care. With the new Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: staff we can now meet peoples gender preferences for support with personal care. Three women will only accept help from female staff. In terms of maintaining their privacy and dignity we do not impose on people, but we do support and encourage them. I would not want to intrude on peoples privacy. We found evidence in peoples care plans that referrals are made for tests and treatment to maintain health and wellbeing. People have had investigations into their medical needs, and have received treatment for these. We saw evidence that people have had blood tests and have regular weight checks. In all of the case files we looked at there is clear evidence of regular liaison and input from healthcare professionals in terms of maintaining the mental health of people who live at the service, and we saw evidence of regular Care Programme Approach reviews. People who we spoke with told us that their health is well looked after, my health is ok, very constant, but it gets to me sometimes that not everyone who lives here is like that. My physical health is fine, they come to check our eyes, feet and our teeth and if I need to see the Doctor I get a taxi there. Staff we spoke with told us, we dont normally need to help people to move, but we have some people who are unwell at the moment. We have people who have support from the dietician and the Diabetes clinic, one person has support from a dermatologist and we have regular contact with Community Psychiatric Nurses and Psychiatrists. We will escort people to the Doctor or to Hospital if requested. I think we know the people who live here really well and we refer on quickly for treatment. We looked at the storage of medication and we were concerned that some medication was stored unsecured on top of the medication cabinet and the fridge in the kitchen. We raised this issue with the manager who removed them and stored them securely, but this is very unsafe practice. There is too much medication for the current storage facilities at the service, and internal and external medications are not being stored separately in line with the Royal Pharmaceutical Society guidelines. Again, this matter was rectified before we left the premises. We were also a bit concerned that medication is being stored in a hot room and that the temperatures of the room are not being maintained to ensure medication is being stored in accordance with the manufacturers directions. Medication is administered from boxes but we could not find evidence that it is being audited to check the records tally with the amounts given and those remaining on the premises. This creates a risk of the misappropriation of medication. People we spoke with said they are happy with their medication, my tablets suit me and I dont get too many side effects. I would like to look after my own tablets but Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: they have said no, they havent explained why. We checked this out with the manager who said that the risk assessment had indicated this was not in the persons best interests (we saw this on file) but they are reviewing this and she agreed to talk to the person about self medication and their plans for the future. The staff we spoke with told us they have received training in administering medication, I give out medication and have had on site training. We administer from boxes, if we drop one we record this, some people do self medicate and others have done this before, but when one person became unwell we found out they had been storing up their medicines. We are looking at it again though. I think medication is given out safely. The staff member was able to talk through good practice when administering and recording medication. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, but the way complaints are being handled is not in line with the complaints procedure. People are protected from abuse, and have their rights upheld. Evidence: The manager told us in her Annual Quality Assurance Assessment that they ensure that people who live at the home, friends and visitors can access the complaints procedure by displaying this. She told us that complaints are a standing agenda item on the residents meeting agenda and that the policy and procedure is robust and genuine. We saw the complaints procedure on display, when we asked to see the record of complaints, none were formally recorded. However, when we looked at the minutes of residents meetings people have actually raised a number of complaints (especially about the environment, maintenance and repairs). There was no evidence that the provider has directly responded to the people living at the service under the complaints procedure to tell them what action will be taken to address their concerns and when. We found that some of these complaints have negative outcomes for people living at the home and they have been outstanding for an unacceptable amount of time. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: People who live at the service told us, I know how to complain, people would respond to them, sometimes I think messages about our complaints dont get passed on. They do seem to listen to us, but not about everything, we wanted the shower fixing but it took ages, about a year, its fixed now but there is no shower curtain so I still cant have a shower. The staff we spoke with told us, I have never dealt with a complaint, id anyone did I would take it to the managers, they would deal with it. We record concerns and complaints. The manager told us in her Annual Quality Assurance Assessment that staff are au fait regarding safeguarding adults. She told us there are independent advocates that people can have access to and can talk to, and she feels confident that people living at the service know managers would act to keep them safe. The service has a safeguarding policy and a copy of the local safeguarding procedures. There have been no allegations of abuse since our last visit to the service, and no one has been referred to the Protection of Vulnerable Adults list. People we spoke with told us, I dont always feel safe here, some people who live here are loud and scare me. I dont think they would hurt me but they are not very constant in their mood and behaviour. The staff have always been good and caring. I dont know if I would tell the staff that I feel scared. Another told us, I get on ok with people and I mostly feel safe. The staff we spoke with told us they have received safeguarding training, the training centred on what abuse is we also went through the procedures to follow if allegations are made. I know about whistleblowing, if I saw someone acting inappropriately I would report it. The staff understand their responsibilities to keep people safe. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The layout of the home is suitable for the needs of people living there, but the home is not well maintained and this compromises the comfort and choices of people who live there. Evidence: The manager told us in her Annual Quality Assurance Assessment that they provide a safe and homely environment, with bedrooms which are personalised with peoples choice of furniture. She told us that a bedroom door has been widened and a walk in shower has been installed in one of the bungalows. She feels they could improve by supporting people to be more proactive in keeping their spaces clean and tidy and by employing a weekend cleaner. We did a partial tour of the building and looked at all communal areas and some bedrooms with the permission of people who live there. We found that bedrooms and communal lounges and dining areas are warm, homely and comfortable. However, there are areas needing attention such as the kitchens in bungalows 14 and 15, new flooring is needed in bungalow 17s bathroom as it has been badly damaged by cigarettes being stubbed out on it. There are thistles growing out of the guttering Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: and because of this the rain is pouring down over the entrance hall. There is a need for an appropriate shelter for smokers now that smoking is not allowed in the service. People we spoke with told us, The home is quite nice really, I like my room but they are very slow at doing repairs and I dont think its on. We wanted the shower fixing but it took ages, about a year, its fixed now but there is no shower curtain so I still cant have a shower. Another said, I like my room, I have a lot of stuff in it. I think I will get used to living here. The staff we spoke with told us, I think the environment is as clean as we can keep it. The maintenance is not good, if it was raining, the gutters would be streaming, they are blocked with leaves, its like having waterfalls over the doors. The showers are working now, except number 17 which has been out of order for months. Care Homes for Adults (18-65 years) Page 25 of 36 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. There are not always sufficient staff on duty to meet the holistic needs of the people who use the service. The evidence does not show that people are safely recruited and that people are protected from those who are unsuitable to work with them. Evidence: The manager told us in her Annual Quality Assurance Assessment that there is a competent staff team who are qualified to do the work, that staff are well trained and that there is a robust recruitment process. 14 of the 16 staff who are employed have achieved National Vocational Qualification level 2 or above. This exceeds the National Minimum Standard. The manager told us that the skill mix of staff has been improved and they have been able to recruit two new male members of staff, and the supervision of staff is given a priority as are staff meetings. We looked at the staff rota and this shows that there are between 2 and 3 staff on duty depending on what is planned for the day. This staffing level does reduce at weekends. People who live at the service told us, there seem to be enough staff on, though the staff we spoke with told us that the staffing levels do restrict what they are able to do Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: with people (See YA 12). They told us, generally we could do with more staff, especially when the clients are unwell. It is difficult to plan for but we struggle then. We looked at the staff files of three people who work at the service to check they have the information and documentation which is legally required to make sure people are suitable to work with vulnerable adults. None of them had a copy of their application form, employment history nor any written verification for the reasons they left employment where they worked with vulnerable people. There were no copies of the original written references from past employers, one person had been working at the home for two months before the Criminal Records Bureau (CRB) check came through. There was no evidence on the staff file that a Protection of Vulnerable Adults First check had been done between the person starting work and the full Criminal Records Bureau check coming through. One nurse has no evidence that their Personal Identification Number (PIN) from the Nursing and Midwifery Council is in date, the person was able to show me their card which proves that this PIN is active, but this evidence should be on the staff file. We could not find evidence of any training (certificates) on two of the three staff files. This requirement has now been outstanding in our last three reports, with a failure to comply since January 2006. We spoke to the manager about this issue, and she told us, Its not my fault, all of the information is held at the headquarters of the Trust, we cant even get references from them, we have no access to the Healthcare Trust which is where the information on Personal and Development Plans (training) are held. When we try and sort this out with the Trust we get nowhere. Staff we spoke with told us, I filled in an application form with my previous employment details on, I wrote the names of two people who would give me references, I have had a CRB check, I honestly cant remember if I had a Protection of Vulnerable Adults First check. We have regular training but we cant get certificates we have phoned and phoned, myself and the manager have done this. I dont know if I have completed a form on my health. As there is a continued failure to meet legal requirements with potentially very poor outcomes for the people who live at the home, we issued a Code B Notice under the Police and Criminal Evidence Act 1984. This notice enables us to seize evidence with a view to enabling us to decide on further enforcement action to secure compliance. The people living at the service told us, the staff show me respect and they are kind and caring, I get on with them all, they will always chat to you, they seem to know what they are doing. Another said, I like the staff, they are nice, they chat to you a lot. Care Homes for Adults (18-65 years) Page 27 of 36 Care Homes for Adults (18-65 years) Page 28 of 36 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 areas requiring improvement must be addressed so that the home runs in the best interests of the