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Inspection on 15/07/09 for Burgess Care Limited

Also see our care home review for Burgess Care Limited for more information

This inspection was carried out on 15th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

A new block of three bed-sit type accommodation has been built to assist the people that live there to develop there independence. Some parts of the home have also been redecorated and had new carpets fitted. New tarmac has been laid in the main driveway, making access to the home much better. The hot water supply has been fixed and no longer runs tepid, making it easier for people to wash.

What the care home could do better:

People`s needs are not always properly assessed before they move in. This is necessary to ensure their needs can be met by staff. Some people have not been issued with contracts explaining what they are entitled to receive from the home for their money. Care plans and risk assessments are in place for people at the home. These documents are being reviewed as they contain some gaps in the information necessary to meet people`s needs safely and in the way they like. Overall the medication is stored safely and recorded properly but some improvements are necessary to the way in which some PRN (as required) medication is carried forward on the records each month to make sure it is properly accounted for. Guidelines telling staff when to give epilepsy medication are in place but need to be signed by a health professional to confirm that the advice is correct.Sharmer Fields HouseDS0000004296.V376502.R01.S.docVersion 5.2There are gaps in some important areas of staff training. In particular there is a need to increase the number of staff trained in fire safety food hygiene and safeguarding from abuse quickly. The acting manager confirmed that the safeguarding manager for Warwickshire Social Services is to provide manager`s with training in the reporting of safeguarding incidents very shortly. Since the inspection the acting manager has arranged fire safety training and food hygiene training for staff to take place over the next few months. Unit managers are finding it hard in some instances to balance their management duties with time spent on rota supporting the people at the home. There is a need to monitor this solely to ensure that there is sufficient time for unit managers to carry out their delegated responsibilities without compromising care in the home. This is also necessary to support quality assurance in the home. Questionnaires have not yet been sent to people, this year, to gain their views of the service and to give ideas for the future development of the home. It is important that people are consulted so that they can influence the ongoing development of the home they live in.

Key inspection report CARE HOME ADULTS 18-65 Sharmer Fields House Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH Lead Inspector Kevin Ward Key Unannounced Inspection 15th July 2009 07:55 Sharmer Fields House DS0000004296.V376502.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. Sharmer Fields House DS0000004296.V376502.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 Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharmer Fields House Address Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH 01926 614048 01926 613048 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) Burgess Care Ms Denise Patricia Cleaver Care Home 19 Category(ies) of Learning disability (19) registration, with number of places Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 maximum number of places 19. The maximum number of service users to be accommodated is: 19. 2. Date of last inspection 21st August 2007 Brief Description of the Service: Sharmer Fields’ registered premise consists of 3 five-bedded self-contained facilities and a block of 3 new bed-sits for more independent people. Each unit is individually identified as the Meadows, Sharmer Fields House, the Paddocks and Tree Tops. Each unit is home for small groups of people with learning disabilities. Burgess Care provides 24 hours support to the people living in the home. The home is set in a rural area, 300 yards off the Fosse Way at the end of a shared drive. There are extensive grounds to the property. Shared facilities in all units consist of a lounge, quiet room, kitchen and laundry. Shared facilities are on the ground floor of each unit; there are also office facilities in each unit. Available also is a converted stable, which offers day-care facilities for the service users. There are well-maintained lawns as well as an allotment area maintained with the assistance of the service users. Two of the units are not suitable for access by wheelchair users. However the provision of another five-bedded selfcontained unit on the premises has full facilities to enable wheelchair access. The fees at the time of writing this report range between £1560 - £3080 per week depending on the level of staffing support people require to meet their needs. For up to date information about fees the reader should contact the home directly. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate outcomes. This was a key unannounced inspection, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Seven questionnaires were sent to people at the home and all were returned, giving their views on the home. The inspection included seeing everyone living at the home. Due to the communication needs of some people living at the home it was not possible to get a clear impression of everyone’s views of the service. The inspection also included case tracking the needs of three people that live at the home. This involves looking at their care plans and records and checking how their needs are met in practice. Discussions took place with eight staff, including three senior staff, as well as a unit manager and the new acting manager. A number of records, such as care plans, complaints records, and fire safety records were also sampled for information as part of this inspection. We also spoke to the contract monitoring team at Warwickshire Social Services Commissioning section as they are currently involved in monitoring the home to seek their views of the service. An annual quality assurance assessment was completed and returned by the provider in time for this inspection, providing the managers views of the homes performance during the last year. What the service does well: The people at the home are supported to plan their social activities and go out places they enjoy. In questionnaires, sent to people when asked what the home does well several people mentioned the activities. Comments included: “Take me out – offsite activities”, “Arts crafts and activities”, “By doing things like arts and crafts and activities and looking after me”. