Inspection on 06/10/09 for Shapland Close

This inspection was carried out on 6th October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shapland Close 11/02/09

Shapland Close 15/01/08

Shapland Close 07/09/06

Shapland Close 04/01/06

Shapland Close 06/09/05

Shapland Close 07/09/04

Shapland Close 29/04/04

Shapland Close 17/02/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Shapland Close Wilton Road Salisbury Wiltshire SP2 7EJ Lead Inspector Alison Duffy Key Unannounced Inspection 6th October 2009 09:50 Shapland Close DS0000028422.V377147.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. Shapland Close DS0000028422.V377147.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 Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shapland Close Address Wilton Road Salisbury Wiltshire SP2 7EJ 01722 419777 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) www.scope.org.uk SCOPE Vacant Care Home 8 Category(ies) of Physical disability (8) registration, with number of places Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care Home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: 2. Physical Disability (Code PD) The maximum number of service users who may be accommodated is 8 Date of last inspection 11th February 2009 Brief Description of the Service: Shapland Close is a residential care home registered to care for eight adults with a physical disability. The home is situated on the outskirts of Salisbury, within close proximity to local amenities. The home is managed by SCOPE. The manager is Mrs Jane Maunders. Mrs Maunders started her post as manager in April 2009 yet is not yet registered with us. Shapland Close consists of two purpose-built bungalows with disabled access throughout. Each bungalow has four single bedrooms, a spacious lounge with dining area and an adjoining kitchen and specialised bathing facilities. A range of individualised, specialised equipment is in place. An additional bungalow contains the office and staff sleeping in room. There is a minimum of five staff on duty during the day. Three staff generally work with people in one bungalow. Two staff work in the other bungalow. At night there is one waking night staff member in each bungalow. Another member of staff provides sleeping in provision. In addition, an on call management system is in place. Fees for living at the home range from £1265.15 to £1667.88 a week. Shapland Close DS0000028422.V377147.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 0 star. This means the people who use this service experience poor quality outcomes. The service was last inspected in February 2009 and was judged as providing good outcomes for people. Since the last inspection however, there have been a number of incidents, which affected people’s wellbeing. These were referred to the local safeguarding procedures. Due to the safeguarding issues raised, we considered another key inspection was required. We therefore brought the key inspection forward, to assess the service further. Since the last inspection there has been a new manager and the organisation has completed a staff restructuring process. The home completed an Annual Quality Assurance Assessment (AQAA) earlier in the year. The AQAA is the home’s own assessment of how they are performing. The AQAA tells us about what has happened during the last year and about the home’s plans for the future. We used the AQAA previously completed for this inspection. We sent surveys, for people to complete with support if they wanted to. We also sent the home surveys to be distributed to staff and health/social care professionals. This enabled us to get people’s views about their experiences of the home. We received surveys from two people using the service, eight members of staff and one health/social care professional. We spoke to two relatives who also completed a survey. This inspection took place on the 6th October 2009 and the 14th October 2009. Mrs Maunders was in London for both of the days and was unable to assist with the inspection. On the first day, two team coordinators helped with any information required. On the second day, there were no senior staff on duty. Staff arranged for the service’s administrator to come in to the home to assist as required. During our visit, we toured the accommodation and met with six people who use the service. Due to people’s communication needs, we were not able to gain verbal feedback about the service they received. We spoke to staff members on duty and observed how they interacted with people. We saw people having lunch. We looked at care-planning information, staff training records and recruitment documentation. We also looked at documentation in relation to health and safety and complaints. The inspection highlighted a high number of shortfalls within the service. These impacted upon how people’s needs were being met and their safety. Following the inspection, the organisation informed us that a senior manager had been designated to investigate the service and to ensure improvement. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 6 All key standards were assessed on this inspection. Observation, discussions and viewing of documentation gave evidence, which showed 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. What the service does well: What has improved since the last inspection? What they could do better: Management must ensure that staffing levels are sufficient at all times to meet people’s needs. A full staffing review must be undertaken to ensure that staff have the knowledge and skills to meet people’s complex care needs. The high use of agency staff should be reduced unless further focus is to be given to agency induction and on going training. A review of the on call roster must be undertaken so that staff have access to management advice and support as required. The manager must ensure clear leadership and ensure that senior staff have the required training to undertake their role effectively, in the manager’s absence. The impact of the service’s current management structure must be considered in relation to the standard of service provision currently in place. Potential risks to people must be addressed within the risk management process. Where a risk such as malnutrition has been identified, this must be Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 7 given high priority with measures to minimise the risk, clearly in place. Any accident must be investigated and control measures must be put in place to minimise further occurrences. Care plans must be fully reviewed and updated to reflect people’s complex care needs. Systems must be in place to ensure all staff have the information required so that they can support people safely and effectively. Any guidance given by health care professionals must be stated in the person’s care plan and be followed without delay. Significant focus must be given to staff training, supervision and on going personal development. Staff must receive up dated training in mandatory topics such as manual handling, first aid, food hygiene, infection control and safeguarding vulnerable people. Additional training in relation to people’s individual needs is also required. This should include subjects such as learning disability, epilepsy, nutrition, communication and sensory loss. Staff must ensure that they use safe manual handling techniques when supporting people with their mobility. Manual handling assessments must be sufficiently detailed to address people’s complex needs. Interactions with people using the service could be improved upon in order to enable greater engagement. Person centred care needs to be developed with measures in place to enable people to be more involved in goal planning and decision making. A formal quality assurance system which meets the needs of the service must be devised and implemented. A review of food provision must take place to ensure all meals are nutritionally balanced and meet the needs of the people using the service. A thorough clean and redecoration of the laundry must be undertaken. The laundry must meet the needs of the service and therefore the second washing machine should be repaired or replaced. Staff must not soak laundry in bowls or leave wet cloths in a pile due to the risk of spreading infection. Staff must ensure that they clean less visible areas of the environment such as skirting boards and the edges of carpet. 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. