Inspection on 10/12/09 for Primrose Hill Farm

This inspection was carried out on 10th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Primrose Hill Farm 11/05/10

Similar services:

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Primrose Hill Farm Primrose Hill Farm Meadowsweet Road Kings Norton Birmingham West Midlands B38 9QW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Donna Ahern     Date: 1 1 1 2 2 0 0 9 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 32 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 32 Information about the care home Name of care home: Address: Primrose Hill Farm Primrose Hill Farm Meadowsweet Road Kings Norton Birmingham West Midlands B38 9QW Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Catherine Dowe Type of registration: Number of places registered: care home 39 Care Through The Millennium Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1.The registered person may provide the following categories of service only: Care Home only PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability LD 39 2.The maximum numbers of service users who can be accommodated is:39 Date of last inspection Brief description of the care home Primrose Hill Farm is located in South Birmingham a few miles from Cotteridge Village. The home has been registered to provide a learning disability service for up to 39 younger adults. It is divided into seven separate houses. Six of the houses accommodate six people and one house is for three people. Central to the community there is a 14th century farm house and barn. The barn is currently undergoing interior renovation and when completed will be a community centre with planned activities. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 39 Brief description of the care home The farmhouse has been converted into offices and a training room is available.The community is fully enclosed by fencing with a gated entrance accessible via an intercom system. All houses have almost identical facilities including fitted kitchen, utility room, lounge and dining room with an additional seating area. All bedrooms are ensuite and are located on both ground and first floor level. To the rear of each house there is a small enclosed garden. There are extensive shared gardens. The houses are wheelchair friendly on ground floor level however there is no lift. It is the homes intention not to provide a service to people who are dependent on a wheelchair to mobilise. The fee level is not specified in the service user guide. This information can be sought from the manager. Individual fee details were contained in peoples care plans. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day; the home did not know we were going to visit. This was the homes first key inspection. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. At the time of this visit eight people were living at the home. People have a learning disability and have some behaviors that challenge the service. We case tracked three peoples care. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Care Homes for Adults (18-65 years) Page 6 of 32 Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The owner and five staff on duty were spoken to. We looked at four of the houses to make sure they were warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We looked at notifications received from the home. These are reports about things that have happened in the home that the home must tell us about. We sent out six surveys to people living in the home and their relatives to seek their views and opinions and ten to staff. At the time of writing the report we had received no completed surveys. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? 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 on page 4. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective new people have the information they need so they can make a choice about whether or not they want to live there. The homes pre assessment process does not demonstrate that a thorough assessment of peoples needs was completed prior to admission which could lead to needs not being met in full. Evidence: When we visited eight people were living there in five of the houses. Two of the houses were unoccupied. We were told that another three people are being assessed for their suitability. People have a learning disability and a range of needs , some people have behaviours that challenge and some have associated mental health needs. The service user guide and statement of purpose tell people what they can expect from the home and had been written in a style that is easier for the people living there to understand. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: There is a pre admission assessment process in place. We saw from looking at peoples care plans and talking to staff that people had the opportunity to meet staff and enjoy a meal or an activity on several occasions before moving into Primrose Hill Farm. We looked at one of the pre admission assessments that had been completed. A detailed format is in place for staff completing the assessment. However we saw that information recorded in the assessments was not comprehensive which could lead to needs not being identified or met. Information about a persons self harm was completed in the current employment section. The persons general health was recorded as average. For incontinence it stated now and again and for mental health needs it stated self harms. It also stated that the person should have a soft diet but did not detail why. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have all the information they need to support people well and protect them from the risk of harm. Evidence: We looked at three care plans. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. We found that the plans looked at gave some information about how staff should support the person in order to meet their individual needs in relation to personal care, communication, health care, social activities, likes and dislikes. Staff told us they are still developing peoples care plans as they get to know people better and they settle into their new home. We were concerned about what we read in a persons care plan about the support they need to keep them safe at night contradicted with what staff told us was happening in practice. We refer to this in more detail under the staffing section of the report. We saw that when care plans are reviewed there is no specific date and the review is not signed by the person completing the review. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: We looked at risk assessments for support in the community, eating and drinking, medication and challenging behaviour. They did not always tell staff how to minimise a risk. A risk assessment for behaviour said if the person becomes aggressive remove them from the environment but it does not say how you would do this. From reading care plans and talking to staff it became apparent that there were other areas of risks known to staff, for which no risk assessment had been completed.This included traveling in the homes transport and people accessing their own bedroom. One of the people who had a deterioration in their mobility prior to moving into the home no risk assessments had been completed. This could put people and the staff supporting them at risk of harm. We saw the minutes of service users meeting for one of the houses and saw that meetings had taken place monthly. It is positive to read that the service user guide and complaints procedure were discussed ensuring people had been informed about their rights. It was not always clear from reading daily records what peoples response was to the care they received from staff. When decisions were made for or on behalf of the person this information was not clear on their care plan. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and opportunities for people is still under development so that people can enjoy fulfilled lifestyles. People are supported to eat a healthy and varied diet and to maintain close links with people important to them. Evidence: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to five staff members and observed care and support on the day. One of the people is being supported to attend college to take part in a preparation for employment course. It is postive that they are being supported to travel on public transport. Some of the people require a high level of staff support and we saw from reading daily records that they had been supported to go out to a variety of day trips including Becketts Farm, Merry Hill shopping centre and swimming. On the day of our Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: visit one of the people had family visiting and the other person was going out for lunch and was going to get their holiday photographs developed. We saw from reading the daily notes that one of the people in another house which is usually staffed with one staff member had only been out three times in November. Staff told us that as they get to know people they are developing their activity plans and as more people come to live there will be more staff available to support people. We saw in the minutes of service users meetings and from talking to people that they had enjoyed a trip out to Disney on Ice and people had been out to buy the Christmas tree and decorations. All the houses we looked at had lovely large lounges with flat screen televisions. The dining rooms have additional seating areas which would be good if people wanted somewhere quiet to sit and relax or to take part in their own hobbies and interests. Each house has a small secure garden and there are extensive well kept shared gardens which are secure. There is a trampoline and swings for people to use. There is a 14th Century barn in the centre of the grounds. Staff told us there are plans to develop this into a resource for people to use during the day. We were told that the barn is currently used for staff training. We saw on peoples files that they are encouraged to maintain links with family and friends so that important relationships are maintained. Staff told us that they worked closely with peoples families especially during the moving in phase. On the day of our visit the family of one of the people was visiting. Staff made them welcome and they joined their relative for something to eat and drink. They told us that they were very happy with the home and they thought their relative had settled well into their new home. We saw a range of tinned, frozen and supplies of fresh food were available. Menus looked at identified a variety of meals. Staff said menus are planned with peoples involvement and they are supported to go to the local shops to buy the food. Staff said people are encouraged to make a choice and can pick something different if they want to. On the day of the visit the menu in one of the houses was sausage casserole but people had decided they wanted sausage and mash and that was provided. We saw care plans had information about peoples likes and dislikes. We saw records of tests in place for food and storage safety checks, which means food is stored and prepared in a hygienic and safe manner. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not ensure that peoples personal and health care needs are fully met. Evidence: Care plans we looked at had some information about how to meet peoples personal care needs. There was information about how much support people required from staff to meet their personal care needs and how they should be encouraged to do as much for themselves to maintain their independence. We saw that people were dressed in age appropriate clothing and people were well groomed, this indicates that people are supported to maintain a good self-image. We saw that after a meal people were supported to wipe their hands and face so maintaining their personal appearance. Records looked at gave some information about how people should be monitored at night. However it was unclear from reading the records for two of the people and from talking to staff how night checks are done to ensure people are safe and needs met. For one of the people there is no risk assessment in place to support this practice and to tell staff how the checks must be done. This may place people at risk of harm if needs are not met. We met six of the eight people who live in the home. We saw that Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: staff were prompt to offer personal care or support as needed. On the day of the visit some of the people were due to visit the local health centre so they could have a health check up which is part of the G.P registration process. It was positive to hear that some of the people