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 6 The people at the home said that they like the staff at the home. Positive use of other health professionals, such as psychiatrists, community nurses and speech and language therapists when reviewing people’s their care. People are being supported to gain access to other health services where necessary to assist them to stay in good health. Staff have recently shown a good deal of commitment and support to a person admitted to hospital for a lengthy stay. The home is clean, comfortable and suitably equipped to meet people’s needs. People’s cultural needs are being supported. A person at the home is supported to attend temple to worship, in keeping with their personal religious needs. Electrical equipment has been tested to make sure it remains safe to use and fire alarms and lights are routinely tested to ensure they work in the event of a fire. What has improved since the last inspection? What they could do better: People’s needs are not always properly assessed before they move in. This is necessary to ensure their needs can be met by staff. Some people have not been issued with contracts explaining what they are entitled to receive from the home for their money. Care plans and risk assessments are in place for people at the home. These documents are being reviewed as they contain some gaps in the information necessary to meet people’s needs safely and in the way they like. Overall the medication is stored safely and recorded properly but some improvements are necessary to the way in which some PRN (as required) medication is carried forward on the records each month to make sure it is properly accounted for. Guidelines telling staff when to give epilepsy medication are in place but need to be signed by a health professional to confirm that the advice is correct. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 7 There are gaps in some important areas of staff training. In particular there is a need to increase the number of staff trained in fire safety food hygiene and safeguarding from abuse quickly. The acting manager confirmed that the safeguarding manager for Warwickshire Social Services is to provide manager’s with training in the reporting of safeguarding incidents very shortly. Since the inspection the acting manager has arranged fire safety training and food hygiene training for staff to take place over the next few months. Unit managers are finding it hard in some instances to balance their management duties with time spent on rota supporting the people at the home. There is a need to monitor this solely to ensure that there is sufficient time for unit managers to carry out their delegated responsibilities without compromising care in the home. This is also necessary to support quality assurance in the home. Questionnaires have not yet been sent to people, this year, to gain their views of the service and to give ideas for the future development of the home. It is important that people are consulted so that they can influence the ongoing development of the home they live in. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 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 provided with information to help them make a decision to move to the home. There is scope for improving the admission procedure to ensure that people’s needs are fully assessed to ensure they can be met when they move in. Failure to issue people with contracts could lead to their rights being compromised. EVIDENCE: Discussions took place with the unit manager in the Meadows unit regarding the admission process for new people and two people’s files were checked. Both people’s files included written assessments by Social Services outlining people’s needs to be included in their care plans. Neither file contained completed assessment forms carried out by the home, as part of the admission procedure. The unit manager explained that in the case of the person recently admitted to the service, the assessment process had been commenced by the home manager who has since left the service and it is unclear if a written assessment had been carried out. Consequently the unit manager had summarised the Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 10 person’s needs to give staff some background information based on information transferred as part of their discharge records from the previous hospital service. Had an assessment been completed by the home before the person moved in there could have been opportunity for a better transfer of information regarding how best to manage the challenges presented by the person concerned and staff could have been properly equipped to physically intervene where necessary, to protect the person from harm. Comments by a person at the home indicated that they had been supported to visit the home before moving in and there was evidence on their file to show that their placement had been reviewed with the involvement of relevant professionals. Questionnaires were sent to seven people at the home. When asked if they had received a contract of terms and conditions three said yes, two said no and two did not know. Two files were checked and neither had a contract in place with the home. The acting manager has since confirmed that the contracts can not be found. It is necessary