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 8 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 9 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 Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 10 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 and 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. There is a clear admission process in place yet information given to people to help them make a decision about using the service needs to be kept up to date and in an easy to read format. EVIDENCE: As there have been no new people to the service, this outcome area was not looked at in detail during this inspection. From the AQAA, we saw that a clear admission process was in place. The person would be assessed to ensure the home was suitable for them. Information would be gained from other agencies to assist the assessment process. The person would be offered a formal advocate, if they needed one in order to support them with the information available and to express their views. We saw that the compatibility of the person in relation to existing people using the service would be considered. People would have a phased introduction to their admission. We saw that this might include a look around the home, staying for lunch, staying for the day and then an overnight stay. As there have been no changes to the admission processes, we used the AQAA and the last inspection to judge that a clear, well managed system would be in Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 11 place if required. However, a health care professional only responded ‘sometimes’ in their survey when we asked whether the care service’s assessment arrangements ensured that accurate information is gathered. We saw that the Statement of Purpose in the manager’s office was not up to date. While acknowledging that this is given out to people on an infrequent basis, the document should be up to date and reflect the service provided. The document should be available in an easy to read format. This would help people understand the information more easily, which would enable them to make a decision whether the home was suitable for them. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 12 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are not reflected within their care plan and therefore staff do not have accurate, up to date information to support people effectively. Systems to support people with decision making could be improved upon. People are at risk of harm through poorly managed risk assessment. EVIDENCE: Staff told us that the care plans in place might not be fully up to date. They said that staff shortages had impacted upon the time available to spend on tasks such as paperwork. They said they had ensured people’s actual care needs had been given priority. Staff believed the standard of care to be good. They said the staff worked hard despite the challenges of staff sickness and a high use of agency staff. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 13 We looked at a sample of care plans and saw that they had not been regularly reviewed. There had been some updates although it was not always clear what the changes to the person’s care had been. At the last inspection, we recommended that each segment of the care plan be dated. This would ensure that all information was current and accurate. We saw that this had not been undertaken. Within surveys, in relation to what the home does well, staff told us ‘good personal care to service users,’ ‘personal care is to a very high standard’ and ‘absolutely brilliant care of the residents and support for their individual needs.’ A relative was not so positive. They said ‘while there are some very good staff, the standard of care at the home has deteriorated. There is a very high use of agency and therefore many staff are not aware of people’s needs.’ A health care professional shared similar concerns. At the time of the inspection, a number of issues regarding people’s care were being addressed within Wiltshire and Swindon’s safeguarding procedures. The organisation had been asked to investigate the areas although a conclusion to date had not been reached. Staff told us about a number of key issues in relation to people’s health and personal care. These issues were not fully identified within the person’s care plan. One person in particular had specific needs in relation to maintaining their wellbeing. The importance and seriousness of the person’s condition if not adequately managed were not clearly identified. There was limited up to date information about this need within the person’s care plan. The person had received various interventions from health care professionals yet the advice given was not fully documented within the person’s care plan. Staff told us about the person’s condition yet felt matters were under control and being managed, as well as they could be. We did not see staff ‘go the extra mile’ to support the person with their primary health care need. Within a survey, a relative told us ‘there have been a number of errors in implementing our son/daughter’s care plan.’ We saw that people’s files were lengthy and contained a large amount of out of date information. Due to this, key information was not easily accessible. The care plans did not reflect the complexity of people’s health and personal care needs. This compromised people’s wellbeing, as the information available to staff to support people effectively was limited. We saw that some people had various charts to monitor their seizure activity, sleeping pattern and/or their food and fluid consumption. These were often disorganised and therefore not easy to follow or evaluate. Not all charts had been fully completed. This made evaluating the information difficult and did not give an accurate picture of events. We saw that people’s daily records contained basic information such as ‘went back to bed,’ ‘toileted’ and ‘had lunch.’ We advised greater detail and more information about quality outcomes Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 14 rather than specific tasks. We saw that there were some entries such as ‘padded for night.’ This was not person centred and did not promote the person’s dignity. The use of such terminology should be reviewed. A number of risk assessments were in place. The assessments showed a review date yet it was not clear if any information had been changed, as a result of the review. We saw that some assessments were not relevant due to the person’s changing needs. These needed to be removed from the file. The assessments we saw did not reflect the complexity of people’s needs and the particular risks involved. The identified control measures were insufficient to reduce the risk. We saw that key aspects such as the risk of choking had not been addressed. One person had a fall yet the circumstances had not been addressed within the risk assessment process. We were not informed of the accident under regulation 37. Staff told us that manual handling assessments were in the process of being reviewed with the Occupational Therapist. The Occupational Therapist gave specific guidance regarding the complexity of people’s needs. This involved people’s day to day manual handling needs and more specialised areas, such as post seizure support. Staff told us that the assessments had been discussed but had not been formalised in writing. There was concern that the risk assessments had not been completed and acted upon, as a matter of urgency. There was also concern that staff did not appear to have the knowledge or skills to complete the risk assessments effectively. One parent told us that that the service was not good at balancing risk. They said that matters were not quickly addressed so people were not safeguarded. Staff had not received any training in risk management. This area must be addressed as a matter of priority to ensure people’s safety. Within the inspection, we identified other factors which impacted upon people’s safety. These are discussed later within this report. Due to their health care conditions, people were unable to verbally express their needs and how they wanted to be supported. Staff told us that family members were strong advocates. We saw limited evidence of this within people’s care plans. There was a space on the care plan for an advocate to say they agreed with its content. Not all had been completed. Staff told us that they encouraged people, as much as possible to make decisions within their daily lives. They said that some people were unable to make decisions and therefore relied on staff or family members to make decisions on their behalf. We saw that one person was asked if they wanted tea or coffee to drink. They were shown the storage containers of both yet the containers looked very similar. This made making a visual choice, quite difficult. One staff member told us that they were in the process of gaining pictures of food and drink to assist people with making individual choices. We did not see that people were given a choice of what they wanted to eat during the day. Staff told us that if a person did not want something, they would show Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 15 it by pushing it away. One person repeatedly did this with the food they were offered. Staff offered alternatives yet were not able to find a food the person enjoyed. Staff told us that consideration is currently being given to enabling people to spend more time at home rather than attending their day service full time. This would enable people to have greater choice about what they did with their time. Staff told us that at present, there were only three senior staff who could drive the home’s vehicle. They said this restricted the opportunities of supporting people with going out. They said that staffing levels had also impacted upon people’s level of social activity provision. One staff member told us ‘it can be difficult to get out and about. We don’t do it, as much as I would like but I definitely make sure that people go out at least once over the weekend.’ Within a survey, a health care professional told us that the service ‘sometimes’ supports people to live the life they choose. With staff support, a person using the service told us ‘I go to DAC [day centre] Monday to Friday for day care. I’m going to be having a day off in the week so I can choose more things to do.’ They said ‘I can choose what time to get up and when I have my bath and what to do for the day. I am unable to talk verbally but can use my communication book to communicate. Staff who know me well can notice when I’m not happy and will use my communication book.’ Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are impacting upon the opportunities available to meet people’s social needs. People are supported to maintain important relationships. People’s nutritional needs could be met more efficiently through less reliance on processed foods. EVIDENCE: On the first day of our visit, there were three people at home. One person was going out yet decided not to because of the weather. Other people were at their day service. Everybody was at home on the second day of our visit due to a problem with the day centre’s heating. Staff told us that three people generally have day care at home. They said they are allocated a member of staff on a one to one basis. They are then supported with personal interests at home or with activities in the community. Staff told us that people are often Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 17 supported to go out for a walk, into town or to the library. When in town, people often have a meal at one of the local pubs or fast food restaurants. Staff told us that the majority of people continue to attend the local day centre run by the organisation. Some people attend other day services for social/educational sessions. They said that consideration is being given to enable people to have more ‘at home’ days rather than attending day services five days a week. This would enable people to have greater choice in how they spend their time. Staff told us that they tried to support people with community events as much as possible. However, with existing staffing levels and only three staff available to drive the home’s vehicle, they said that undertaking spontaneous activity was a challenge. Within a person’s care plan, we saw it was documented that one person had gone to various theme parks. These visits were not however recent. There was some evidence that people had meals out and went shopping. One care plan contained an activity sheet yet the person’s name was not completed on the top of it. Within surveys, in relation to what the home does well, a staff member told us ‘provide a high quality of social care.’ Another staff member said ‘more staff needed for outings. Not enough drivers (mini bus takes two staff.) Social outings should be fun and not hard work.’ We asked one staff member about the home’s transport. They said ‘it is difficult when we go out, as each person needs the support of one or two members of staff. The vehicle then limits the amount of people who can go out at any one time.’ They said ‘if we had a smaller vehicle, more staff would be able to drive it and people could go out more regularly on an individual basis.’ Staff told us that family members continued to be strong advocates for people. They said that many families visited regularly and were very involved in people’s care. Some people went home to their families at weekends. Within their survey, a relative told us ‘residents have a severely limited capacity to express their views, or to comprehend the quality of the service they are receiving. The role of parents and other relatives to act as advocates is acknowledged, although sometimes we are not consulted and do not feel our input is valued.’ They said there used to be parent’s meetings, which enabled views to be shared. However, these had stopped although the first meeting since the appointment of the new manager, had recently taken place. They said they believed communication could be improved upon. They also felt that the home was slow to react to any issue raised. Within a survey, a staff member told us that they felt staff should receive more support in how they could help people’s families. During the inspection, we saw that staff interactions with people varied. For the first part of the inspection, the music channel was on the television. Staff interaction with people was limited. There was little communication with people Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 18 yet staff talked between each other. One staff member sat with a person and made models out of ‘play dough.’ They talked to the person yet the person was not involved in touching the dough. One person had a hand held percussion instrument. Another used their feet to make sounds with an electronic organ. Staff initially left people with the instruments to complete other tasks. They later returned and then promoted people’s involvement. At this stage, some people were more animated. We saw one person return from their day care session. The staff member pushed the person in their wheelchair, into the lounge. There was no communication. The staff member did not ask the person where they wanted to go or if they needed assistance to take their coat off. Staff on duty did not welcome the person back home. We saw that one person slept for long periods of time. They had very little interaction from staff. We saw within the person’s care plan that they should be tilted back in their wheelchair if sleeping. We did not see staff support them to do this. When people were supported with tasks such as eating or moving around, staff did not readily communicate with individuals. Staff told us that the menus had recently been reviewed. They said people generally enjoyed traditional food, which was easy to swallow. This included foods such as cottage pie. The menu for the week was displayed in the kitchen. It was not in a format for people using the service to understand. We saw that there were two choices for the evening meal yet at times, the choices were similar. There were for example, two chicken dishes available for one mealtime. Staff told us that they now cook something different in each bungalow. This enables people greater choice. They said that if a person did not like the alternatives they could choose something being cooked in the other bungalow. It would then be brought across for them. We said that greater consideration should be given to cooking more individualised meals for people in each bungalow. Staff told us that people have regular snacks throughout the day in addition to the main meal times. We saw one person having fresh fruit and biscuits during the morning. Staff told us that they had a cooked breakfast earlier. We saw another member of staff encouraging a person to eat. They initially had toast yet this had gone cold due to the person not eating it quickly. They were then offered sardines, then a jacket potato with curry for lunch. The curry was from a tin and not homemade. The food did not look appetising yet the staff member said the items were a favourite of the person. We saw from the person’s care plan that they were not eating well. Due to the risks involved, we were concerned that greater emphasis was not put on a high calorie, freshly prepared diet. Within the person’s care plan, there was a letter from a dietician. This recommended high calorie items such as cream, be added to sauces etc. There was no evidence that this advice was being followed. We saw that other people had tinned ‘big soup’ for lunch. We did not see that people were asked what they wanted. One staff member said ‘what shall we give her/him?’ In order to meet people’s nutritional needs, greater emphasis Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 19 must be put on cooking fresh ingredients rather than using processed foods. A relative told us that they believed the food to be poor. They said there was a high use of tinned and packaged food, which were high in salt, sugar and additives. They said when they visited on a recent Saturday, people were having tinned ‘big soup.’ On the Sunday, they were having beans on toast. They said that there were never any items such as home made cake or puddings. They also said that at times the home ran very low on food. Staff told us that sometimes it was difficult to fit the shopping in due to the staffing levels. On the first day of our inspection, a staff member had stayed on later than their scheduled finish time to do the shopping. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not having their health and personal care needs met and therefore are at risk of harm. Greater focus is required, to minimise the risk of error and to ensure the medication systems meet people’s individual needs. EVIDENCE: People have very complex health and personal care needs. They are reliant on staff to support them with all their personal care routines. People were unable to verbalise how they wanted their care to be given or if they were feeling unwell. Staff needed to recognise any signs or symptoms through non verbal communication. As stated earlier in this report, parents were also strong advocates and some were very involved in people’s care. Due to the complexity of people’s health care conditions, it was essential that staff had detailed information about their needs. Staff told us that some of the staff team knew people well. However, they said the high use of agency staff made it a challenge to ensure each staff member was fully aware of detailed information. The lack of up to date training, as stated later within this report, Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 21 also impacted upon the staff’s knowledge to meet people’s needs and ensure their wellbeing. At the last inspection, we saw developments had been made to care plans. However, the documents sampled on this occasion did not reflect people’s complex care needs. Not all aspects of the support people needed were identified. Specific risks were not addressed. The measures to manage the risk were inadequate. There was guidance from health care professionals that had not been adhered to. One person had food and fluid charts in place. These had not been consistently completed. They had not been evaluated at the end of the day. One daily record stated ‘observe future bowel movements’ yet there was no information to show that any monitoring had taken place. Another person had disturbed sleep. The records showing the disturbances were disorganised and difficult to follow. Some records had not been fully completed. We saw that some people had physiotherapy programmes. There was no information to show that staff were supporting people with their exercises. Some care plans had not been updated to show revised practices such as supporting a person with their mobility or maintaining a healthy weight. At the last inspection, we made a requirement that each person had their risk of developing a pressure sore assessed. We saw that a pressure sore risk assessment had been completed. However, it was not sufficiently detailed to minimise the risk of developing a sore. The assessment did not address being in one position for long periods of time or other factors such as a continence pad being inappropriately fitted or a leg strap being too tight. Specific areas of the body prone to a pressure sore, other than a person’s sacrum had not been addressed. We saw within one person’s daily records that sore areas had been caused by the person’s shoe insoles. There was no further information as to how to minimise further occurrences of sore areas. Staff had documented any marks, scratches or bruises they had noted on people. They had written ‘bruise on right knee’ yet had not given any specific information such as its size or colour. Potential reasons for the marks had not been identified. Not all marks had been identified on body maps. We saw a person eating an apple, dried fruit and biscuits. The apple had been cut up and the biscuits broken to minimise the risk of the person choking. One member of staff said that the food should have been cut up into smaller pieces. The staff member who prepared the food did not agree. They said ‘I always do it like that and s/he’s fine.’ There were no specific guidelines or a risk assessment in place, which confirmed what size pieces the person needed in order to eat safely. During our visit on the first day, one person spent a large amount of their time at the dining room table. Their arms were not covered by clothing and they repeatedly knocked their elbows on the dining room table. Staff did not react Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 22 to this or move the person away from the table. The person was at risk of fracturing their elbow. We saw that they had a sore area on one elbow. This was not identified on the person’s care plan. We saw one person being moved in a wheelchair without any footplates in place. There was a risk of them hurting their legs or feet without the adequate support. Within a person’s daily records we saw that there had been an accident involving their wheelchair. There was no risk assessment in place to minimise further incidents. Another person had a fall in the bathroom when left unattended. Staff told us how they believed this happened. They felt the person needed their privacy and were still safe when alone for a short period of time. Again, there was no risk assessment in place. We saw that one person was being transferred to the bathroom or the dining room table on a shower chair. Staff told us that staff were not supporting the person to walk due to the risk of injury, which had been identified to their backs. We saw that an occupational therapist had been contacted for advice about this. Staff told us that a decision about how to move the person safely had not been reached. While acknowledging priority needed to be given to ensuring people’s safety, the process was taking a long while to address. This was potentially having a detrimental effect on the person’s muscle strength and their ability to mobilise at a later date. Within surveys, a health care professional told us that ‘sometimes’ people’s health and social care needs are properly monitored, reviewed and met by the care service. They said ‘Very very occasionally’ does the care service seek advice and act on it to meet people’s social and health care needs and improve their wellbeing. A relative told us within their survey ‘we are not always informed about medical appointments. This has made it difficult for us to attend when necessary and has also resulted in unnecessary tests or distress for our son/daughter.’ People had ‘OK Health Care’ checks on their files yet these were not up to date. Staff told us that people’s epilepsy management plans were being updated. We saw that one epilepsy management plan, which was on the person’s file was not up to date. At the last inspection, we made a requirement that any staff member who administered suppositories must have updated training from a health care professional and have their competency assessed. Without this training, staff were not to undertake the procedure. Staff told us that the majority of staff had received up to date training. There was a list of staff who had attended the training in the diary. There was no evidence to show that the staff had showed competency in the procedure. Staff told us that they believed the certificates from the Community Nurse had not yet arrived. They said they would follow this up. We said these must be in place to ensure staff were skilled to undertake the procedure. Without staff being competent in the procedure, people were at risk of harm. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 23 Staff administered people’s medication via a monitored dosage system. An issue regarding the administration of people’s medication had been raised as a safeguarding issue, before our inspection. We saw an instruction regarding this within the staff communication book yet people’s medication regime’s had not been updated. Staff told us that they believed the organisation’s medication policies and procedures were held in the office. Not all staff had undertaken up to date medication training. At the last inspection, the previous manager had identified that the controlled drugs cabinet did not meet current legislation. They said a new cabinet was on order. Staff told us that to their knowledge, a new cabinet had not been fitted. Within the medication administration record, we saw that one person had been prescribed medication for pain relief. The instruction did not identify the dosage or the frequency of its use. A maximum dose was not documented. The instruction stated use ‘as directed.’ There was one signature to show it had been administered yet the amount given had not been stated. One person was prescribed two different suppositories. Staff told us the difference between the medications yet there was no information on the person’s care plan. There was one gap in the medication administration record. It was not clear if the medication had been administered. Topical creams had not always been signed to show they had been applied. There were no details on the person’s care plan about the creams, the reasons for their use or where they should be applied. This information is required so that staff are clear about the safe and effective use of the medications. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns are being raised yet are not being effectively addressed. People are at risk of harm through unclear leadership, inadequate systems and minimal focus on addressing the shortfalls. EVIDENCE: Staff told us that they would inform a senior member of staff if they received a complaint about the service. Within a survey, when asked if they knew what to do if a person had concerns about the home, one staff member said ‘no.’ We asked a health care professional in their survey, if the service responded appropriately to concerns raised. They said ‘I can’t say never but in my experience – no.’ We saw that complaints training for staff had been arranged for the following month. As the manager was not available during this inspection, we were not able to view the service’s complaint log. Senior staff told us that they believed there had been complaints since the last inspection, yet they were not aware of their content. As part of this inspection, we spoke to two relatives. They were concerned about the current standard of the service. They raised some issues, which have been identified within this inspection. They said they had identified their concerns on various occasions with the management and staff. They were concerned that matters had not been addressed and improvements had not Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 25 been made. They had not received a response about some issues they had raised. They said that having a ‘remote’ working manager impacted upon the ability to raise and discuss concerns. Within their survey, a relative told us ‘we believe that the current problems require radical changes of attitude and practice. It will not be sufficient only to address specific issues such as the ones mentioned. We are convinced that these are merely symptomatic of much more serious underlying problems.’ Staff told us that they had not received up to date training in safeguarding vulnerable people. Training records confirmed this. They said they would inform a manager if an allegation of abuse was made. We saw that safeguarding training had been arranged for the following month. At the last inspection, we recommended that all staff should sign to demonstrate their receipt of the Wiltshire and Swindon’s safeguarding procedures. There was no evidence of this on the staff members’ personnel files. As stated in the summary of this report, there have been a number of incidents, since the last inspection, which have been raised as part of the Wiltshire and Swindon safeguarding procedures. Some issues remain outstanding and are currently being investigated by the organisation. We were concerned that a clear action plan had not been devised to address the safeguarding issues identified. There was no evidence of a dedicated focus to improve the service. Staff told us that they wanted to see progress yet were not aware of the work to be undertaken to achieve this. They attributed the organisation’s staff restructuring process to many of the difficulties. We saw that systems such as staff training, risk management and care planning were inadequate to effectively meet the needs of people and to safeguard them. There was unclear leadership and the skill mix of staff, including the high use of agency, placed people at risk. These areas are identified later in this report. Part of a safeguarding alert, which has not as yet been concluded, involved medication administration. We saw that there was an instruction in a person’s daily records which stated that staff must not force feed them, their medication or food. It is concerning that this is an issue, as such practice is extremely poor and must not on any account be undertaken. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from a brighter, redecorated and refurbished environment in some areas. The standard of cleanliness and measures to minimise the risk of infection to safeguard people, require improvement. EVIDENCE: Shapland Close consists of two purpose built bungalows. Each bungalow has four single bedrooms, a lounge/dining room, a kitchen, bathroom and separate toilet. The bungalows have full disabled access. There are patio doors from the lounge, which open onto a patio area. The office and staff sleeping in room are located in a separate but adjacent bungalow. The laundry facilities are also in a small room, which is separate from the bungalows. We saw that people’s rooms were personalised to a high degree. Flat screen televisions and music centres were positioned at heights, which were suitable for the person. One person had a large frame type bed. We spoke to the last Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 27 manager about this and were told that it would be reviewed, as to whether they now needed such a design. There was no evidence to show that this had been undertaken. People had specialised equipment in relation to their needs. This included overhead hoists, wheelchairs and armchairs. We saw that while the decoration of the home was adequate, redecoration and some refurbishment would ‘brighten’ the home. The home was generally clean although staff must ensure that they clean less visible areas such as the edges of carpets, pipe work and skirting boards. We saw that there was debris between the radiator and the door frame in the main corridor. There was dust on the pipes in the toilet. The door to the room which houses the boiler was open although it should have been kept locked. The room was very dusty and needed a thorough clean. This also applied to the laundry room. There was a high level of dust on the floor and around the machines. This created a fire risk. Paint was flaking from the walls and the floor was impossible to keep clean. There was a bowl of soaking laundry and a pile of wet cloths in another bowl. Both practices increased the risk of infection and therefore must be stopped. At the last inspection, we recommended that all staff had infection control training. There was no evidence within training files that this had been addressed. In light of these aspects, such training is required. Staff told us that the laundry facilities were not currently meeting the needs of people. One washing machine was not working and had been out of action for a long while. To minimise the risk of soiled laundry not being immediately laundered, the washing machine should be either be repaired or replaced without delay. We saw within the bathroom that the shower chair, the toilet frame and a storage trolley were rusty and in need of replacement. A toilet seat was broken and the light pull chords were dirty. The side of the bath had been taken off for maintenance work but had not been replaced. There was a wheelchair which was stored in the bathroom. This had food debris in between the side of the chair and the seat cushion. The framework of the wheelchair was dusty. Staff told us that the jets within the Jacuzzi style bath did not work. The bath was still used yet the jets could not be flushed through. This gave a high risk area for legionella, which was potentially dangerous for people. Within surveys, as a means to improve the service one staff member said ‘have more modern equipment. Repainting in living area (a nice cheerful colour.)’ Another staff member said ‘decent furniture in living area.’ In their survey, a person using the service said, with staff support ‘my bungalow is cleaned everyday when I go to DAC. I clean my room with staff in the mornings and listen to music.’ Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient staff to cover the staffing roster and a very high level of agency staff is used, which is detrimental to people’s wellbeing. People are at risk of harm through staff not having the opportunity to update their knowledge and skills. Interactions with people could be improved upon. There is a clear recruitment procedure in place. EVIDENCE: The organisation has undergone a major staff restructuring process. The post of senior support worker was withdrawn and replaced with three team coordinators. Two team coordinators work part time and the other is full time. Staff said that the role of the team coordinator was similar to that of a manager. They were responsible for the day-to-day management of the home. They said that 50 of their role involved supporting people and working with the staff team. 50 involved completing general administration and systems such as risk assessments, medication administration and liaising with health care professionals. The team coordinators said that in practice, this did not work. Staff told us that since the introduction of the team coordinators, their Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 29 workload had been significantly increased. They said they were expected to now take on more responsibility yet they had not been trained for the role. We saw that the team coordinators had also not been trained in relation to management tasks and responsibilities. Staff told us that the manager’s responsibility for two services had impacted upon the home and its ability to develop. Senior staff did not appear to demonstrate a united, cohesive team approach or understanding of the requirements needed to address the shortfalls within the service. They said they had meetings yet without a manager being on site and the team coordinators working different shifts, continuity was a challenge. Staff told us that there were five members of staff on duty throughout the working day. They said there were generally two staff on duty in one bungalow. In the other bungalow there were three staff on duty. We saw that people had complex care needs. The majority of people needed to be supported at times by two members of staff. This meant that there were times in one bungalow when people were not supervised. We saw that some staff members due to their own physical disability required the assistance of other staff members, to undertake tasks such as manual handling. This impacted upon staffing levels and also challenged the skill mix of the staff on duty. Both aspects had the potential of affecting people’s wellbeing and how their needs were being met. Within surveys, five staff told us that there were ‘sometimes’ enough staff to meet the individual needs of people. One staff member said there were never enough staff. On the first day of our inspection, a member of staff had to work later to do the shopping. There were insufficient staff to cover the working roster, so they then stayed on, to provide support to people. Later in the afternoon, two staff left to collect people from their day service. This left the staff member on their own with three people who had very complex health and personal care needs. There was a team coordinator in the office yet gaining assistance would have taken time. Leaving only one member of staff in the bungalow with three people was poor practice and placed people at risk of not receiving the support they required. We saw on the staffing roster that a very high level of agency staff was used to maintain staffing levels. There were often two agency staff on each shift during the working day. This was almost half of the staff team on each shift. Staff told us that they aimed to use the same agency staff to maintain consistency for people. At the last safeguarding meeting, it was agreed that the organisation would undertake a review of staffing levels. Staff told us that management had looked at the number of staff employed. They said they had been told that the service had enough staff. We were concerned if this was the case, as clearly from the staffing roster and the time spent covering the shifts, this was not an accurate assumption. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 30 Within surveys, staff told us that their induction did not fully cover what they needed to know to do their job. We saw that there were copies of agency staff inductions on file in the office. Not all had been completed. Not all agency staff had an induction, which was documented. Staff told us that inducting agency staff was at times difficult due to the time restraints in place. We said that priority must be given to this area, as without a full induction, staff would not be aware of people’s needs. Staff told us that maintaining staffing levels was a challenge. One staff said ‘we do our best in the circumstances but I know with more staff and a better staffing structure, we could do more. We don’t seem to be able to do the extra things although we try to ensure people get what they need.’ A team coordinator told us ‘the staff work hard and there are some very good staff. They are under pressure though and therefore always reacting rather than developing. The trouble is that there are not enough role models. We need to increase the skill mix of the team and move forward.’ They continued to say ‘the staff team really do try hard and do their best for people. In some cases they just need a little direction and support. I wouldn’t want to ‘have a go at them’ and moan about what they haven’t done. It’s not all their fault. Their training and personal development has not been encouraged so we have to take some responsibility for that.’ Within a survey, a relative told us ‘large numbers of agency staff have been used (up to 50 per cent according to a statement made by the unit manager). This means that our son/daughter is frequently in the care of people who do not really know him/her. Even regular staff tend to focus on basic care (e.g. washing, dressing and feeding) rather than a truly person centred care plan. In some cases staff ignore residents altogether.’ As stated earlier in this report, we saw that interactions between staff and people using the service were minimal. Some staff often spoke between themselves rather than talking to the people using the service. Some staff talked over the person such as ‘what did they have for lunch yesterday?’ While interactions could have been improved upon, some staff spoke about people with concern. Some staff had known people over a number of years and were able to recognise subtle forms of body language. Within surveys, staff told us ‘Shapland has a core group of staff who are hard working and committed to providing the best care – often in very difficult circumstances.’ Four staff said they were usually given enough information about the needs of the people they supported. Two people said they were sometimes given enough information. One person said they never had enough information. They said the ways of passing on information did not always work. One staff member told us ‘Shapland Close does have some staff who are not fit for purpose and have to be carried by people like myself. It runs me down. Staff communication has broken down due to low moral and staff Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 31 sickness due to depression and fatigue etc.’ Another staff member said ‘staff doing really long shifts, get tired and despondent. No staff. Staff carry other staff at times.’ We asked within surveys, what the home did well. One staff said ‘very little at the moment. The place is really low on spirit and there needs to be changes.’ There were various suggestions about what the home could do better. These included ‘support staff better and have better managers. Value staff’ and ‘communication is rubbish. Not have so many agency staff. Bring back senior support worker job. Less paperwork. Better organisation.’ Other comments were ‘get senior staff to work together not against each other. This is turn would rub off to staff’ and ‘better staffing.’ Two staff said there could be better communication. They said ‘be more organised (management) and communicate better (staff and management)’ and ‘communicate between staff and seniors, communicate between staff and parents. Support each other regardless.’ We looked at a sample of staff personnel files and saw that staff were not up to date with their mandatory training. Many staff had not completed recent manual handling, first aid, food hygiene or safeguarding training. Other topics such as the prevention of person centred care, pressure sores, eating and drinking, catheter care, learning disability, physical disability or communication had not been covered. A team coordinator told us that all staff files were being reviewed to check what training staff had undertaken. A training matrix was in the process of being developed. They told us that manual handling and complaints training had been arranged. Their concern was the availability of staff to attend the training when the staffing roster needed to be covered. We saw that this was a real challenge as during the inspection, staff were telephoning other staff to complete shifts at relatively short notice. Staff told us that the home had been significantly short staffed. Many staff had worked extra or longer shifts to provide cover. They said there had been a high level of sickness which had put extra strain on the remaining staff. One staff told us ‘we are getting back on track with training. Things have been arranged so it’s getting better.’ Another staff member said ‘I’ve done food hygiene and first aid. Manual handling has been booked.’ Within a survey, one staff told us ‘having the staffing resources to ensure training and personal development are up to date’ is what the home could do better. Within surveys, four staff told us that they had training, which was relevant to their role. Two staff told us that they did not receive up to date training. Not all staff felt they had the right support, experience and knowledge to meet the different needs of people. Three staff said they sometimes met with their manager to gain support and to discuss how they were working. Three staff said they never did. During the inspection, staff told us that the opportunity for supervision had recently improved. Within their survey, a relative told us ‘training for staff appears to be inadequate. At present it seems to rely mainly on specific short courses and to focus on practical matters such as food Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 32 preparation or manual handling. We believe there needs to be greater emphasis on understanding the nature of learning disability and the effects of cerebral palsy. There is also needs to be more training on how to support residents emotionally as well as physically and on the relationships with relatives carers and advocates. We also feel that the systems for the on-going supervision and support of staff should be improved, leading to more truly person centred care.’ We looked at the personnel files of the most recently appointed member of staff. We saw that a clear recruitment procedure was followed. The file contained an application form and two written references. One of the references was from the staff member’s previous employer. Documentation showed that a Protection of Vulnerable Adults check (POVA First) and a Criminal Record Bureau disclosure (CRB) had been undertaken. There was a medical declaration in place. Within surveys, all staff told us that their recruitment was undertaken thoroughly, with the required checks undertaken. On the first day of the inspection, two team coordinators were planning to interview a prospective member of staff. We were concerned that the manager was not involved in the selection of the staff team. The staff had not received training in interview techniques. The team coordinators told us that they consulted with the manager about their views of the person and what they had to offer the service. They said they did not make a decision about employing the person until authorisation to do so from the manager. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clearer leadership and greater monitoring of the practice within the home is required to ensure people’s safety. Systems are not in place to ensure the ongoing development of the home. People are at risk through insufficient focus on the risk management process and inadequate staff training. EVIDENCE: The previous registered manager left his position in April 2009 after being in post for approximately a year. Mrs Jane Maunders was appointed manager in April 2009. Mrs Maunders has not as yet registered with us. In addition to managing Shapland Close, Mrs Maunders also manages another residential care service, located on the other side of the city centre. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 34 On both days of this inspection, Mrs Maunders was not available. Two team coordinators assisted us on the first day. On the second day, a senior staff member was not on duty. Staff told us that they had already used the on call management roster to make contact with a manager. This had been unsuccessful. We were concerned that if there had been an emergency, management support and advice would not have been available. Staff told us that Mrs Maunders generally spends two days a week at the home. They said that this might vary due to other commitments such as management meetings and training. Some staff raised their concerns about having a manager who was not present in the home on a daily basis. They said that the day-to-day management issues were undertaken by the team coordinators. The team coordinators told us that they had not received any specific training regarding their new role. Team coordinators were therefore undertaking systems such as staff recruitment, staff supervision and risk management without any training. This placed people at risk of potential harm. One staff member told us ‘it seems like we are just left to get on with it. We try to do our best but we know that things could be better here. The structure doesn’t promote clear management.’ Another staff told us ‘it’s not Jane’s [the manager] fault. The restructuring process cut the level of senior staff too much. We all have added responsibility but with the high level of agency staff, it’s really hard to do everything.’ A relative also told us that they felt having one manager for two services had significantly impacted upon the standard of the service provided. Within a survey, they said ‘we believe the situation has deteriorated following inappropriate changes in the management structure, together with a succession of 4 different managers since December 2006. Managers and all senior staff need to take a more personal interest in the residents and to work more closely with the parents or relatives.’ Within surveys, one staff member told us ‘have a full time manager to provide solid leadership. Acknowledge the shift leading role as a ‘senior support worker’ position – in order to ensure good supervisory practice at times when the manager and team coordinators are not on site.’ Another staff member said ‘management do not support staff enough or correctly. Never praise just criticise.’ As stated earlier in this report, we saw that there were many shortfalls in the systems within the home. This included inadequate care planning, poor risk management, inadequate staff training and lack of priority to address issues, which had been identified within the safeguarding process. These issues gave evidence of poor management and placed people at risk of harm and of not having their needs met. We asked staff about quality assurance and the systems the home had in place. They told us that they used to have a quality action group although this was no longer in place. They said a parent’s meeting had been arranged although there had not been one for a while. They were not aware that any Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 35 surveys had been sent out to people or their advocates in order to gain their views about the service. They were not aware of any other quality assurance systems currently within the home. We saw that records were in place to demonstrate the monthly regulation 26 visits. These did not detail any concerns, which we identified during our inspection. A relative told us ‘we used to meet regularly at a parent’s meeting and within a formal development group. The development group has stopped due to the manager leaving and parent’s meetings have not happened. They don’t seem to have any formal systems for assessing the quality of the service. They certainly don’t ask for our views, which because of our son/daughter’s needs, is essential feedback for them.’ Within a survey, a relative stated ‘relatives meetings have always been an important way of communicating with parents and discussing issues affecting the operation of the unit. The current manager did not arrange such a meeting until after the unannounced inspection, even though she had been in post for 7 months. At that meeting it became clear that she had not previously met one set of parents, even though they are still actively involved with their son/daughter.’ The organisation had a range of health and safety policies and procedures in place. Staff had not received training in health and safety. Staff told us that manual handling training had been booked for the following month. The team coordinators were concerned that due to the difficulty in covering the shifts, the availability of staff to attend the training may be limited. We saw one incident of poor manual handling whereby a person was prompted to sit down by pulling at the top of their trousers. Another person was restricted with their mobility as staff were using a wheelchair for them rather than assisting them to walk. Staff told us that this was due to the risks involved. They said that after receiving manual handling training, they would once more support the person to walk. Without staff being skilled in this area, people were at risk of harm through poor practice. To ensure people’s safety, we said that all staff must attend the manual handling training and it must not be cascaded down through the team. As stated earlier in this inspection, we saw that risk assessments were limited and insufficient to minimise the identified risks to people. We were told that having time to update and develop risk assessments was a challenge. We said that priority must be given to this area in order to safeguard people. To assist with the process, staff should receive training in risk assessment. We looked at the file which demonstrated the servicing of the hoists. It was disorganised and difficult to see the dates of when each hoist had been serviced. In October 2008, it was recommended that three ceiling hoists were replaced. There was no information to state that this had been done. Staff told us that there had been one new hoist, as a person now required one. They did not say that some hoists had been replaced. At the last inspection, we saw that the radiator covers had been taken off to enable more heat to circulate the room. We made Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 36 a requirement to risk assess this. We did not see a written risk assessment but noted that the radiator covers had been replaced. The fire log book showed that the fire alarms were tested as required. There was no evidence of a recent fire drill. There was a fire risk assessment in place which had been originally dated 2006. A yearly review date was stated yet it was not evident if changes had been made. The risk assessment stated that staff were trained in the use of fire extinguishers and regularly instructed in evacuation procedures. There was limited evidence that this was so. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 37 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 3 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 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 1 X X 2 X Version 5.2 Page 38 Shapland Close DS0000028422.V377147.R01.S.doc Are there any outstanding requirements from the last inspection? Yes 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 Statement of Purpose must contain information as identified in Regulation 4, Schedule 1 of the Care Home Regulations 2001 and be regularly reviewed so that it is up to date. Care plans must be sufficiently detailed and regularly updated to reflect people’s complex care needs. Care charts must be fully completed and be evaluated at a frequency which meets the person’s needs. Risk assessments must address the complexity of people’s needs and address potential risks such as choking. Any accident must be reviewed within the risk assessment process in order to minimise further occurrences. A review of meal provision must be undertaken to ensure people’s nutritional needs are being met. Epilepsy management plans must be in place for those people who have epilepsy. Consideration must be given to assessing people’s risk of DS0000028422.V377147.R01.S.doc Timescale for action 31/12/09 2 YA6 15 31/12/09 3 YA6 12(1)(a) 14/10/09 4 YA9 13(4)(c) 31/12/09 5 YA17 16(2)(i) 31/12/09 6 7 YA19 YA19 12(1)(a) 12(1)(a) 31/12/09 31/12/09 Shapland Close Version 5.2 Page 39 developing a pressure sore. If a risk is identified, control measures must be put in place and clearly evidenced. This was identified at the last inspection. It has been addressed yet the assessment does not cover the full extent of the risk or sufficient measures to minimise potential pressure damage. Staff must receive up to date training in the administration of suppositories. If training is not available, the responsibility of the procedure must be passed to the district nursing team. 8 YA19 12(1)(a) 31/12/09 9 YA19 12(1)(a) This was identified at the last inspection. Staff said that training had been undertaken yet there was no evidence to demonstrate the competency of each staff member. Guidance from health care 14/10/09 professionals must be detailed within the person’s care plan and be immediately followed in order to meet the person’s needs. Clear instructions showing the clear administration of any medication, must be detailed on the medication administration record and the person’s care plan. Staff must sign the medication administration sheet to show they have applied a topical cream. The service’s complaint procedure must be initiated and followed when any complaint is received. This must include the implementation of the identified timescales and ensuring the DS0000028422.V377147.R01.S.doc 10 YA20 13(2) 14/10/09 11 YA20 13(2) 14/10/09 12 YA22 22(3) 14/10/09 Shapland Close Version 5.2 Page 40 complainant is informed in writing of the investigation and the outcome. 13 YA30 23(d) Staff must ensure that they 14/10/09 clean less visible areas of the home and items in need of repair are done so without delay. The laundry must be refurbished and a review of procedures be undertaken to minimise the risk of infection. 31/01/10 14 YA30 13(3) 15 YA33 18(1)(a) Staffing levels must be reviewed 30/11/09 to ensure they meet the needs of the people using the service. Measures to minimise the use of agency staff must be considered. A review of the skill mix of staff team must be undertaken to ensure people are supported in a safe, effective manner. 30/11/09 16 YA33 18(1)(a) 17 YA35 18 YA35 19 YA39 18(1)(c)(i) Staff must receive up to date 31/01/10 training in safeguarding and all other mandatory subjects such as first aid, food hygiene, manual handling, medication, and infection control. 18(1)(c) Senior staff must receive 31/01/10 training in relation to their role. This must include training in topics such as risk management, staff supervision and recruitment procedures. 24 A formal quality assurance 31/01/10 system must be developed and implemented within the home. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 41 20 YA42 13(4)(c) A risk assessment must be in place regarding the removal of radiator covers to enable more heat. This was identified at the last inspection. There was no evidence of a risk assessment yet the radiator covers had been replaced. A review of manual handling practices within the home must be undertaken to ensure people are being supported effectively and safely. All staff must receive manual handling training by a specialised trainer. Each staff member must take part in a regular fire drill so that know how to respond in the event of a fire. 31/12/09 21 YA42 13(5) 31/12/09 22 YA42 23(4)(e) 14/10/09 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 YA6 Good Practice Recommendations Each segment of the care plan should be dated to ensure all aspects are up to date and an accurate reflection of the person’s needs. This was identified at the last inspection but has not been addressed. Consideration should be given to the use of a short-term care plan to address aspects of current need, such as a sore/dry area of skin. This was identified at the last inspection but has not been addressed. Staff should review each person’s care plan and remove information that is no longer relevant. Greater focus should be given to communication and how people could be supported to make more decisions. People’s medication regimes should be updated and clearly form part of the person’s care plan. DS0000028422.V377147.R01.S.doc Version 5.2 Page 42 2 YA6 3 4 5 YA6 YA7 YA20 Shapland Close 6 YA23 7 YA23 8 YA35 9 YA35 10 YA35 All staff should sign to demonstrate their receipt of Wiltshire and Swindon’s safeguarding procedures, ‘No Secrets.’ This was identified at the last inspection but has not been addressed. Another member of staff should countersign the balance sheet in the event of any transaction with people’s personal monies. This was identified at the last inspection but has not been addressed. Training documentation should be reviewed to ensure it is an accurate reflection of the training staff have undertaken. This was identified at the last inspection and is in the process of being addressed. The training matrix should include details of when staff need refresher training in the identified subjects. This was identified at the last inspection and is in the process of being addressed. Staff should receive up to date training in relation to people’s needs. This should include person centred care, learning disability, communication, tissue viability, eating and drinking and catheter care. Shapland Close DS0000028422.V377147.R01.S.doc Version 5.2 Page 43 Care Quality Commission London Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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). 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