who previously lived locally have been given the choice to retain their G.P . We saw that medical appointments and the outcome of these had been recorded so people health needs can be monitored. One of the peoples mobility and health had deteriorated prior to moving into the home. Staff told us that referrals have been made to other professionals including the Occupational Therapists so they will get the support and advice to meet peoples complex health care needs. We saw that systems are in place to weigh people regularly. This is good practice as weight gain or loss can be an indicator of other health problems. We saw that one of the people had lost some weight. Staff told us that the cause maybe due to a medication change. However we could not see how this had been followed up on and details of any action staff should take in the event of further weight loss was not on their care plan. Medication is stored in a locked cabinet in the office in each of the houses. We looked at the arrangements for medication in two houses.The cupboards was found to be clean, tidy and well ordered. The medication administration records (MAR) had not been signed for on one day for one person which may mean they did not get their medication as required. Correction fluid had been used on the MAR records and handwritten entries had not been signed by a second staff member. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. None of the people self-administered their medication. Staff training records indicated that over 50 of the staff had not completed medication training which may mean that staff do not have the basic skills and knowledge to support people living there with their medication. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure that concerns would be dealt with thoroughly. Evidence: The complaints procedure was in the statement of purpose in an easy read format so it is more meaningful for the people who live there. We saw a copy of this on peoples care files. The procedure needs updating so CQC name change and contact details are available to people who may want to contact us. We saw that the procedure is general and is not personal or specific to Primrose Hill Farm which may mean that people do not know who they can contact directly in the event of not being happy about something. We received an anonymous complaint about the home just before we did this visit. The person raised concern about the homes recruitment practice. We found no evidence to prove the specific allegations, although we did make recommendations about some aspects of the homes recruitment practice as stated in the staffing section of this report. Staff who we spoke with demonstrated a general understanding of their duty to safeguard people and how to report concerns on to senior managers. We looked at training records to determine that training in safeguarding vulnerable adults had been provided. Safeguarding procedures and a whistle blowing policy was available for staff to refer to. However the safeguarding policy refers to NCSC (National Care Standards Commission) which may mean people are unsure of who Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: they would contact in the event of an incident occurring. The Manager and senior staff have completed Mental Capacity and Deprivation Of Liberty Safeguards training. There are plans to roll this training out to the whole staff team so they are aware of the importance of this legislation and the impact on the people they support . The complaints log was not available for us to look at we were told that this was locked away and as the manager was not on duty senior staff did not have access to this. Staff told us if a complaint was made they would record the information and pass this on to the manager. The manager had appropriately made a safeguarding referral to the police and social services following financial irregularities in the home. After a criminal investigation the matter was referred back to the manager and the member of staffs employment was terminated. We were told that the financial procedures in the home have been reviewed since this event so peoples money is safeguarded. We saw that records are kept of peoples money and staff sign any transactions that have been made on peoples behalf. Balances of peoples money kept for safe keeping and peoples bank cards are signed for at the point of a staff handover. We spoke with the manager after the visit about the restrictions that are in place for one person. They had only recently moved into the home and the restrictions in place were established where the person lived previously. The manager agreed to review this with the person their family and other professionals and if needed will refer to the Best Interests team of the local authority who ensure that any restrictions in place is in the persons best interest. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and comfortable home that meets their individual needs. Evidence: The home consists of seven separate houses. All seven houses have almost identical facilities. Central to the houses there is a 14th century farm house and barn.The barn is currently undergoing interior renovation and when completed we were told it will be a community center with planned activities. Staff told us that it has been used for staff training and is not currently in use for people living there. We were told that there was no key available on site at the time of the visit so we were not able to look at the barn facilities. We looked around four of the houses. We saw that each house has a well decorated spacious lounge with plenty of seating and a flat screen television.There is also an additional lounge/diner with sufficient seating space. We saw that in one of the houses there has been a lot of wear and tear to the fabric of the building. This included damaged walls, wood work, water damaged ceiling in the dining room, soiling of furniture and curtains, broken blind in bathroom, small hole in wall. We were told that these matters were being dealt with by the organisations own maintenance people. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: We looked at four peoples bedrooms. Bedrooms seen were personalised to individual tastes and interests. One persons bedroom because of their needs had minimal items in their room . Staff told us that there are plans in place to add sensory equipment to the room to make it more suitable for the persons individual needs. Each person has their own ensuite which ensures personal care is attended to in private promoting peoples privacy. Underfloor heating has been installed and each room has its own temperature regulator so people can have the room at a setting that suits their needs. Each house has a utility room with a washing machine and tumble drier. We saw that cleaning products and other products assessed as a potential risk to people were kept in a locked cupboard. We were told by staff that there is no separate staff to do household cleaning and laundry this work is done by people living there and the support staff. Each of the houses we saw were free from offensive odours. We saw in one of the houses that it had become more difficult for staff to maintain hygiene standards. There was staining on furniture, soft furnishings and walls which could present an infection control risk to the people living there. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not ensure that people are supported by an effective staff team. Evidence: The AQAA told us that some staff have been recruited from within the company which has enabled some to take up promotion postions within the new houses. New staff have been recruited through a Goverment initiative where organisations employ people through working closely with the job centre. Staff receive relevent training at a local college and have a two week trial period working supervised in the home before employment is agreed. The home is not staffed as stated in the homes statement of purpose as it is not yet at full occupancy. We saw that staffing levels varried across the five houses that are currently open. Some houses have one staff on duty across the day to support either one or two people. In one of the houses where people have high support needs we saw staffing levels of mainly three on most shifts. We looked at the rotas for two weeks it was difficult at times to fully track who was working in which house. We saw that house managers are not always on the rota of the house they are working in and some shifts have been covered by agency staff but details of their names were not on the rota. This made it difficult for us to fully assess that staffing levels were adequate Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: to meet the needs of people. A persons care plan stated they must have staff on duty during the night to meet their needs. The rota we saw and staff confirmed for us that no waking night staff were on duty in this particular house only staff on sleep in duty. This means that staffing levels do not always meet peoples assessed needs which may put people at risk of harm. We saw consistent shift patterns of staff working a long day, doing a sleep in shift and working another full day. Rotas indicated and we saw in three of the houses only one staff on duty at a time. We asked how staff who work alone take a break. We were told that house managers will cover for staff but there is no set arrangements in place for staff to have a break. We saw a copy of the lone working policy however it was general and not specific to the individual houses. The risk assessment attached was not completed. It was therefore not clear how staff would be suported to work safely when working alone. We saw minutes of a staff meeting indicating that only one meeting had taken place since the home opened. There should be at least six staff meetings a year so staff can be updated in the changing needs of the people living there , changes in the organisation and best practice. We saw from looking at the rota that staff come into work ten minutes before their shift starts to take part in a handover. This mean the exchange of important information about people is relaint on staff turning up early for work. We looked at the recruitment records of four of the staff. These generally included the required information. We found that some information is held at the organisations main headquarters office located within the grounds of the home. Some information is held in the individual houses that people work in.We saw an application form which did not have the dates of the persons full work history and could not see if this had been followed up on. We were concerned about what action the home had taken to ensure that information gained from criminal record checks had been followed up on so people living there are not at risk. We were provided with further information on day two of our visit which indicated that systems are in place but they are disorganised and do not demonstrate a full audit trail of action taken by the home to safeguard people. We were told that the manager does not currently have an office or a secure place to hold information which could breach confidentaility procedures. We were told that all staff take part in an induction programme and each have a work book providing evidence of what they have completed. We found it difficult to assess training across the houses as the head office keeps a monthly record of training across the organisation. We saw on some staff files certificates of training but the individual Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: training record had not been kept updated. We were provided with a training matrix after our visits so we could see what staff had completed. The majority of staff had completed fire training, manual handling, food hygiene, first aid and health and safety and further training was planned for January for staff who had not yet completed these. However, less than 50 of the staff had completed medication training, infection control and challenging behaviour. Only very few staff had received training in epilepsy, communication, autism and dementia awareness which would help staff meet the very specific needs of the people who live at the home. Only 20 of the staff have a National Vocational Qualification (NVQ) level 2 or above in care. However the majority of staff are working towards achieving this which should help with ensuring staff have the knowledge and skills to meet the needs of the people living there. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure the health safety and wellbeing of the people living there. Evidence: The manager was previously a registered manager at one of the organisations other homes and has a number of years experience of working with people with learning disabilities. She has a National Vocational Qualification level 4 and the Registered Managers Award. The manager was not on duty at the time of the visit. She has been very helpful with providing us with any additional information we have required since our visit. The visit has identified a numbers of areas that require attention to ensure the home is being run well for the people living there. Systems are in place but are not working consistently across all the houses. There is not a dedicated area for the manager to work from which seems to have caused problems with how and where information is stored securely. The arrangements for staff recruitment are not robust and areas of Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: staff training require attention. Staffing levels do not always meet peoples assessed needs and some areas of health and safety should be improved so people are safe. Regular visits by a representative of the provider take place each month. We asked to see these reports but were told they were locked away and no one had access to them. These were forwarded to us after our visit. Monthly reports had been done which evidenced that people living there and staff had been asked their views about the home. The information in the reports was brief and no concerns had been identified as a result of these visits. Some policies and procedures we saw were not specific to the home and are generic in their content. This includes the lone working policy, complaints and safeguarding policy. These need to be specific to Primrose Hill Farm so staff are fully informed on how they promote peoples best interests. We looked at the fire records in two houses. These showed that regular fire drills do take place but there was limited information recorded about the outcome of the drill and if any difficulties were encountered. Regular testing of the fire alarm takes place ensuring this is in good working order. We saw that a problem with some of the doors which had been recorded in October had still not been dealt with. We were told that the doors were not shutting properly and were going to be dealt with the week after our visit. We saw that records of the emergency lights test which should be done monthly were blank. Staff told us they are tested every three months by the fire company. We looked at two fire risk assessments and saw that they had been completed before people moved into the home. Both risk assessments were the same and did not take into account the different needs of people and staffing arrangements that we saw in place in each house. It did not mention the problems identified with the doors closing or the need to not check emergency lights monthly. In one of the houses where the staff do a sleep in shift we were told and shown how a persons bedroom door, which is a fire door, is propped open so the person can get out of their bedroom during the night if they need to. We were told by staff that the door is too heavy for the person to open. Records showed that electric and gas equipment had been tested to ensure it was safe to use. Staff test and record the water temperatures regularly so people are not at risk of being scalded. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Any known risks to people should be assessed and guidelines must be in place for staff to follow. So people are protected from the risk of harm. 31/01/2010 2 20 13 Arrangements must be in place for the safe recording and administration of peoples medication. So people receive their medication safely and as prescribed. 31/01/2010 3 33 18 There must be enough staff on duty at all times. To meet the needs of the people living there. 31/01/2010 4 34 19 Arrangements must be in place so that recruitment practice is robust. 31/01/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 To ensure people living there are protected. 5 35 18 Staff must have the training they need. So they know how to support the people living there to meet their needs. 6 42 13 Arrangements must be in place to protect people from the risk of fire. To minimise the risks to peoples safety and wellbeing. 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 31/01/2010 31/01/2010 1 2 Pre admissions assessments should be comprehensive so the home is confident they can meet peoples needs prior to admission. Comprehensive care plans should be in place so staff can support people well and meets their assessed needs. Peoples care plans should say how their nighttime needs will be met so staff know how to meet these needs and keep people safe. Peoples care plans should detail why their weight is being monitored and what action staff should take to ensure peoples wellbeing. The complaints procedure should be specific to the home and say who people can refer to if they are not happy about something. CQC contact details should be updated. Page 30 of 32 2 3 6 18 4 19 5 22 Care Homes for Adults (18-65 years) 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 6 22 The complaints log should be available to senior staff so they can log complaints that may be received when the manager is not available. The safeguarding policy should be updated so staff know how to contact CQC in the event of an incident occurring. A review of how general hygiene standards will be maintained in one of the houses should take place so it is clean and any risks to people living there is minimised. Consideration should be given to allowing time in staffs working day for a handover between shifts to take place. So the importance of this task is recognised. Arrangements should be in place so staff who work alone get the support they need to do their job safely. There should be an accurate record of staff on duty each day and who is working in which house so staffing ratios can be determined ensuring people get the level of support they require. Policies and procedures in place should be specific to Primrose Hill Farm so peoples best interest and rights are promoted. Records required by regulation for the protection of people and the efficient running of the home should be secure and available for CQC to see. 7 8 23 30 9 33 10 11 33 33 12 40 13 41 Care Homes for Adults (18-65 years) Page 31 of 32 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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