to issue contracts so that the people at the home and their representatives are clear about the service they can expect to receive for their money. The acting manager said that letters from Social services, detailing people’s contribution to their care are available for each individual (example seen on a person’s file). People’s files contained a copy of the service user guide which has been well illustrated with photographs to make it easier for people to read. Copies of the service user guide were also seen on display in the home for people to read. The acting manager explained that the home’s Statement of Purpose (containing the home’s aims and objectives) is currently being updated to take account of changes in the service over the last year. In seven questionnaires people were asked if they had been provided with sufficient information to help them to decide if the home was the right place for them. Five said “yes” and two said they “don’t know”. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is continued scope for improving care plans so that staff have the information they need to support people in a person centred way. EVIDENCE: Three people’s care plans and risk assessments were checked. A team manager responsible for two people’s care plans explained that extra support has recently been given by an assistant psychologist to update these documents to include clearer guidance on the management of challenging behaviours. A comparison between earlier care plans and the current ones shows that these have been notably improved in some respects. The care plans now include much clearer guidance on when to use physical intervention, in the event that other behavioural management strategies fail to work. The behaviour management care plans include advice on what action to take in Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 12 various situations and how to attempt to diffuse the behaviours to avoid them escalating to the point that physical restraint is used. The earlier care plans failed to do this. This was due to the fact that until very recently staff had not been trained to use physical intervention with people who place themselves or others at risk of injury. Consequently, guidance on when to use restraint was not included in care plans. This has resulted in some incidents where people have been left in situations where they or others may have been at risk of injury. For example a person’s risk assessment indicates a high risk in relation to road safety but the care plans did not contain guidance on the need to physically intervene and stop the person from crossing the nearby busy road at the top the drive, where necessary. This has now been addressed. Warwickshire Social Services have also recently carried out monitoring visits at the home and noted some shortfalls in the quality of the information contained in some care plans. The acting manager confirmed Warwickshire Social Services are in the process of sampling care plans to monitor improvements in this area of practice. The care plans seen, contained other information about people’s needs, such as their personal care needs, social needs and communication needs. This information was brief in some cases needs further development for the benefit of new staff joining the staff team. For example people’s personal care routines are not detailed to inform staff of the way people like their care to be provided and the care plan of a person with high communication needs contained minimal advice about how to communicate with the person concerned. Discussion with staff demonstrated that they had a good appreciation of the person’s individual means of communicating with people (by using modified makaton signs). However this was not recorded anywhere for the benefit of new staff. This was recognised by the team manager who said she is arranging for a speech and language therapist to assist in the development of a communication passport concerned. A chart of makaton (sign language) pictures) used by the person concerned had also been put on the office wall for staff to refer to for advice. The team manager of Meadows unit also explained that she had recently prioritised her efforts on ensuring that people’s behaviour management care plans were improved and that she would be improving other aspects of the care plans in due course. A range of recently reviewed risk assessments were seen to be in place to support safe practice in the home, such as trips and slips, bathing, epilepsy and road safety. Comments by people at the home confirmed that they are asked to make everyday choices about what they do and what they eat. Staff in Meadows unit were seen to ask people what they wanted for breakfast and check with people that they are happy with their plans for the day. A worker in the Life Skills unit, on site explained that some people are being supported to develop personal objectives, such as cooking and shopping. Some use is being made of Person Centred artwork and assist people to draw up and keep their personal Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 13 goals, e.g. one person had developed an artistic holiday plan and circle of friends (that she could refer to for help). Another person ahs been supported to design a time line to help them to plan when they go home and another person had an activities chart on display illustrated with photographs to remind them of plans for each day. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 14 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: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in planning activities and meals so that they are provided with a suitable range of activities and meals they enjoy. The people at the home are assisted to stay in touch with friends and relatives so that important relationships are maintained. EVIDENCE: Comments by people at the home confirmed that they are supported to go out shopping to choose their clothes and other personal items and some people do some light grocery shopping. During the site visit a person was supported to go to the hairdressers to have their hair cut and dyed in a modern style, in keeping with their wishes. Later in Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 15 the day some people were seen to enjoy relaxing a hand massage, which they said they enjoyed. The home provides a satisfactory range of activities for people that stay at home during the day. The home provides staff to lead on the provision of day activities at the life skills centre in the grounds of the home. People confirmed that they are consulted about their day activities plans and indicated that they enjoy a satisfactory range of options. Examples include: bowling, swimming, shopping and lunch, massage, walks, parks, sensory room, cookery, arts and crafts and literacy projects. When asked in questionnaires if the home arranges activities they can take part in six people (of seven) answered “always” and one person replied “don’t know.” Comments by a staff member in the life skills unit confirmed that greater emphases is being placed on focusing support where it is needed, to support better outcomes and the development of everyday living skills for the people that live at the home, such as cooking. A unit manager explained that people are given £25.00 per week for personal activities and £300 towards the cost of their holiday. A small group of people set off from the home to enjoy a few days at Alton Towers. The people concerned confirmed that they were looking forward to the break and had chosen to go there. A staff member explained that there are plans for another person at the home to go away to Euro Disney with support from staff and a relative. Good work has taken place to support an Asian person at the home to attend a new Sikh temple to worship there, in keeping with their wishes. Entries in care reviews and daily records demonstrate that people are supported to maintain contact with their relatives. Two recently employed staff explained that they had received sexuality awareness training as part of their induction at the home. This better equips staff to respond appropriately to people involved in relationships, where this may be necessary. The home has several vehicles to enable people to get out and about. This is essential in supporting people to maintain good community access as the home is in a rural setting. Comments by the people at the home indicate that they are happy with the food provided and are consulted about what they eat. Some also take part in shopping for food and groceries. A sample examination of recent menus indicates that people are provided with a reasonably balanced diet. People confirmed that they are offered a choice of food and can have an alternative meal if the want it. Staff comments indicate that attempts are made to strike a fair balance between personal choice and healthy eating. One person was not eating food off the group menu and has been supported to develop a personal Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 16 menu to encourage them to eat better. The person concerned said that they are happy with the new menu and confirmed that they sometimes shop for groceries with staff. Staff explained that they shop for low fat options to try to encourage healthier eating. Fruit was seen to be available in the home for people to eat. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home are supported to have their health needs appropriately monitored and met. Shortfalls in physical intervention training have compromised safe care practices. EVIDENCE: As noted earlier in the report until recently there have been some gaps in people’s behaviour management care plans which are being addressed. This led to some difficult and dangerous situations where staff did not feel able to intervene, as they had not been trained in physical intervention techniques and believed they were meant to withdraw. On one occasion a member of staff used unsafe restraint which was reported and investigated under the adult safeguarding procedures. This matter is being addressed and the team manager for Meadows unit reports that staff in this part of the home have now all received behaviour management and physical intervention training. The Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 18 acting manager for the home reports that this training is now being rolled out to everyone else on site. This was verified in comments by staff. Discussions with staff indicate that they are still getting used to this new practice and anticipate the need for ongoing support and advice to ensure they are assisted to follow safe practices. As previously noted staff demonstrated a good understanding of the communication needs of a person at the home and what their individual signs and gestures mean. Comments by people at the home indicate that they like the staff that support them and find them to be friendly and helpful. In surveys sent out to seven people they were asked do you receive the support you need. Five said “always” and one said “usually”. One person did not understand the question. The same responses were received when asked if staff are available when needed. During the site visit staff were seen to be responsive to requests for help and to enjoy a good rapport with the people living at the home. All personal care support was carried out behind closed doors indicating a regard for people’s dignity. Entries in the person’s health records show that the person concerned has been supported to see health professionals, such as a consultant psychiatrist and an epilepsy nurse specialist, to monitor their seizures and changes in their medication. A staff member spoke in an informed manner about the person’s epilepsy and of the advice provided by health professionals. A helpful, up to date recording chart is in place graphing the person’s seizure activity to assist in monitoring any improvements or deterioration in the person’s condition. This indicated that the person’s condition was currently stable. An epilepsy protocol is in place for a person who needs PRN (as required) medication when they have