Inspection on 07/01/10 for Pennine Centre

This inspection was carried out on 7th January 2010.

CQC found this care home to be providing an Poor 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pennine Centre 27/01/09

Pennine Centre 06/11/07

Pennine Centre 14/11/06

Pennine Centre 08/02/06

Pennine Centre 05/10/05

Pennine Centre 03/12/04

Pennine Centre 30/06/04

Pennine Centre 27/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Pennine Centre Pennine Way North Bransholme Kingston upon Hull East Yorkshire HU7 5EH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Angela Tew     Date: 0 7 0 1 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Pennine Centre Pennine Way North Bransholme Kingston upon Hull East Yorkshire HU7 5EH 01482839311 01482839021 pat.walker@hullcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kingston upon Hull City Council care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: That the intended work as stated in the action plan in regard to the premises is carried out. To provide personal care and accommodation for three service users with physical disability who have reached 65 years of age. Date of last inspection Brief description of the care home The Pennine Centre is a modern purpose built care home situated on a large housing estate on the outskirts of the city of Hull. It is owned and run by Kingston Upon Hull City Council. There is an adjacent day centre, which people staying in the home can use if they wish to. The Pennine Centre has been subject to extensive refurbishment and is registered for up to 12 younger adults who have a physical disability. The home offers care and accommodation mainly on a short term and respite basis. The statement of purpose and service user guide has been amended and clearly states how the needs of people staying there will be met. The home is secure and has its own well tended grounds. Public transport is accessible adjacent to the home and there are some local facilities nearby. The home has a ground and first floor with a passenger lift Care Homes for Adults (18-65 years) Page 4 of 31 2 7 0 1 2 0 0 9 12 Over 65 1 Brief description of the care home connecting the two. There is ample communal space for people, including three lounges, a visitors room and a large dining area. The home offers eleven respite and one long term placement. On the first floor there are two rehabilitation bedrooms. People are given a service user guide explaining what the home will provide. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. This site visit took place over one day and took a total of 8 hours. A regulation inspector visited the home as part of the process. Prior to the visit surveys were posted out to people living in the home, staff members and health and social care professionals, information was gained from these and this has formed part of the evidence. The Annual Quality Assurance Assessment was returned to the CQC prior to the visit taking place. It had been completed to an adequate standard. Several of the people living in the home were spoken to throughout the day about the care they receive and what it is like to live in the home, some of their comments have been included in this report. Two files of people living in the home and three staff personnel files were looked at during the site visit. Four staff members were spoken to, Care Homes for Adults (18-65 years) Page 6 of 31 this was to find out what it was like working in the home and what training support and supervision was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The medication procedure and the way that incidents are reported was looked at and the manager was given feedback at the end of the visit. The manager told us that the current fees charged range between £47.53 and £59.36. Additional charges are made for the following, newspapers, magazines and sweets, hairdressing. We also checked how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. CQC are concerned that the homes management team continue to show a lack of awareness and commitment to improve the service. This is evidenced over the previous three inspections. The management team are failing to ensure that the quality of the service improves, meaning that peoples needs may not be met, they may not be protected from the risk of harm and their wishes and choices are not always respected. We would like to thank the people that stay at Pennine, staff and management for their hospitality during the visit, and also thank the people who had discussions with us. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: People have care plans and risk management plans that are basic in style and content, however they do not always include specific direction to staff about what they need to do and any preferences to how the person receive their support. Errors continue to occur when medication is administered, therefore people using the service do not always receive their medication in a safe way. Care Homes for Adults (18-65 years) Page 8 of 31 People are not always protected from possible harm or abuse due to incidents not being referred appropriately. Staffing levels are not always sufficient to meet need, training and supervision are not undertaken as regular as they should be. This would ensure that staff have the skills, knowledge and guidance to meet the needs of people they care for. Three complaints received by the home since the last inspection state that people could not have a bath/shower when they wanted one, therefore choice and independence may be compromised. The homes management team continue to show a lack of awareness with regard to safeguarding people and there has been different issues raised over the past three inspections and there has been a failure to improve. 