people who live there. Evidence: The manager told us in her Annual Quality Assurance Assessment that the home is well run and is underpinned by the philosophy of therapeutic relationships. She told us the managers are approachable, inclusive and available. People who live at the service told us, I like the manager, she is a nice person and she seems to run the home well. Staff told us, I love my manager, she is fair and approachable. She will take us to one side if there are problems. We have supervision but if we have something we need to talk about we go and talk to her, the door is always open. We looked at the last monthly report by the service provider and found that these are not in compliance with legal requirements. There was no evidence to show that service Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: users, visitors and staff are being interviewed and their views recorded, and they seem to be monthly audits rather than overall assessments about how the service is being conducted and managed. As our evidence shows there are many strengths within the management of the service but also a number of areas which could be improved upon to secure better outcomes for the people who live there (See YA6, 20, 22, 24, 34, 35.) These issues must be addressed. We did not inspect the Quality Assurance of the service during our visit as the questionnaires have been sent out but not received back as yet. The manager told us in her Annual Quality Assurance Assessment that all tests and servicing of essential equipment have been completed at the required intervals. We could not find written evidence that people have received training in statutory health and safety subjects (see YA35). Staff told us, if we have any health and safety issues we talk to the manager. I have done fire training, and have Food Hygiene and Moving and Handling training coming up. Care Homes for Adults (18-65 years) Page 30 of 36 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 34 17(3)(b) All items as specified in 31/03/2007 Schedule 2 must be kept in the care home or made available for inspection. This is repeated from the previous inspection, initial timescale 31/01/06 not met. This requirement has still not been complied with, timescales of 31/01/06 and 31/03/07 not met. A Code B Notice has been issued with a view to assessing the findings and deciding on further enforcement action. Care Homes for Adults (18-65 years) Page 31 of 36 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 6 14 Key information about 30/03/2009 peoples mental health needs, their risk history and the symptoms of their illness and of it worsening must be contained in each persons care plan. So that all staff have full information about how to help and support people with their needs. 2 20 13 There must be sufficient storage facilities for all prescribed medication to be securely stored in each bungalow To ensure the safety of people living at the service. 27/02/2009 3 20 13 Daily checks on the room temperatures where medication is being stored must be maintained. To ensure it is being stored in accordance with the manufacturers instructions. 30/01/2009 Care Homes for Adults (18-65 years) Page 32 of 36 4 22 22 Complaints must be recorded and responded to in line with the complaints procedure To make sure that peoples concerns are heard and responded to formally and so they know what action will be taken and by when. 23/01/2009 5 24 23 A shower curtain must be provided in Bungalow 17 So that people who live at the home have a choice of a bath or shower. 30/01/2009 6 24 23 The guttering must be cleared of weeds and leaves regularly To ensure that the guttering carries water away effectively and to avoid people getting wet when trying to enter the home. 30/01/2009 7 24 23 The flooring in the bathroom 31/03/2009 of bungalow 17 must be replaced To ensure that the flooring can be properly cleaned and does not harbour germs. 8 35 19 There must be certificated evidence on the premises of the training people have undertaken. To prove that people have received the training necessary for their role in supporting people who live at the home. 30/01/2009 Care Homes for Adults (18-65 years) Page 33 of 36 9 37 10 The manager of the service must address the areas which require improvement from this report To ensure the home runs in the best interests of the people who live at the service. 31/03/2009 10 37 26 The monthly reports on behalf of the provider must contain the views of people living at the service, any visitors and staff To meet legal requirements and to show that the service is listening and responding to the views of the people who use it. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The keyworkers should read through care plans with people who live at the service so they are clear about what they are and what their purpose is. There should be evidence that people are involved in care planning or a clear written explanation of the reasons why they are not. Care plans should be written in a person centred way, and should reflect not only the needs, but the personality, wishes and aspirations of each person living at the service. There should be a consistent format to all care plans so that staff know where to locate information about people who live at the home quickly and easily and can meet their needs. Consideration should be given to the Mental Capacity Act 2005 (where relevant) in care plans and if a person is assessed as lacking capacity to make a decision, there must be a record which shows how a determination of capacity was made in line with the Code of Practice. 2 6 3 6 4 7 Care Homes for Adults (18-65 years) Page 34 of 36 5 15 Issues around peoples sexuality, sexual health and contraception should be discussed and (if needed) form part of the care planning for people to ensure their needs are met and they remain well and healthy. There should be sufficient storage facilities for all prescribed medication to be securely stored in each bungalow to ensure the safety of people living at the service. Regular audits of records of medication are recommended to make sure the tablets received, given and remaining tally so that the risk of misappropriation of medication is minimised. The kitchens in bungalows 14 and 15 require upgrading to provide safe and comfortable accommodation for people living at the home. The holistic and dependency needs of people who live at the service should be kept under review and staffing levels should be responsive to these needs. 6 20 7 20 8 24 9 33 Care Homes for Adults (18-65 years) Page 35 of 36 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!