seizures but this has not been signed by a health professional to confirm that it is correct and up to date guidance. Entries in people’s health records show that they are being supported to attend healthcare appointments to monitor and treat diagnosed health needs. Commendable support was given by staff for a person who was recently admitted to hospital for a serious operation. This involved staff supporting a person during the day and night for over a month. People’s records show that they are being supported to attend routine health appointments, such as annual health checks, dental check ups, eye tests and reviews of their medication. The medication cabinets in two of the living units were checked. Staff in both units confirmed that only staff that have received medication training and have been properly observed and assessed by managers, are allowed to give out Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 19 medication. Three people’s recent medication assessments were seen on file n the office, as verification of this fact. Both unit managers explained that PRN (as required) medication is only given with the agreement of the home manager. An audit of three PRN medication was carried out in the Meadows unit and the number of tablets were found to balance correctly against the record. Good PRN protocols were in place in the meadows unit detailing the circumstances under which medication should be given to people. A senior worker in Sharmerfield unit explained that only one person has non blister packed PRN medication. The medication sheet was checked and the number of tablets carried over from the previous month had not been recorded so it was not possible to check that the number of tablets in the bottle was correct. A PRN protocol detailing the circumstances under which this medication should be given was not in place. Entries on the medication sheets show that the amount of medication received for people is being recorded so that it can be accounted for properly. A senior worker in Sharmerfield unit confirmed that all unused medication, in blister packs, is returned to the chemist and not carried over till the next month. Staff in both units confirmed that medication is checked by senior staff twice daily to make sure that it has been given out and signed for properly, so that any errors can be promptly picked up and addressed. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 20 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 adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is scope for increasing the frequency of staff safeguarding training updates to ensure they are equipped to protect people from home. EVIDENCE: There have been no complaints made to us about the home since the last inspection. A complaints procedure is in place in the home and in the service user guide. An easy read version of the complaints procedure was seen on notice boards in the home and a sheet containing picture illustrations is used to help people to express how they are feeling, e.g. pictures of happy and sad faces. Staff explained that they provided with abuse awareness training and whistleblowing, as part of their induction training but four staff of staff said that they had not any further recent training on this subject. The acting manager confirmed that there has been no recent training updates on this subject and explained that training packs have been ordered to address this matter, which staff will start very shortly. Three staff spoken with demonstrated a satisfactory understanding of the types of abuse they might encounter and to whom they should report any concerns. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 21 There have seven safeguarding incidents at the home reported to Social Services. Several of these incidents have been investigated with the involvement of Social Services and the home manager. On one occasion the quality of a safeguarding investigation by the home has been below standard as the home and did not take account of the potential impact on another person in the close vicinity of an incident of challenging behaviour. The home has been receiving monitoring and support from staff of Warwickshire Social Services Department to carry out improvements to the service. The acting manager explained that a safeguarding officer at Warwickshire Social Services is currently assisting the home to review their reporting procedures and will be delivering training to the management team at the home shortly. Two people’s financial records were viewed. The records indicate that suitable measures are in place for accounting for people’s monies. A breakdown of people’s individual expenditure is retained along with numbered receipts. The staff and the manager now sign the expenditure record to verify every entry. As previously noted staff are now being provided with training to enable them to physically intervene and protect people from harm where this is assessed to be necessary. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is clean and comfortable and people benefit from well maintained accommodation that meets their needs. EVIDENCE: Since there last inspection the have been notable changes at the home. A new building, “Treetops”, has opened to enable 3 residents to live in a bed-sit setting, allowing a greater level of independent living. The home’s registration has been varied to reflet that the service now provides accomodation for 19 people. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 23 Various areas of the home have been re-furbished to make it nicer for the people that live there, including some bedrooms and carpeting in communal areas. The hot water supply was a problem at the last inspection as it used to run at a tepid temperature. A unit manager confirmed that this has now been fixed so that people can wash more comfortably. The lounges are well decorated and attractively furnished. Seven bedrooms were seen. People confirmed that bedrooms have been decorated with personal colour preferences in mind. A new person at the home has been supported to paint their bedroom pink and said that they had chose a new pink carpet to match, which would be fitted very shortly. Bedrooms contained evidence of personal belongings, equipment and pictures indicating that people are supported to personalise these areas to their own liking. The bathrooms were clean and the home was free from unpleasant odours. Some of the bathrooms are quite spacious and fitted with grab rails for people with mobility problems. The home has an industrial type washing machine that is capable of washing continence laundry, situated in The Meadows. This is currently available for people in the other units to use if necessary. A unit manager explained that no one at the home has high continence support needs but that red dissolvable bags are available for carrying soiled laundry safely, in the event that this should become necessary. Cleaning schedules are in place for day and night staff to sign as they complete cleaning tasks in the home. Stacking systems containing gloves, aprons, bags etc are in place in toilets convenient for staff to use. . Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place for vetting new staff to ensure that suitable people work at the home. Gaps in some training could compromise safe practices in the home. EVIDENCE: The manager’s in each of the units have been working as part of the rota most of the time with one day off rota each week. This has just been amended so that they are now off rota for two days a week. Discussions with staff and unit manager’s indicate that the need to meet people’s assessed needs often breaks into the unit manager’s duties and takes them away from management tasks, such as reviewing care plans or staff supervision. This was apparent in Meadows unit several people’s needs necessitate 1:1 staff support or 2:1 in some situations, such as where physical intervention may be required. This leads to the unit manager being drawn away from managerial tasks to support the care of the people at the home. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 25 Discussions with staff indicated that their access to Health and Safety related training has been varied and only limited training has been provided at the home during the last year. Further evidence of this is apparent in the managers’ staff training matrix, which shows there are significant gaps in some safe practice subjects. Most notably no staff have received fire training for several years and only small number have had food hygiene training updates. The acting manager reports that currently 9 staff are completing National Vocational Qualifications (and 10 staff already hold these qualifications) which also includes training in all Health and Safety related subjects. Similarly new staff are provided with induction training that includes an awareness training in safety related practices and safeguarding against abuse. The acting manager explained that the training matrix only includes training courses for which there is certificated evidence and does not include staff who have done the training but have not received / kept their certificates. The acting manager said that he intends that all staff will have received training in safe practice subjects within three to six months of this inspection and would be giving the highest priority to ensuring that staff are provided with fire safety training and food hygiene training. The acting manager said that the rotas are arranged so that there is always a member of staff on duty that has been trained in first aid and a member of staff trained to give stesolid (medication for epilepsy) to ensure that people are supported safely in this regard. A unit manager and the acting home manager confirmed that there is no-one living at the home that requires support with moving and handling that would currently necessitate this training. The matrix shows that 18 staff have been provided with epilepsy training in the last 2 to 3 years. The acting manager said that he intends to ensure that more staff have this training this year. The acting manager also said that he plans to arrange equality and diversity training for staff when the training in safe practice subjects, mentioned above, have been addressed. The files of two staff were checked and found to contain records to confirm that appropriate recruitment and vetting procedures are followed, including taking up references and Criminal Record Bureau checks / POVA first (check the list of banned workers) before staff start work at the home. Two recently employed staff confirmed that they had received induction training. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is scope for improving the quality assurance process to provide more consistent arrangements for checking the work of the service and for routinely seeking the views of the people that live at the home and other relevant parties. EVIDENCE: The organisation’s business development manager is currently covering the management of the home. The acting manager holds the National Vocational Level 5 in management as well as a social work qualification. The acting manager has many years experience of working with people with learning Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 27 disabilities. The acting manager said that he intends to apply to be registered with us shortly. The acting manager explained that the views of the people at the home, their relatives and relevant professionals have not yet been surveyed this year but said that he would make plans to do so. Staff were sent surveys last year and a summary report was seen, outlining the findings of the consultation. The acting manager said that staff surveys have just been sent out again for this years consultation exercise. There are a number of quality assurance checks at the service but some of these are carried out irregularly. “General managers’ reports had been carried out each month since the start of the year, by the previous home manager but stopped recently, April 09.There had also been a break of several months at the end of last year. These