Inspection on 30/04/09 for Quarrydene

This inspection was carried out on 30th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Quarrydene 07/05/08

Quarrydene 24/05/07

Quarrydene 12/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Key inspection report CARE HOME ADULTS 18-65 Quarrydene Pavenhill Purton Wiltshire SN5 4DA Lead Inspector Alison Duffy Unannounced Inspection 30th April 2009 09:50 Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 2 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 Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quarrydene Address Pavenhill Purton Wiltshire SN5 4DA 01793 772736 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) info@holmleigh-care.co.uk www.holmleigh-care.co.uk Holmleigh Care Homes Ltd Manager post vacant Care Home 9 Category(ies) of Learning disability (9), Physical disability (9), registration, with number Sensory impairment (4) of places Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th May 2008 Brief Description of the Service: Quarrydene is a residential care home run by Holmleigh Care Homes Limited. The Director is Mr Rod Correia. The Registered Manager, Mrs Janet Ashford left her position in December 2007. Mrs Sheridan Bidmead is now Acting Manager. Mrs Bidmead is in the process of submitting an application to us to become the Registered Manager. Quarrydene was registered on 7th August 2006. Previously a care home for older people, the property was totally refurbished. It now accommodates nine younger adults with a physical and/or learning disability. Four people may also have sensory impairment. Quarrydene is a spacious bungalow that is located in the village setting of Pavenhill, Purton. There are a number of communal areas including a sun lounge and a sensory room. All bedrooms are single rooms and provide an ensuite of either a specialised bath or wet room. In some instances, the en-suite may be shared between two bedrooms. There is a range of specialised equipment to assist with individual need. Staffing levels are maintained at five support workers in the morning and four in the evening. At night there two waking night staff. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on the 30th April 2009 between the hours of 9.50am and 7.30pm. Mrs Bidmead, the acting manager was available throughout the inspection. We met with people who use the service and staff members. We looked at the medication systems and at care-planning information, staff training records and recruitment documentation. We toured the accommodation and saw people having lunch. People within the service have varying communication methods. We gained some feedback about the service people received. We also observed interactions between people using the service and staff members. We used the quality of these interactions, as evidence to make our judgements, identified within this report. We sent Mrs Bidmead an Annual Quality Assurance Assessment (AQAA) to complete. This is a self assessment which identifies how well the service is performing. It also gives information about the service’s future plans. Information from the AQAA is detailed within this report. The last key inspection of this service took place in May 2008. The service has been without a registered manager since December 2007. Since this time, there have been three acting managers. While acknowledging the impact of this regarding consistency, we saw that compliance in meeting the requirements we made, was poor. At our last inspection, we said that if considerable improvement was not assured, we would consider taking legal action. At this inspection, Mrs Bidmead demonstrated a clear focus to improve service provision. In a relatively short period of time, Mrs Bidmead has made significant progress. This is detailed later within the report. Mrs Bidmead told us she is in the process of finalising her application to become registered with us, as the registered manager. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A new care plan format has been introduced. The format is comprehensive and well organised. The care plan, which had been completed in the new format, was very well written, clear and person centred. People using the service have been readily involved in developing their care plan. A summary of each person’s needs has been developed with each individual. The summaries are located in people’s bedrooms. People have chosen the colour scheme of their bedroom and each room has been decorated accordingly. The hallway and communal areas have been redecorated. Risk assessments are in the process of being developed. Those undertaken were clear, comprehensive and related to the person’s care plan. People have had their risk of developing a pressure sore assessed. Clear measures to minimise potential risk are clearly identified. Staff training in tissue viability has been undertaken. A new assessment format has been developed. The manager now takes the lead within the assessment process to ensure appropriate placements. Consideration has been given to enable people more opportunities for social activity provision. A games console has been purchased. There is now a computer with Internet access. College placements are being investigated. Consideration has been given to the provision of transport and two smaller vehicles have been ordered. Staff recruitment has been successful and there is now less reliance on agency staff. All documentation in relation to the control of substances hazardous to health (COSHH) has been updated and is relevant to the substances in use. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 7 The Statement of Purpose has been updated yet the acting manager is planning to review the document to make it more ‘user friendly.’ The Wiltshire and Swindon safeguarding procedures are clearly displayed within the service. Consultation has been undertaken with the Fire and Rescue Service to improve fire safety within the home. Commitment, determination and a clear focus to improve the service has been adopted. 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. 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. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the admission process yet these need to be followed through in practice to ensure a clear, robust assessment process. EVIDENCE: At the previous inspections, we saw that the Statement of Purpose did not comply with regulation 4, Schedule 1 of the Care Home Regulations 2001. It did not detail fee levels or the care needs, which could be met within the home. Additional information such as transport costs, the absence of locks on bedroom doors and a call bell system were also not included. We made a requirement to address this so that all people who are considering using the service receive accurate information about the home, before making a decision to live there. Mrs Bidmead told us that the Statement of Purpose had been reviewed. She confirmed it met with regulation other than not detailing staff members and their qualifications. Mrs Bidmead told us however, that she felt the document could be improved upon. She said it was not currently conducive to peoples’ needs and there was much more information she wanted to include. This included aspects such as meal provision, social activity and education, Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 10 involvement in the day to day running of the home and the promotion of independence and enablement. Mrs Bidmead told us that she planned to involve existing people using the service, to develop the documentation. We saw within the AQAA that developing the Statement of Purpose and Service User’s Guide were areas planned for improvement. There have been no new admissions to the home since Mrs Bidmead has been in post. Within previous inspections, we saw that the assessment process was insufficiently robust. There was little written documentation to evidence that people had been appropriately assessed, before being offered a placement. Mrs Bidmead told us that improvements to the assessment process would be made. She said giving time to this area was essential to enable people’s needs to be met. Mrs Bidmead told us that she would lead the assessment process and meet the person initially in their own environment. A thorough assessment would be undertaken and the person would be encouraged to make various visits to the home. Mrs Bidmead said that consultation with the person’s family and any other people involved in the person’s support, would take place. Mrs Bidmead told us the needs of people already living in the home would be taken into account, before a decision was made to formalise the placement. Mrs Bidmead showed us an assessment format, which the organisation had recently developed. The format was clear, comprehensive and much improved in respect of the system previously used in the home. We said the way the assessment format was completed would be key to ensuring staff have the required information when providing the person’s support. Within the AQAA, Mrs Bidmead confirmed that a comprehensive assessment process would be undertaken by a competent individual. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements have been made to one care plan yet all plans need to be of the same standard. Greater focus is being given to enabling people to make decisions. Risk management is being developed. EVIDENCE: At previous inspections, we saw that care plans did not reflect the complexity of people’s needs. One person did not have a care plan and staff were relying on documentation from a previous placement. To ensure people’s needs were effectively met, we made requirements to address the shortfalls in care planning. Mrs Bidmead told us that she had given her full attention to this area. We saw that a new care planning format was in the process of being introduced. This was comprehensive and easy to follow. Mrs Bidmead told us that so far, one Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 12 care plan had been fully reviewed and updated to the new format. Attention was to be given to the other plans in order to ensure the same standard. We looked at the updated care plan. It was person centred, detailed, comprehensive and very well written. Mrs Bidmead told us that she was aiming to fully involve people in the development of their plan. After looking at the care plan, we asked the person using the service about it. They told us they had helped do the care plan. They said it was good. They told us they liked what was in their plan. The person showed us another care plan in their room. This was a single sheet describing the person and their likes and dislikes. They said they told Sheridan [the acting manager] what to write. They said they helped decorate the care plan with stickers and glitter. A staff member confirmed this. They told us that each person now has a basic care plan in their room. They said a more detailed plan addressing the support people needed with their health and personal care, was being developed. Within discussion, Mrs Bidmead’s desire to enable people to make decisions and exercise their rights, as individuals was clearly apparent. She said that ensuring people’s involvement was a key factor in providing a service. She said she would be working with the staff team to develop ‘each person’s voice’ and the choices available to them. Within the AQAA it stated ‘care plans implemented with input from service users or significant others to reflect individual need and choice.’ Staff told us that people are able to choose aspects such as what time they get up, what they eat, colour schemes of their room and what they want to do during the day. Preferred routines are now addressed within the new care planning format. Mrs Bidmead told us that people are beginning to be involved in menu and activity planning. We saw that people were asked what they wanted for lunch. One person was asked if they wanted to play games or use the games console. Staff told us that one person had been supported to leave the service into more supported living arrangements. Mrs Bidmead told us that ‘service user’ meetings had been introduced. This enabled people to share their views and be informed of things that were going on within the home. As a means to further improve decision making, Mrs Bidmead told us that focus would be given to developing people’s communication methods. As part of the new care planning format, we saw that risk assessments were being developed. Those that had been completed so far were detailed and clearly corresponded to the person’s care plan. Mrs Bidmead told us that she was aware that more assessments were in need of completion. She said these would be undertaken when each care plan was reviewed. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the 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 now have greater opportunities to be involved in age related social activity provision. Important relationships are supported. Greater focus on communication systems would enhance people’s rights and responsibilities. People have a range of meals they enjoy. EVIDENCE: Within the AQAA, we saw that community access and educational opportunity were aspects the home could do better. Staff told us that this area had already been approved upon and people were now going out more. They said that people may go out shopping, for a walk within the village or out for lunch. We saw that two people went out to the cinema during our visit. Staff told us that people had recently gone to a farm park, to London and to Weston-Super- Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 14 Mare. They said a trip to Bristol Zoo had been arranged. There were photographs of various events within the sun lounge. Mrs Bidmead told us that individual social activity and the need for age related opportunities were being given clear focus. Two people were being supported to look into college courses they may like to attend. Other staff also told us about this. One person told us they wanted to go to college. They said they liked dancing. They said they were able to meet with their friends. They also used the computer to keep in contact with people important to them. They had a boy/girlfriend. Staff told us that this relationship was supported. Mrs Bidmead told us that the computer with Internet access had recently been purchased. She said some people regularly used it. Other people were to be given staff support to experiment with it. We saw that staff supported one person to play bowling on the newly purchased games console. The person then changed the game to boxing. Another person spent time within the sensory room. Others sat with staff in the dining room and did craft work. We saw that there were some good interactions. However, there were times when staff spoke between each other and did not involve people using the service. One person repeatedly asked questions yet these were not always answered. We saw that one member of staff asked a person if they wanted to play a game. This was not followed through and the person remained unoccupied. Staff told us of some good work that had been undertaken with one person using the service. They said the person was more relaxed and now enjoyed external social activity. Staff said they liked to help with the home’s food shopping. They also liked personal shopping for items such as toiletries and clothing. Staff told us that people may accompany them on errands such as collecting prescriptions or going to the village shop. Mrs Bidmead told us that it had been identified that the home’s vehicle was not easy to drive. She therefore requested two smaller vehicles. These were on order. Mrs Bidmead told us that the majority of staff would then be able to drive the vehicles. People could also be supported to go out more on an individual basis. We saw within care plans that social interests were not fully expanded upon. Staff had recorded activities undertaken yet these generally detailed ‘watching television’ and ‘listening to music.’ There was little evidence that the activity was linked to the person’s individual needs. Within daily records we saw that focus was given to tasks and meeting people’s physical care needs. We advised that staff should document activities people were involved with and which appeared successful. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 15 Staff told us that routines of the day were flexible and depended on what people wanted. One person told us that they did not like getting up early. Staff said that people are supported to get up when they wake. They said they were aware of people’s preferences and aimed to meet these, wherever possible. At the last inspection we saw that one person’s bed had been tipped up against the wall. We said that alternate behaviour management strategies should be sought from a specialised health care professional, such as a psychologist. Mrs Bidmead told us that the restriction had been discussed with the person’s family. Further discussion was to be undertaken during the person’s review. Mrs Bidmead told us that while the restriction currently remains in place, staff were aiming to improve the person’s involvement within social activity provision. This would minimise the need for any such intervention. Mrs Bidmead told us that the situation was being monitored. We saw that the person was asked if they wanted a rest in the afternoon. Mrs Bidmead told us that if the person wanted this, they would be supported to lie on their bed. Staff told us that the menus had been revised. They said people continued to have a snack at lunchtime and a hot meal in the evening. The menus showed the availability of a cooked breakfast at weekends. Items such as soup, beans on toast or sandwiches were shown as a lunch time meal. Examples of the evening meal were quiche and salad, roast chicken and lasagne with garlic bread. Staff continue to undertake the responsibility of food preparation. Mrs Bidmead said that she did not see the need for a cook. She told us she had spoken to senior managers about making the kitchen more ‘user friendly.’ People could then be supported to assist in meal preparation, if they chose to. Some people have specialised eating programmes. The guidelines for these had been reviewed yet not dated. One person told us they liked curry. They said the food was good and staff were ‘good cooks.’ Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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 receive a high level of support with their daily living routines. People have good access to health care personnel. Medication administration is well managed therefore reducing the risk of error. EVIDENCE: People continue to receive a high level of staff support to meet their physical care needs. A range of equipment is in place to assist people. Within the newly updated care plan, there were clear details about the support the person required. Their individual wishes such as not wanting to be disturbed during the night, were stipulated. We discussed the need of ensuring people’s wishes balanced with the home’s duty of care. Mrs Bidmead said she was aware of this and had explored capacity issues. She said she was confident that the identified person could make informed choices and would request help, if needed. We recommended that this was regularly monitored and documented. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 17 The person had had their risk of pressure damage assessed. There were clear guidelines in place to minimise any potential risk. Specific areas of the body, which staff needed to check for pressure damage, were clearly identified. Within the AQAA, it identified that ‘accessing a wide ranging multidisciplinary team’ and ‘accessing all health care checks’ were something the home did well. There was a record of any health care intervention the person had received. This included the GP, community nurse, podiatrist, psychiatrist and dietician. Staff told us that one person was currently in hospital. Staff were supporting them with their personal care routines at the hospital, to ensure their needs were met. We saw that some people had food and fluid charts in place. These had not been consistently filled in and had not been evaluated at the end of the day. Mrs Bidmead told us that each person ate and drank well. Unless the person was unwell, she said she was not sure of the reason for the charts. Mrs Bidmead told us that she was planning to discuss the need for such monitoring with visiting health care professionals. She said their advice would be followed. As a means of improvement, the AQAA stated ‘develop communication tools where needed.’ One person told us that they had an electronic communication system yet they did not like using it. They said they liked to practice their voice and had their own system of enabling people to understand what they were saying. They told us staff were good at ‘working things out’ and identifying their needs. We looked at the medication administration systems in place. We saw that the medication administration records (MAR) were appropriately maintained. There were no gaps in the signing of medication, which had been administered or refused. Handwritten medication instructions had generally been dated, signed and witnessed by another member of staff. There were protocols in place for people needing ‘as required’ medication. Clear indicators in relation to pain, were stated in the person’s care plan. We saw that a GP can authorised in writing, that one person could have their liquid medication in a drink. Another GP had authorised a list of homely remedies their patient could take safely. One person had signed their consent to enabling staff to store and administer their medication on their behalf. Another consent form had been signed by the person’s representative. We saw that the label on one medication stated to be taken ‘as directed.’ Another medication was stated as ‘as required’ yet was detailed on the MAR as ‘to be taken twice a day.’ We advised that these aspects be discussed with the GP so that people received all of their medications safely. One person used ‘patches’ as a form of medication. We advised that the management of these be clearly detailed within the person’s care plan. Staff told us that they received medication training and were assessed as competent, before they administered any medication to people. Within the AQAA we saw that the medication policy had been updated. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the 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 are generally dependant on others to raise concerns on their behalf. Systems are in place to manage complaints effectively. People are better safeguarded from harm due to staff’s awareness of local adult protection procedures. EVIDENCE: We saw that a pictorial formatted complaint procedure was in place yet Mrs Bidmead told us that in time, she wanted to develop this further. Developing a more user friendly format was identified with the AQAA. We saw that one person had been supported to use the existing format. They had raised a concern about the house being in a ‘mess.’ Later within the complaint form, it stated ‘Corridors have been painted and look much better. I am pleased.’ We saw that a neighbour had raised a formal complaint. The complaint was in writing and documentation showed the investigation of the complaint and its outcome. We saw that the outcome was verbally discussed with the neighbour. We advised that any such interaction be followed up in writing. Mrs Bidmead told us that there had not been any formal complaints made to the service since the last inspection. The AQAA confirmed this. Staff told us that they would aim to resolve any issue which was brought to their attention. They said they would inform Sherrie [the acting manager] without delay if a Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 19 complaint was received. Staff told us that people’s family members or representatives remain strong advocates for people. They said they aim to keep relatives regularly informed so that any issues can be readily addressed. At the last inspection, we saw that staff had received adult protection training yet Gloucestershire safeguarding protocols were covered. As the home is in Wiltshire, we said that staff should be aware of the local adult protection reporting procedures, rather than those of Gloucestershire. Mrs Bidmead told us that this had been addressed. Discussion had taken place with staff during staff meetings. ‘No Secrets’ documentation, which summarises the Wiltshire and Swindon safeguarding protocols were posted on the notice boards. Mrs Bidmead told us that staff had been given a copy of the documentation. She said she would make sure that any future adult protection training would take place in Wiltshire. The training would also involve Wiltshire and Swindon’s safeguarding procedures. We saw that some staff had completed the ‘Safeguarding Alerter’s Guide’ training. We asked staff a hypothetical question about abuse and what they would do if an allegation was made to them. They told us that they would immediately report any allegation to management. We asked about local safeguarding units and they told us that the home came under the Swindon area. Contact details of the Swindon Safeguarding Unit were detailed within documentation on the notice board in the main office. We looked at the procedure for managing people’s personal monies, held for safe-keeping. We saw that changes had been made to the auditing of the monies. We saw that the monies were counted and checked at each shift change. This was meant each cash amount was checked and witnessed three times a day. We said the checks appeared excessive and appeared to take valuable staff time away from people using the service. Due to the level of checking, we did not count any cash amounts. We saw that receipts demonstrated appropriate expenditures such as toiletries and clothing. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the 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 an environment, which is comfortable, well-equipped and conducive to individual need. Bedrooms now positively reflect each individual’s preferences and identity. Consultation with the Fire and Rescue Service has enabled people to be further safeguarded in the event of a fire. EVIDENCE: Quarrydene is a spacious bungalow within a quiet village setting. There are nine single bedrooms. Some have individual en-suite facilities including a specialised bath or shower. A number of rooms share an en-suite facility. To ensure people’s privacy and dignity, we said people requiring full staff support with their personal care needs, should occupy these rooms. Staff could then make sure that the doors were closed appropriately. Mrs Bidmead said she was aware of this and would ensure it was adhered to. The en-suite facilities have a very small hand wash basin, which potentially makes it difficult to use. At Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 21 previous inspections, we have made recommendations, to ensure people are satisfied with the hand wash basin. Any decision should be recorded within the person’s file. This has not been addressed. All bedrooms have overhead hoisting facilities. Since the last inspection, there have been significant developments in the individualisation of people’s rooms. People have chosen the colour scheme of their room and it has been decorated accordingly. Staff told us that one male person using the service chose bright pink. Staff told us that while stereotypically this colour was not expected, the person’s wishes were respected. Another person told us they chose pink and mauve. They said they chose which wall was painted which colour. They told us they had