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 9 of 31 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 31 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 use this service have their needs fully assessed and usually have the opportunity to visit the home before they decide to move in, this means choice is promoted and people can make an informed decision about whether to move into the home. Evidence: The manager told us that people have their needs assessed prior to and following admission. We received an annual quality assurance assessment (AQAA) that the home had completed and this gave information about the support and care offered to people. We looked at three files of people staying at the home confirming that people have their needs assessed before they move in and from speaking to people during the visit it was clear that this is done in consultation with them. Surveys were received from people who live or stay at the Pennine Centre and some comments included, yes I had been before so I knew what it was like, my sister came to have a look for me, I had to come here in an emergency, so did not vist beforehand. I was pleasantly surprised, it is a fantastic place. One survey did Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: contain negative comments, I was not asked if I wanted to move to this place and I thought it was the only place to go to. Care Homes for Adults (18-65 years) Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans and risk management plans that are basic in style and content, they do not always include specific direction to staff about what they need to do to meet peoples needs and do not include preferences to how the person receive their support. Care plans need to be further developed in a way that includes the person and details all of their needs. Evidence: The manager told us that the home is implementing a new training programme involving person centred thinking. She said, this will eventually be undertaken by all staff and care plans will be developed that gives an idea of what the persons needs, wishes and preferences are. However, this is in its infancy stage and it will be some time before it is implemented. We looked at three care files of people staying in the home and although these gave the reader information about the basic needs with short and long term objectives for that person. They did not describe in detail how staff should undertake the tasks or Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: how they should offer support. For example, one persons care plan stated they required some assistance to dress and undress, encourage to participate in activities. However, it did not say exactly what assistance was required or what activities the person liked and how often this should take place. We saw that risk is managed to a certain degree, however, the files that were looked at did not cover all risk. For example one person is alcohol dependent and the home had not prepared a plan that would describe any associated risk and how this could be reduced and managed. Not all paperwork was signed by the person, staff or the manager. Usually choice, participation and independence are all promoted and people living or staying for respite in the home told us that they were able to make choices on a daily basis. Some comments included, I can get up and go to bed when I want, I can get a shower when I want to. However, since the previous inspection visit three complaints had been received by the home regarding people not being able to have a bath or shower when they wanted one. Although these complaints had been responded to it was clear that choice for some people staying in the home had been restricted. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who live in the home are enabled to take part in activities and education. However, this is not the case for all of the people as staffing limitations can affect this. People are encouraged to maintain outside links with family and friends and the menu offered is of an excellent standard. Evidence: Some people told us that they are encouraged to attend day centres or community groups. Written evidence in case files confirmed that some people attend the adjacent day centre on a regular basis and one person is supported to maintain a job in the community. Some people using the service also told us that visitors are made welcome at any time and one person said, my son visited at 8.15 pm and was made welcome, I can see my visitors in private and they are always offered a drink by staff. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: However, from speaking to several people living in the home and staff it was clear that activities do not occur always occur on a regular basis. People living in the home said, there is not much going on, I usually watch TV or go to my room, I can do what I want, but its boring in here. From discussion with the staff and manager it was clear that the activities depend upon the staffing levels and if the staff are busy then they do not get time to spend on a 1-1 basis with people. Written documentation was looked at confirming that outings take place during the warmer months, however not all people can take part in these. The home continues to offer a varied menu and from speaking to people living in the home, it was clear that choice is offered and the quality of the food is excellent. Some comments included, it is excellent, its like a hotel, it is brilliant, cannot fault it. The home received a score of A with the Environmental Health Department, this means the hygiene in the kitchen was of an excellent standard. The home has also maintained the Healthy Option Award. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive a good level of personal and healthcare support, however errors continue to occur when medication is administered, staff do not follow the procedure, therefore people using the service do not always receive their medication in a safe way. Evidence: During the visit three files of people who live or stay on respite in the home were looked at, written evidence was in place confirming that healthcare checks are undertaken. People told us that they are supported to attend hospital, GP and other healthcare appointments. Aids and adaptations are sought to assist people with their mobility and independence. People told us that staff assist them in a way that promotes their independence, maintains their dignity and privacy. Comments from people living in the home included, the staff are very good, they talk to me all of the time they are helping, the staff are good, think its an excellent home, cant fault it. Surveys received commented, I receive care with dignity at all times, I am treated very well, the care is first class. However, as mentioned earlier in the report the home has received Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: three complaints over the past year about people having to wait or not being able to have a shower/bath when they wanted to. Although these complaints have been investigated by the manager, the problem appears to be longstanding and on a frequent basis there are not sufficient staff on duty at busy times. The manager told us that the medication procedure has been further developed and there is a new system when booking in medication, all staff have undertaken further medication training and a homely remedies policy has been developed. However, mistakes continue to occur and staff do not always record accurately. One person who was prescribed paracetamol 500 mg one to two tablets four times a day as required, had 133 tablets in stock upon admission and eight had been given and there should have been 125 remaining. However, there were 124 in stock and the senior informed the inspector that she had administered the medication and forgot to sign on the medication record. Other signatures were not clear whether 1 or 2 tablets had been given. This has been raised in previous inspection reports and although staff have re-trained, the procedures have been looked at and new ones implemented, mistakes continue to occur. Following this inspection visit the home forwarded two notifications to CQC stating that further errors in the adminstration of medication had occurred. The first detailed that a person staying in the home may not have received the correct amount of medication and this was recorded incorrectly and the second notification stated staff had been administering medication to a person and the MAR did not have the persons name on it. The medication procedure is not been followed and people are being placed at risk of receiving their medication incorrectly and not in a safe way. The home has a returns procedure, which detailed the name of the person the medication was for, the medication prescribed and dosage. The medication is stored in a locked medication room and within that room there are several locked cabinets and a controlled drugs cabinet. There is also a medication trolley. The home has a refrigerator to store medication and evidence was seen confirming that the temperature is taken on a daily basis. Controlled drugs are stored securely and records show that two staff always sign when given. Care Homes for Adults (18-65 years) Page 18 of 31 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 informed about the complaints procedure and are able to express their concerns in an open culture. People are not always protected from possible harm or abuse due to incidents not being referred appropriately. Evidence: The home has a complaints procedure and it was confirmed from speaking to people living in the home and from surveys received that complaints are listened to and acted upon. People told us that, yes I know I about the complaints procedure, but I have no reason to complain, it is fantastic here, I have no complaints. However, there had been eighteen complaints since the previous inspection visit. Written records confirmed these were dealt with and responded to. A written outcome letter was also forwarded to the complainant. However, some complaints relate to there not being enough staff to provide personal care when it is needed or wanted, this has not been addressed. The home has a multi agency policy and procedure for the prevention of abuse. Staff undertake mandatory training in this area. Since the last inspection there have been three safeguarding referrals made to the Local Authority Safeguarding team. Two incidents had occurred whilst the individuals were not in the home and these included verbal and physical assaults. The manager confirmed that safeguarding referrals had Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: been forwarded immediately to the Hull Safeguarding Team and CQC had been notified too. The third safeguarding referral involves an allegation that two staff members had physically and emotionally abused a person living in the home. This incident was reported to a senior care assistant and it was not until the manager returned from annual leave 7 days later that a safeguarding referral was made. Again the lack of understanding about the seriousness of this situation shown by the senior staff is concerning and there has been a failure to improve in this area over the last three years. This incident is currently being investigated by the Hull Safeguarding Team. The home has a policy and procedure for dealing with peoples monies and financial affairs. Records for maintaining the personal finances were looked at were up to date and in order. People living in the home told us that they were able to gain access to their money when they wanted to. There is also a lockable facility in each of the bedrooms. Care Homes for Adults (18-65 years) Page 20 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained to an excellent standard and the environment is clean, hygienic, comfortable, homely and meets the general needs of people living there. Evidence: During the visit a tour of the building was undertaken and the standard of accommodation and cleanliness was excellent. The health and safety of people living in the Pennine Centre is maintained and promoted. An occupational therapist has undertaken an assessment of the building aids and adaptations, the majority of the recommendations have been implemented. Individual bedrooms were decorated to a high standard and were personalised with pictures, posters, dvds and belongings. People living in the home told us that the home was very clean and comments included, its really good here, the rooms are good too, it is very clean, the staff work very hard. The home was clean, hygienic and had no offensive smells present. Staff receive training