reports served to monitor a range of matter in the living units, such as, significant incidents, complaints logs, staff training, Health and Safety and other issues. Presently there is no formal process for the acting manager to review the incident forms in the home. This is necessary to demonstrate there is clear management monitoring of these situations so that any additional support, advice and resources may provided where necessary. Monthly monitoring visit reports are being carried out by a senior manager within the organisation. The acting manager explained that issues raised at the visits have been the focus of meetings and action plans to address shortfalls and make improvements to the service. Examples given, include reviewing the staffing rota, re-focusing the support provided by the Life skills unit, based at the home to become more outcome focused and arranging support from within the organisation (e.g. psychologist involvement) to improve the quality of care plans and risk assessments. The manager and staff on the living units confirmed that medication audits are carried out to check that people’s medication is given out and accounted for correctly, evidence of which was seen in information provided by the manager. Shift handovers take place at the home to support a good team work approach between shifts so that important information gets passed on. Similarly staff confirm that team meetings take place at the home. Records of two people’s money were seen. The records show that two staff sign to verify all expenditure and receipts are being kept to account for monies spent. As noted previously shortfalls have been left to develop in some essential aspects of staff training needs and care plans, which should have previously been addressed by managers. The acting manager reports that these issues are now being addressed by the organisation. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 28 Information provided by the manager in the annual quality assurance assessment indicates that suitable measures are in place for maintaining a safe environment. A sample examination of Health and Safety records was carried out. The fire log in the Meadows unit was checked and the records indicate that the alarms and lights are being tested at the correct frequency and regular fire drills are being carried out at the home. A hot water monitoring log was seen, demonstrating that the hot water temperature in the home is routinely checked to make sure it is safe and does not pose a threat of scalding. Records were seen verifying that all the electrical equipment across the site has been tested to ensure it is safe to use. A clinical waste contract is in place for the safe disposal of relevant items where necessary. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 x 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 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 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 x 2 x x 2 x Version 5.2 Page 30 Sharmer Fields House DS0000004296.V376502.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA35 Regulation 23 (4) (d) Requirement Action must be taken to ensure that staff are provided with fire safety training. This is necessary to ensure that staff are familiar with the actions to take to keep people safe in the event of a fire. Action must be taken to ensure that staff who are involved in preparing food are provided with food hygiene training to ensure that they maintain good food hygiene practices. Timescale for action 21/10/09 2 YA35 18 (1) (c)(i) 23/10/09 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 YA2 Good Practice Recommendations Action should be taken to ensure that people’s needs are fully assessed before they move in. This is necessary so that everyone is clear that the home is able to meet their needs and so that any essential training identified can be arranged in advance of the person moving in. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 31 2 YA5 3 YA6 4 YA19 5 YA20 6 YA20 7 YA23 8 YA32 9 10 YA37 YA42 People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Action should be taken to increase levels of information about people’s personal care routines and communication needs, where necessary, to ensure that new staff have the information they need to support people in a person centred way. Action should be taken to arrange for epilepsy management protocols, involving the administration of PRN (as required) medication to be signed by an appropriate healthcare professional, to ensure that the information is correct and safe practice is followed. Medication protocols should be put in place, where this is not already the case for people prescribed PRN (as required) medication, so that it is clear under what circumstances the medication should be given. Action should be taken to ensure that any tablets carried over to the next month are recorded on the medication sheet so that it is possible to ensure that medication is accounted for correctly. Proceed with plans to provide staff with safeguarding training updates where they have not recently received this training. This is necessary to ensure that staff are equipped to protect people from harm. The staff rota should be monitored and kept under review to ensure that there are sufficient staff on duty to enable unit managers to carry out their managerial duties effectively. Proceed with plans to survey the views of the people at the home, their relatives and other interested parties so that they can contribute to the development of the service. Systems should be put in place for the acting manager to review significant incidents that involve physical intervention being used by staff. This is necessary to ensure that physical restraint is used appropriately and staff are provided with the support they need to ensure safe practice. Sharmer Fields House DS0000004296.V376502.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission West Midlands Region 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. 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