Inspection on 30/01/09 for Quinton House

This inspection was carried out on 30th January 2009.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Quinton House 2 The Hill Kirkby In Ashfield Mansfield Nottinghamshire NG17 8JR zero star poor service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Litchfield Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Quinton House 2 The Hill Kirkby In Ashfield Mansfield Nottinghamshire NG17 8JR 01623723321 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Freres Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The registered person may provide the following categories of service only: Care Home only - Code 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 - Code LD The maximum number of service users who can be accommodated is 4 Date of last inspection A bit about the care home Quinton House is a service for people who have a learning disability. It provides accomodation in a large house for up to four people, each with their own large room and three have an ensuite bathroom. The building is large with a lounge, dining room and big kitchen. Quinton House is located in Kirkby-in-Ashfield, close to the town centre with its shops and local amenities. There was no manager in post at the time of this inspection, with the manager from another home taking responsibility for the day to day running of the service. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We visited the home in January 2009 and we met the acting manager, staff and people who use the service. We asked the acting manager and staff about what they do for people. We looked at peoples records. We wanted to see what information it had and where it came from. We wanted to see if people are happy with their service. We also looked at staff files to see if they are safe to work with people. We looked at other paperwork and information the service has sent to us. What the care home does well Some people had lots of information about themselves and what they want staff to help them with. Staff are able to give people lots of attention. People are able to make choices like about what they do with their time, and what they eat. People live in a large home that is clean and comfortable. What has got better from the last inspection What the care home could do better The service needs to make sure that staff and management are properly employed with all the right systems in place so people are well supported and the service well managed. The service needs to make sure staff are fully trained and supported around how to keep people safe. The service needs to make sure it has all the necessary information for people to understand about the home and make decisions about it. Some peoples records need much more information about their needs and expectations and about how staff can support them. Medication needs to be managed correctly with the records showing when people have had their medication. When we ask for information from the service it must be correct. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact David Litchfield CSCI CPC1 Capital Business Park, Fulbourne, Cambridge, CB21 5XE 01233 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 . People are not provided with a guide to the service and not all people have all full assessments of their needs and expectations from the service. Evidence: We looked at the information available about the service. We saw that there is a required document called a statement of purpose and this did tell people about the kind of service available from Quinton House, and about how to make a complaint. However, we found information was not up-to-date, for example it gave the name of the previous manager who has since left. This document also refers to an information pack that is given to people who are thinking about using the service. We asked if there is a guide or pack for these people and the acting manager told us there isnt one. She did say that she had identified it as something that needed to be produced. Family members of people using the service told us that they were not aware of any information packs being provided when their relatives were considering the service. We were told there is no written procedure for introducing people to the service but that people are encouraged to visit and come for tea, and have a chance to look around and meet staff and other people living there. We were told that other people using the service would also be consulted to see how they feel about it. A family member told us that their relative did visit first saying they took him round a couple of times, asked him if he wanted to live there and he said yes. We spoke to people using the service and were told I like it and other said he was Evidence: happy with his room, being able to look out of the window. We looked at peoples records to see what information is found out about them before they receive a service. We saw one example where the person had lots of information about their needs and expectations. We saw that there was information from a social worker, and that the service had then gathered lots more information about what the person will need from staff and their preferences. Some of this information was clearly presented in a way to help staff understand that person. We looked at another persons records and found very little information about the person. There was no clear information about what that person needed and expected from the service, although there was some information about their aspirations. Despite being funded by the local authority, there was no information from them about the persons needs; the manager told us that this had been lost. We spoke to staff who confirmed there was not much information but we heard that they were able to find out about him by talking to him directly about his needs. We did not find any information about how peoples needs and expectations differ from others. For example, the acting manager told us that one person had attended church in the past but there was no information about this. We spoke to staff and found that while some knew about this, not all did. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People exercise choice but not all have a plan of care to clearly show staff how they need and expected to be supported. Evidence: We looked at the information staff are given about the way people need and expected to be supported. One person has a very detailed plan about their care divided into lots of different sections covering things like support with personal care, communication, health needs and others. It is up-to-date and sections are written in a style that show what the person expects from the care, the objectives and plenty of information to help staff know exactly what to do. The person told us that it is his plan and that he is happy with it. We saw that each month the plan has been reconsidered to see if it is still working, although there is no record of whether the individual had been involved themselves in that check. However, the information does not cover how the person differs from others and how that could affect the support he needs. As mentioned earlier, the person has attended church in the past but there is no information about this to tell staff if he needs or expects support in this area. The other person using the service does not have a plan about the care he needs. There is some brief information about aspirations from the service but nothing about exactly how staff should support him. We heard from this person that he was about to have a meeting with his social worker and the service to discuss his care. We asked staff about how they know how to care for this individual and we were told that they discuss any support directly with him. Evidence: Family members told us that people who use the service are able to make choices in their lives. We heard from one that a person is now a lot more self-confident and he has choice, if he says he wants to go to bed, he does. Staff also said people were able to take control of their lives saying thats the beauty here, youre here just for them. We saw that the service has identified risks in peoples lives and put in place steps for staff to take to minimise them. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service are able to make choices around their lifestyle and are supported to develop skills. Evidence: We saw that daily records are kept that record some of the activities people participate in, for example we saw a visit to a market mentioned. One of the people using the service keeps his own record of activities and we saw things like cooking and family activities recorded. Both people using the service attend educational and leisure activities away from the service during the week. We looked at how people are supported to develop skills in the household, and saw that the person who has a plan of care, has guidance for staff around how to support him with domestic tasks. Staff confirmed that he is involved in managing the household saying hell strip the bed and help to make it and hell polish. The other individual does not have a plan around this, but staff told us we are working on developing his skills. That person told us that he puts clothes in the wash, hoovers a bit, and washes the pots. We looked at how people using the service are supported to maintain relationships with those important to them. Family members told us they are kept informed and made welcome at the home. One person has a plan in place around how to support with family. The other person has no information about this despite staff telling us that it is a complex area in the persons life where support is needed. However, we did hear Evidence: from this person and his family that he has been able to maintain his relationships. We looked at records around the food people eat. We heard that there is no fixed menu and it is planned on a daily basis. This was confirmed by one person using the service, and we saw records are kept of what people eat and that it is nutritious and balanced. Staff told us that people get involved in making tea and they just choose between them, the supermarket is down the road, we just have a wander down. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People receive the personal care and health care support they need in a dignified and respectful way. Evidence: We observed staff interacting with people using the service and saw that staff acted in a kind, supportive way. A family member told us that staff are respectful. A person using the service told us he can talk to staff about whats gone off and they will listen at all times. We saw that one person needs regular support from an outside professional and we saw that this in place. We spoke to staff and found that their were aware of this individuals health needs and their responsibilities around it. We saw that records are kept about the support people have received, including details of any appointments they attend. Staff told us that with a small number of people using the service we spend a lot of time and get to know them and that they get all the attention of the carer. We spoke to family members about the care people receive and heard that since hes been at Quinton weve seen a change, he looks really well now, a picture of health. Another family member told us that because its almost 1 to 1, it is better, now he gets more attention and thats what he needs. We also heard that staff are respectful. We saw that people are supported with their medication. We looked at records around this and found that medication due the night before had not be recorded as given. The acting manager called the staff member and was told that they had forgotten to sign Evidence: for it, and the person whose medication it was told us he had taken it. We looked to see if the service had a policy around what to do if medication is missed and saw that there is no written guidance for staff to follow. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People may not be fully able to complain; they may not be kept safe as staff are not aware of all their responsibilities in this area. Evidence: We looked at how people can make complaints about the service. We saw that the service has a policy in place but we heard that no complaints have been made since the service started operating. However, as mentioned earlier, people are not provided with an accessible guide to the service that would clearly explains how to complain. One person told us that they did not know how to complain as it is hard to know about it but if you get stuck than ask someone about it. We also heard that if he was unhappy he would tell someone, staff. We looked at how the service keeps vulnerable people safe from the risk of abuse. We saw they have a policy about this that gives staff useful information about abuse and who they might contact such as ourselves or the police, but there is no mention of the local authority, the lead organisation for these issues. We saw that the service does not have a copy of the local authority procedure to show them how to refer concerns although we did see a training booklet from the local authority around the subject. There have not been any situations referred to the local authority for people using the service. We spoke to staff around their knowledge in this matter. All described to us how they would recognise indications of abuse and told us that if concerned they would report it to a senior person in the organisation. We heard that if their concerns were about a manager they would take it higher up. However not all were aware of the need to report to the local authority. The acting manager showed us that she had already identified the need to develop the policy on whistle-blowing which would explain how and when to report concerns outside of the organisations. 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 clean and homely environment. Evidence: We saw that the home is kept tidy and clean and smelt fresh throughout. A family member told us I think its lovely. In places the decoration is space with only a few homely touches, but we were told that this is down to it being not fully occupied yet. We heard that the style of the home would develop with the individuals who come to live there. We saw that there was plenty of room for the people who live there with a large kitchen, dining room and lounge. We looked at peoples bedroom and each has a large en suite bedroom. Of the two vacant rooms at the time of the inspection, 1 is also en suite. We saw peoples rooms were personalised to their tastes, and people using the service told us they are happy, one saying he liked the view out of his window. We saw that there is suitable laundry facilities and staff were aware of the need to control the risk of infection. There is a cleaning checklist for staff to follow to make sure that the home is kept hygienic, and we saw that food safety guidelines are followed in the kitchen. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported by people who are not formally employed by the service. Evidence: We looked at how staff are employed to work at the home. We found that the registered company that owns and runs Quinton House only employs one of the members of staff. The other staff are employed by another organisation running another registered care home nearby. Staff at Quinton House work in both locations. While both organisations are owned by the same individual directors, they hold separate registrations with no formal agreement or relationship between the two. As the acting manager of Quinton is also the registered manager at the other home, we found it was possible for the service to check that people had been recruited safely with the necessary checks such as criminal checks and references. No information about the staff was kept at the service, but a director was able to retrieve staff files from the other home and we saw that they contained all the necessary information including information. However, there was no formal agreement concerning working at Quinton House or any written confirmation between the organisations that appropriate checks are done. In the case of the one individual employed directly by the service, we saw that they had checks made as required. We also saw training records showing she had received training in key areas such as infection control, food safety, and how to keep people safe from abuse. The acting manager told us she has not carried out regular supervision meetings with individual workers around their work performance or development needs. We also heard there are no specific team meetings about Quinton, although the service is mentioned when staff meet at the other home. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People use a service that has some systems for ensuring ongoing improvement, but changes are needed to involve people using the service and ensure their safety. Information provided to us about the service is not correct and people do not receive a service from a properly employed and registered manager . Evidence: We found that the service was registered with a manager who had left the service, with a certificate displayed that was out-of-date. The service rang to request a new certificate reflecting the current situation during the inspection. We found that an acting manager was in place, who is registered with us to manage another service provided by a different organisation. There is no formal contractual arrangement or documentation about her work at Quinton House, although the directors of the two organisations are the same and fully able to check her suitability. We saw that the acting manager had carried out an audit of the home and noted areas where changes and improvements needed to be made such as staff training, and policies. We saw that some of these had already been done, for example it had been identified that electrical equipment needed testing which had since taken place. Other important changes remained necessary such as carrying out fire drills. Before our inspection we had asked the service to complete a document telling us about the work they have done since opening along with their plans for improvement. We found this document did not provide us with the information they need. Also, we found that its contents had been largely been copied from an equivalent document for another service meaning incorrect information had been copied over. For example in Evidence: one section it gave the wrong name for the service, and in others information about what they do was wrong, telling us about surveys and meetings for people that does not happen at Quinton. We saw that necessary checks are made on the environment such as fire testing and checks of water temperatures and that there had been no recorded accidents since the service was opened. We also saw that the registered provider of the service makes unannounced visits to check how the service is running. However, we heard that there have been no formal gathering of the views of people using the service, staff and others to feed into this process. We saw that there are detailed policies in place and staff confirmed that they are required to read and understand them. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description Timescale for action 1 1 2 There must be an assessment of the needs of people using the service. 28/04/2009 This will ensure that people are confident their needs and expectations can be met. 2 1 4 There must be an up-to-date 28/04/2009 statement of purpose. This will ensure that people are provided with accurate information about the service. 3 1 5 There must be a written 28/04/2009 guide to the care home provided to people using the service. This will ensure that people have appropriate information about the service. 4 6 15 There must be a written plan 28/04/2009 as to how peoples needs are to be met. This will ensure that people are supported in the way they need and expect. 5 20 13 There must be arrangements 28/04/2009 for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This will ensure that people are supported safely with medication. 6 23 13 There must be arrangements 28/04/2009 to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This will ensure that people are safe 7 34 19 The registered person must 28/04/2009 not allow a person to work at the care home unless they have obtained in respect of that person written confirmation from their employer the information specified in schedule 2 along with written confirmation that the employer is satisfied to the authenticity of the references. This will ensure that people are supported by people who are safely recruited. 8 37 8 The registered provider shall 28/04/2009 appoint an individual to manage the care care. This will ensure that people receive a well managed service. 9 39 24 Correct information must be 28/04/2009 supplied to us with respect to the quality monitoring procedures when requested. This will ensure that people receive a well managed service. 10 42 23 Fire drills must be carried out 28/04/2009 at the service at suitable intervals. This will ensure that people are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 Peoples plan of care should describe what support people needs and expect from staff to enable them to maintain relationships with people important to them. There should be regular staff meetings focused on Quinton House to ensure people are cared for by well-supported staff. There should be regular staff supervision meetings to ensure people are cared for by well-supported staff. 2 33 3 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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