in relation to infection control and there are clear guidelines set down to staff to follow if there are any infectious diseases. The home has a laundrey with two industrial washing machines and two industrial dryers, there is a sluice facility and sterilising unit. Care Homes for Adults (18-65 years) Page 21 of 31 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 home recruits staff in a safe way. However, staffing levels are not always sufficient to meet all of peoples needs. Training and supervision are not undertaken as regular as they should be. Evidence: During the inspection visit three staff files were looked at confirming that the recruitment procedure is followed. The recruitment documentation including criminal records bureau check, references and an application form are held at the Personnel Section. Each person had undertaken an in-house induction and a more thorough corporate induction that meets the skills for care specification. Supervision is offered to all staff and from looking at written evidence it was confirmed that this is not as regular as it should be. CQC recommend a minimum is six per year as this would ensure good practice is being followed and staff receive sufficient support, supervision and guidance, however the local authority have their own policy which states supervision must be offered on a monthly basis. Although staff are offered essential training, it was apparent from looking at records that this is not always updated as regular as it should be. Staff are offered induction training that meets the common induction standards and 74 of staff have achieved NVQ level 2. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Some staff had undertaken training in relation to meeting more diverse needs and these included transgender awareness, eating and drinking difficulties, learning disability awareness, mental health first aid, stroke awareness. From speaking to two of the care staff it was clear that they had developed a good understanding of the needs of the people who use the service. One staff member, I have approached the manager before about different needs people may have and I went on a course for Parkinsons. I feel more confident when dealing with that person. Other courses that staff have undertaken include values and attitudes, mental capacity act and deprivation of liberty. The staffing levels were looked at for this week and taking into account the level of need and number of people in the home at this time, it would appear that they are sufficient to meet the needs of individuals. People confirmed that the care staff are very helpful, professional and polite when offering personal care, however they also said that sometimes they are kept waiting as the staff are very busy. Three complaints received by the home since the last inspection stated that people could not have a bath/shower when they wanted one, again due to the staffing levels or the way that the rota is planned. It would appear that the staffing levels vary as the number of people receiving a service varies from day to day and the majority of the people use the home for respite care. However, from speaking to care staff and people using the service it was clear that the planning of the shifts and the support from senior care staff could be improved. Some comments received included, the seniors do not always offer practical support, it depends who is on shift, some are more willing than others, the seniors could help more, if the door is closed then we tend not to go in. Care Homes for Adults (18-65 years) Page 23 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home seeks the views of people using the service, but does not always demonstrate that those views have been acted upon. Incidents are not always managed, reported and recorded in accordance with procedure and therefore peoples health and safety may be placed at risk. Evidence: Over a number of inspections since 2007 the home has been subject to requirements and although these have been partially met, there continue to be concerns identified at each inspection visit and new issues and new requirements made. In January 2009 requirements were made about the medication administration procedure and people not receiving the correct amounts of medication. Staff were retrained and the procedure was updated, an external manager undertook an audit of the medication system and gave feedback about how the home could improve. Also incidents that placed people at risk were not being reported until two months after the event, nor was the safeguarding team been alerted. Again staff received further safeguarding training and meetings held with the senior management team at the home to ensure that this didnt occur again. During this inspection it was found that errors in the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: medication system were still happening and an allegation made by a person using the service was not reported to the safeguarding team until 7 days after the event. This is not acceptable and the management team are not learning from their mistakes, there appears to be a lack of commitment to change or accept that practice is poor. The organisation must ensure the safety of the people using the service. CQC have found in previous inspection visits and this one the senior care team are not always welcoming and defensive to any suggestions or requirements made. The home needs to ensure that there are sufficient staff on duty in order to offer personal care when people require it and for activities to take place on a regular basis. Although the registered manager has 19 years and the senior care team have significant experience in the care setting, there appears to be a lack of awareness and commitment in how to deal with serious incidents, such as safeguarding referrals. The manager has obtained NVQ 4 in Care and the Registered Managers Award. She told us that she has kept her knowledge up to date by attending training in interpersonal aspects of management and leadership, deprivation of liberty, employment law essentials, mental health first aid and person centred thinking. She also confirmed