bedding to reflect their favourite musical. We saw that curtains within people’s bedrooms had been replaced to coordinate the colour scheme of the rooms. People had a range of personal possessions within their rooms. Some people had posters around their room, which reflected their individuality. Some people had televisions, music and sensory equipment. Staff told us that one person was planning to have ‘glow in the dark’ shapes on their ceiling. We saw that the communal areas including the lounge, sun room, main corridor and kitchen had been decorated. Mrs Bidmead told us that an on going programme of redecoration and refurbishment would continue. A new fire safety system, new garden furniture and a vegetable plot were also planned. We saw that plans to make the kitchen access easier, as earlier stated, were identified within the AQAA. We saw that the sensory room was effective and was being enjoyed by the person using it. The chairs in the sun room would however benefit from being covered, as the seating material was split. Mrs Bidmead told us that staff continue to be responsible for the cleaning tasks within the home. She said that in the future, she wishes to develop people’s involvement in maintaining their own room, with staff support. We saw that the home was clean on the day of our visit. There are two laundry rooms within the home. This is so that soiled linen is not carried from bedrooms to the main laundry room via communal rooms. Mrs Bidmead told us that the tumble drier in the small laundry room is no longer used. The room became very hot and was felt to be a health and safety hazard. The washing machine continues to be used as before. We saw that staff had access to disposable protective clothing. Policies and procedures are in place to manage soiled linen. At the last inspection we saw that all fire doors were locked and needed a small knob to be turned to unlock them. This appeared time consuming in the event of a fire. We advised that the locks be discussed with the Fire and Rescue Service. Mrs Bidmead told us that this had been undertaken. The locks were of a satisfactory standard. As part of the visit, a new fire safety system Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 22 was recommended. This has been purchased although has not as yet been installed. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People using the 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 now benefit from a more consistent staff team due to less reliance on agency staff. The opportunities of staff training are improving yet some topics need to be arranged so that staff have adequate knowledge and skills to meet people’s needs. EVIDENCE: Staff told us that there are generally five staff on duty during the waking day when people are at home. At present there are four staff, as one person is in hospital. The fifth person normally working on shift is currently supporting the person in hospital. At night there are two waking night staff. The staffing rosters demonstrated this. Mrs Bidmead told us that staffing levels currently meet the needs of people using the service. She said that once the home is fully occupied, staffing levels would be further reviewed. We saw that there is now less reliance on agency staff. Previous to Mrs Bidmead commencing employment, a successful Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 24 recruitment drive had taken place. Mrs Bidmead said had also appointed staff yet they have not commenced employment due to waiting for satisfactory recruitment checks. As there have not been any new staff since Mrs Bidmead’s appointment, we did not look at the recruitment documentation of staff members. At our last inspection, recruitment documentation regarding some staff could not be located. Other staff files showed clear, robust recruiting procedures. Mrs Bidmead told us that she was aware of all documentation and checks, which needed to be undertaken before an applicant commenced employment. We said we would look at staff recruitment documentation at our next inspection. As stated earlier in this report, we saw some positive interactions with people. We saw one staff member clearly evidence that they were aware of a person’s needs. On return from the cinema, people using the service were warmly welcomed by staff. Another person was sensitively supported to the table for a drink. There were other interactions however, which were not so positive. We heard one person being asked quite loudly if they wanted to use the toilet. This did not promote the person’s dignity. Some staff talked ‘over’ people and spoke between themselves, rather than involving people using the service. One person was asked if they wanted to do some drawing. They said ‘no.’ The staff member asked ‘why not?’ Another staff member said ‘because s/he’s lazy.’ We spoke to Mrs Bidmead about this in feedback. She said she would address the issues with staff but suspected that the last comment was made in a joking manner. Mrs Bidmead told us that she felt all staff genuinely cared about people and wanted to do their best for them. Staff told us that opportunities for staff training had increased. They said they had recently completed manual handling training. Mrs Bidmead told us that a clear focus was being given to ensure all staff were up to date with their mandatory training. She said this was ‘well underway’ although recognised that some shortfalls remained. The staff training matrix showed details of each person’s name and the training they had completed. Some training topics, such as first aid showed an expiry date when refresher training was required. Other topics, such as infection control showed ‘never expires.’ This implied refresher training was not needed. We discussed this with Mrs Bidmead. Mrs Bidmead said she had identified this and felt all training needed to be updated on a regular basis. Within documentation we saw no evidence of up to date infection control training. The matrix showed that some people had completed this in 2007. There was no evidence that staff had completed training in specialised areas such as ‘peg feeding.’ Mrs Bidmead told us that she believed staff had received the training although she would ensure sessions were repeated. At our last inspection we recommended that other training, specifically linked to people’s needs, should be arranged. We also recommended that visual impairment Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 25 training should be arranged. These recommendations have not been addressed. Within the AQAA, ‘poor access to training and lack of encouragement to train’ was seen as a barrier to improvement. We saw that identifying further training in relation to need was planned. This included key worker and person centred planning training. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the 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 development of the home has been restricted through management changes and an insufficient emphasis on the shortfalls previously identified. People are now benefiting from direct leadership and a clear focus to improve standards. EVIDENCE: There have been various changes to the management structure within the last 18 months. The registered manager left her position in December 2007. For a short period of time, an existing member of staff undertook the role of acting manager. A staff member within the organisation was then seconded to the role. Mrs Bidmead was recruited from an external organisation in April 2009. She is a registered nurse and has maintained her PIN although she is aware Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 27 she will not be able to practice her nursing skills at the home. Within the AQAA, we saw that Mrs Bidmead has experience of working with people with a physical disability and has managed a large staff team. Mrs Bidmead told us that she is in the process of completing her application to become registered with us, as registered manager. She believed that frequent management changes had been a barrier to improvement. She said staff had experienced management inconsistency, which had impacted upon morale. Mrs Bidmead told us that she believed this to be improving, as staff were embracing the changes and working hard. Mrs Bidmead told us that she had recently completed a number of short courses. These included safeguarding, equality and diversity, record keeping, first aid and food hygiene. Mrs Bidmead showed a clear desire to develop the home and to improve people’s quality of life. Staff told us the management style of the home had now improved. They said Mrs Bidmead had given the home stability and morale was much improved. They felt they were involved in the development of the home and were pleased that clear, directed leadership was now in place. We saw that representatives had visited the home, as part of the organisation’s responsibility under regulation 26. Documentation showing consistent monthly visits was not available. There was little evidence that the previous poor compliance to meet the requirements made, had been discussed or addressed during the visits made. Not all records showed that discussions had been held with people using the service and staff members. Mrs Bidmead told us that senior managers were now planning to complete the regulation 26 visits so greater consistency and detail was expected. At our last inspection, we made a requirement to ensure a quality auditing system was implemented in the home. Mrs Bidmead told us that this had been addressed in part. An audit had been undertaken and a number of surveys were sent out to people’s representatives. There was no evidence of the feedback received. People using the service were not involved in the process. Mrs Bidmead told us that following the completion of all care plans, she would give her attention to quality assurance. Mrs Bidmead was aiming to develop a user friendly format to encourage people’s involvement. Mrs Bidmead showed us a file which contained details of the maintenance of the home’s equipment. This included the testing of the portable electrical appliances, a gas safety record, servicing of the fire alarm systems and hoisting equipment. All checks were up to date and no outstanding works were evident. We saw that external contractors had tested for legionella. A recent health and safety inspection had recently been undertaken. The inspection identified the need for more risk management. Mrs Bidmead told us that this work was in the process of being undertaken. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 28 We saw that documentation in relation to the safe use of chemicals (COSHH) had been updated. A number of generic risk assessments were in place. These had been undertaken in March 2008 and were in need of updating. We saw there was a risk assessment regarding violence to staff. It stated ‘all staff to be instructed as to how to respond to threats of violence.’ There was no evidence that staff had received such instruction. The fire log book showed regular testing of the fire alarm systems. However, there was little evidence of fire instruction for staff. Mrs Bidmead told us that fire drills are now taking place on a regular basis. Fire evacuation procedures have been reviewed and are available in each person’s room. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Version 5.2 Page 30 Quarrydene DS0000067364.V375402.R01.S.doc Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Requirement The Registered Person must ensure that the Statement of Purpose contains details of the fees and the care needs, which can be met at the home. Transport costs and the absence of locks on doors must also be stipulated. Timescale for action 30/06/09 2 YA6 15 This was initially identified in 2006. The Statement of Purpose has since been review yet shortfalls remain. The acting manager gave assurances the document would be further reviewed in a user friendly format. The Registered Person must 30/07/09 ensure that due to peoples’ limitations with their communication, all care plans are to be developed and signed by the person’s representative. This was initially identified in 2006. Some progress has been made. The acting manager gave assurance that all plans would be signed when in the new format. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 31 3 YA26 12(4)(a) The Registered Person must ensure that people who use the service and/or their representative are asked if they wish to have lockable storage space and a lock on their bedroom door. This must be evidenced within the person’s care plan. This was initially identified in 2006. The acting manager gave assurances that this would be addressed within the review of all care plans. The Registered Person must ensure that a quality assurance system is developed and implemented within the home. 30/07/09 4 YA39 24 30/07/09 5 YA2 This was initially identified in 2006 and has been met in part. The acting manager gave assurances that the system would be further developed to incorporate people’s views. 30/04/09 14(1)(a)(b) The Registered Person must ensure that people are only admitted after a robust, assessment process, to see whether their needs can be met. The home must complete a formal documented assessment and a copy of the assessment undertaken by the placing authority must be gained. This requirement was identified at a previous inspection yet was not assessed, as there have been no new admissions to the home. The Registered Person must ensure that peoples’ complex needs and safety are taken into account when considering new admissions. 6 YA3 13(4)(c) 30/04/09 Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 32 7 YA34 8 YA35 9 YA37 10 11 YA42 YA42 This requirement was identified at a previous inspection yet was not assessed, as there have been no new admissions to the home. 19 The Registered Person must ensure that written documentation is available to evidence a robust recruitment procedure. This requirement was identified at a previous inspection yet was not assessed, as there have not been any new staff since the acting manager has been in post. 18(1)(c)(i) The Registered Person must ensure that all staff receive infection control training and training in ‘peg feeding.’ 26 The Registered Person must ensure that monthly organisational visits are made to the home and records are available to evidence each visit. 13(4)(b)(c) The Registered Person must ensure that all risk assessments are up dated on a regular basis. 13(4)(c) The Registered Person must ensure that staff receive regular fire instruction. 30/04/09 30/07/09 30/04/09 30/04/09 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA12 Good Practice Recommendations The Registered Person should ensure that daily records contain evidence of social activity and quality of life matters, rather than routine care provision. This was identified at previous inspections but has not been addressed. The Registered Person should ensure that greater focus is DS0000067364.V375402.R01.S.doc Version 5.2 Page 33 2 YA16 Quarrydene 3 YA19 4 5 6 7 YA20 YA22 YA23 YA26 8 YA35 9 YA35 given to communication systems so that people are enabled to express themselves more. This was identified at previous inspections but has not been addressed. The Registered Person should ensure that the recommended level of fluid intake for wellbeing is recorded on the fluid intake charts. This was identified at previous inspections but has not been addressed. The Registered Person should ensure that guidance for the administration of ‘patches’ is clearly identified within the person’s care plan. The Registered Person should ensure that the complainant is informed of any complaint investigation outcome in writing. The Registered Person should consider reducing the amount of times a day people’s personal monies is checked. The Registered Person should ensure that people who use the service or their representatives are satisfied with the provision of a small sink in their en-suite facility. This should be recorded within care plans. This was identified at previous inspections but has not been addressed. The Registered Person should ensure that the home’s training plan is specifically related to people’s needs and should therefore contain topics such as communication and individual health care conditions. The Registered Person should ensure that staff receive sensory impairment training. This was identified at previous inspections but has not been addressed. Quarrydene DS0000067364.V375402.R01.S.doc Version 5.2 Page 34 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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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