that she receives supervision from her line manager on a regular basis and commented, the support I receive is excellent, we meet monthly usually and I attend the disability team meetings every two weeks. People using the service and staff spoke highly of the manager and told us, the manager is always available, she is very approachable, the manager does listen to what we have to say. The quality assurance system was looked at and surveys are sent to people using the service, their relatives, health and social care workers, GPs and. The results are gathered and analysed and presented in a report format this is shared with the people living in the home. The home has also developed a newsletter that incorporates the views and stories of people living in the home and staff also contribute. All compliments and complaints are recorded. However, although peoples views are sought they are not always acted upon and the service does not demonstrate that is has learned from its mistakes. The building is well-maintained by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. Staff undertake all health and safety courses within the first 6 months of employment ensuring that the staff are knowledgeable and have the necessary Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: skills to deal with emergencies. However, some mandatory training is out of date and not all incidents are reported and recorded appropriately in particular safeguarding issues that have not been referred immediately. As mentioned earlier in the report an incident that placed a person at risk was not reported immediately to the safeguarding team, it was delayed from 27.12.09 until 4.1.10 as the manager was on annual leave and this had not been dealt with by the senior care staff during her absence. The homes management team continue to show a lack of awareness with regard to safeguarding people and there has been different issues raised over the past three inspections and there has been a failure to improve. Equality and diversity is promoted. People are able to attend religious meetings of their choice. Some of the staff have attended training in relation to values and attitudes, alcohol, physical and learning disability awareness. From speaking to the manager it was evident that the local authority regard equality and diversity training highly, as this is a mandatory course for staff. The Local Authority offer understanding a physical disability and some staff have undertaken this. Care Homes for Adults (18-65 years) Page 26 of 31 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 20 13 Medication must be administered as prescribed, accurate records must be kept for all medicines. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 12/05/2009 2 42 13 Incidents must be managed 12/05/2009 and reported in accordance with procedure and regulation, this would ensure that peoples health and safety is promoted. To ensure that all incidents affecting people are reported and dealt with appropriately. Care Homes for Adults (18-65 years) Page 27 of 31 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 15 The care plans require development to include specific direction to staff about what they need to do and any preferences to how the person receive their support. This would ensure that care plans are developed in a way that includes the persons choices and preferences and would give clear direction to staff. 08/04/2010 2 7 12 People must be able to have a bath or shower when they want one. This would ensure that choice and independence is maintained and promoted. 08/02/2010 3 9 12 Risk management plans 08/04/2010 require further development and must include all areas of risk and be specific about the intervention required by staff. Page 28 of 31 Care Homes for Adults (18-65 years) 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 This would ensure that all risk is managed or reduced effectively and staff know what they need to do. 4 14 12 Activities must be held on a 08/04/2010 regular basis both inside and outside of the home. To ensure that people have the chance to take part in activities they enjoy and this would promote social skills and inclusion. 5 20 13 There must be a risk 08/04/2010 assessment in place that details whether the person is able to administer their own medication. To ensure that where it safe to do so, the person is enabled to take control of their own medication. 6 33 18 Staffing levels must be improved to ensure that they are sufficient at all times to meet peoples needs, including personal care and preferences for people. To ensure that choice and self-determination are promoted. 7 37 10 The organisation and the manager must make sure 16/02/2010 08/04/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 that incidents/accidents are managed effectively, ensuring that other staff follow the procedure. This would make sure that people live in a well-run home that maintains their safety. 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 20 Staff should make sure that they record clearly how many tablets have been given when the prescription states 1 or 2. This would ensure that the stock control records are correct and accurate. People living in the home should have a photograph in their medication file. This would ensure that medication is given safely to the person it has been prescribed for. There should be a written agreement stating that the person living in the home has given consent for the home to adminsiter their medication, unless a risk assessment states otherwise. This would ensure that the person is consulted and has given permission for the home to administer the medication. Training should be offered and updated on a regular basis, as this would ensure that people have their needs met by appropriately trained staff. Supervision should be offered to staff on a monthly basis in line with the organisations policy. This would ensure that staff receive the support and guidance to carry out their responsibilities and good practice is promoted. 2 20 3 21 4 35 5 36 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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