Inspection on 26/10/09 for Skelton Court

This inspection was carried out on 26th October 2009.

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

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

Other inspections for this house

Skelton Court 02/10/08

Skelton Court 09/10/07

Skelton Court 26/07/06

Skelton Court 01/11/05

Skelton Court 14/06/05

Skelton Court 08/03/05

Skelton Court 25/10/04

Skelton Court 09/12/02

Similar services:

St Marys Nursing Home

Thornham Grove

Chater Lodge

Conifer Lodge

Tixover Care Home

Toynton College (Cluster Five)

Egerton Lodge Care Home

Cedar Court Nursing and Residential Home

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

Key inspection report CARE HOME ADULTS 18-65 Skelton Court 41 Ryder Road Kirby Frith Leicester LE3 6UJ Lead Inspector Linda Clarke Key Unannounced Inspection 26th October 2009 08:45 Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 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. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 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 Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Skelton Court Address 41 Ryder Road Kirby Frith Leicester LE3 6UJ 0116 2321834 0116 2321835 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.lha.org.uk Leicester Housing Association Manager post vacant Care Home 20 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (10), Mental disorder, excluding learning of places disability or dementia (20), Mental Disorder, excluding learning disability or dementia - over 65 years of age (20), Physical disability (10), Physical disability over 65 years of age (10) Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User Numbers in `Yellow Acre`. No person falling within categories MD, DE, MD(E) or DE(E) may be admitted in ``Yellow Acre`` when 10 persons in total of these categories/combined categories are already accommodated within `` Yellow Acre``. Service User Categories accommodated in `` Yellow Acre ``. No person of category MD or DE who is under the age of 50 may be admitted to `Yellow Acre`. Service User Categories accommodated in `Redwood` No person falling within categories MD/PD or MD/E, PD/E, ie dual disability may be accommodated in `Red Wood` when 10 persons in total of these categories/combined categories are already accommodated in `Red Wood`. Categories admitted to `Redwood` No person falling within the categories PD or PD/E may be admitted to `Red Wood` unless that person also falls within category MD or MD/E I.e. dual disability 2nd October 2008 2. 3. 4. Date of last inspection Brief Description of the Service: Skelton Court is a care home providing personal care and accommodation for people aged 50 and over with Dementia and Mental Health problems, including people who have Huntingdon’s Disease or an Acquired Brain Injury and associated Physical Disabilities. Skelton Court is situated on a modern housing estate within reach of a range of facilities, with a minibus providing additional transport. Skelton Court is single storey and horseshoe in shape; communal facilities consist of a smoking lounge, separate lounge, separate dining room and lounge/diner. All bedrooms are single and have an en-suite consisting of a toilet and wash hand basin. There is a central courtyard, which is partially paved with seating, a gazebo and mature plants and shrubs. Information is located on site detailing the range of services offered, which includes the Statement of Purpose and Service User Guide. Copies of the Commission for Social Care Inspections, Inspection Reports, are available by request at Skelton Court. Information about fees is available by contacting the home. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 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. ‘We’ as it appears throughout the Inspection Report refers to the ‘Care Quality Commission.’ The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is selfassessment tool, completed by a representative of the service, reviewing previous Inspection Reports, and any information we have received. We undertook an Annual Service Review of Skelton Court on 21st September 2009, as we had planned, consistent with our policies and procedures. When we undertook this review, we had been advised by Leicester Housing Association of concerns they had about the home, which had resulted in them undertaking a comprehensive review. We were provided with a copy of their findings. As a result of all the information we have received we decided to carry out a Key Inspection, which included a site visit to the home. We sent surveys to people when we undertook the Annual Service Review on the 21st September 2009, comments received within surveys we sent to people living at Skelton Court, their relatives and health and social care professionals have been included within this Inspection Report. The unannounced site visit commenced on the 26th October 2009, and took place between 08:45 and 16:45. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was ‘case tracking’. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Skelton Court. Four people accessing services were selected. Discussions were held with the two people chosen, along with other people living at the Home. Two members of care staff were spoken with along with senior representatives of Leicester Housing Association. What the service does well: Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 6 Staff we spoke with had a good understanding of the needs of individuals who live at Skelton Court, and were enthusiastic about providing them with the care and support they need. Activities within the home are organised, including themed events which are popular with both individuals who live at the home and their relatives. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 7 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 Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 8 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): 2. 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. Individuals moving into the home may not have their needs met, as the homes assessment process is not robust, consistent with their policies and procedures. EVIDENCE: We wanted to find out how individuals who required residential care can be confident that Skelton Court can meet their needs, we did this by looking at the self assessment tool completed by a representative of the home. They stated ‘before a potential service user comes into the home we meet with them in their environment and they visit, completing assessments to ensure the home can meet their individual needs.’ We looked at the records of four people living at Skelton Court, and found that three of them who had lived at the home for several years had at the point of moving into the home an up to date assessment carried out by Social Services identifying their needs. This would have enabled the Manager of the home to determine whether their needs could be met. We also looked at the records of Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 9 someone who had moved into the home recently, and found that an assessment of the persons needs had not been undertaken, medical health needs were identified within the information contained from hospital discharge records, which meant that the home admitted someone without knowing whether their needs could be met. This practice potentially puts the person at risk, along with those already living at the home and staff employed. We spoke with the Responsible Individual who was at the home when we visited, who said they would speak with the individuals Social Worker to obtain and assessment of need. They confirmed that the practice of admitting someone into the home without an assessment was not consistent with the homes policies and procedures. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 10 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. Opportunities for individuals’ to influence the care and support they receive are limited, and restrictions are placed on some individuals through the risk assessment process and daily routines of the home. EVIDENCE: We wanted to find out how people living at Skelton Court influence the care and support they receive and what consultation arrangements are in place to support them with their lifestyle choices. We looked at the records of four people, and found that care plans were in place but in many instances these were not signed by the person nor were they dated. There was evidence that care plans were reviewed, however we could find no evidence as to whether the person had been involved in the Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 11 review of their care plan and what comments they had made, which leads us to believe their goals and aspirations are not discussed with them. We looked at the daily records of four people, which provide information on a person’s day to day life, the information contained was often limited to personal care, and therefore little information is available to consider when reviewing care plans. We were advised that one person whose records we viewed was hoping to move out of the home in the future, we found no evidence that the care plan had been updated to reflect this, and that goals had been discussed with the person for them to achieve, to promote their independent living skills. Information we received within the self assessment tool did not provide any information as to how people are encouraged or supported to undertake educational courses, or be involved in vocational or work place activities including work placements or training schemes, which shows little thought is put into respecting peoples individual rights with regards to achieving goals and aspirations. We looked at risk assessments for the four people whose records we viewed, and found that these in most parts were comprehensive and supported individual care plans. We did identify that restrictions continue to be placed on people with regards to retaining responsibility for their cigarette lighters and/or cigarettes, and that risk assessments detailed that these were kept by staff as their were identified risks to individual and other peoples safety. We noted that whilst risks had been identified, in some circumstances evidence as to how this decision had been made was not evident. We also found that ‘smoking breaks’ are in place, with allocated times for people to access the ‘smoking room’, which enables staff to be available to hand out cigarettes and light them, whilst observing individuals smoking to reduce risk, this is an extremely institutionalised process, and does not promote well-being, choice, independence, respect or dignity for individuals involved. We discussed with the Responsible Individual that the restrictions placed on individuals should be considered as a deprivation of an individual’s liberty, and that referrals should be made consistent with the Mental Capacity Act, which safeguards individual rights to maintain and make decisions for themselves. We also noted that by the serving hatch in the dining room, there is a list of times as to ‘tea breaks’, which refers to when tea and coffee are served to people living at the home, this shows an institutional approach to care, not reflective of person centred care and the promotion of peoples rights and choices. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 12 Surveys we received from people who live gave mixed views to many questions asked, with some people indicating that they feel supported and cared for, with staff listening and acting on what they say, whilst others indicated that the care and support they receive is not always as they would wish, for many this is related to their ability to smoke and take part in activities outside of the home. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 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. Opportunities for service users to engage in activities and recreational pursuits are provided; access to activities outside of the home is dependent upon staffing levels. Service users benefit from a wholesome and varied diet, and have their specialist dietary needs met. EVIDENCE: We wanted to find out what opportunities are available to people living at Skelton Court with regards to lifestyle choices. Information provided within the self assessment tool told us that care plans include information as to what people wish to do, and that care plans are signed by them, we however found that many care plans were not signed. The self assessment tools states that individuals are supported to undertake shopping for personal items such as Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 14 clothing, but acknowledges that the lack of transport and staffing impacts on the ability of people to participate in organised events We spoke with one lady who said “I like to go to the café in Aikman Avenue, but it depends whether we have enough staff, I like the café it’s very friendly.’ Whilst someone else we spoke with said “I like to go out, but we have no transport and taxis are very expensive.” One person we spoke with told us that they had recently been out with a member of staff and enjoyed a meal, and that on another occasion weekend had attended a show at DeMontfort Hall, which they said they had enjoyed very much. Surveys we sent to people living at the home recorded additional comments to questions which included:‘I would like a friend.’ ‘Would like to go home more.’ ‘More outings, more information.’ We sent surveys to relatives and advocates of people who live at Skelton Court who recorded additional comments to questions, which included:‘Meals appear to be nicely prepared and good standard. Evidence of craft work etc done by residents displayed. Theme days etc. well done by staff and are cheerful and well accepted by residents.’ ‘Staff all seem to be kind and care which is good, but seem to spend a great deal of time in the office, leaving some residents alone for quite a long period of time when they clearly long for company.’ ‘More stimulus for residents for example reading papers, doing crosswords etc in the afternoon. It appears that very little happens in the afternoon, other than sleeping and watching television.’ We sent surveys to health and social care professionals, who told us that in their view activities, are insufficient. In the morning of our visit a group of people sat with staff undertaking craft work for the Halloween Party, later in the week, everyone participating appeared to enjoy what they were doing, and people were enthusiastic about the party. In the afternoon we observed a member of staff support two people to access the local shop to purchase personal items. A majority of people in the afternoon spent time in their bedroom or in one of the communal rooms watching television, or reading a magazine. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 15 Daily routines are not always flexible due to the regime of smoking and tea breaks, the Responsible Individual told us that they were looking at this issue, and had advised staff to be flexible about smoking to promote choice. We sat and ate with people at lunchtime in one of the two dining areas; the atmosphere was calm and quiet. Staff supported and served people with their choice of meals, everyone we spoke with was complimentary about the meals and the food, with a majority of dishes being prepared and made within the homes kitchen by the catering staff. Care plans for some people included guidance a to an individuals nutritional needs, where foods supplements were required in an alternative format such as via a Pegg feed, or liquid diet. Clear guidance was in place which had been written by a Nutritionist for staff to follow. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and welfare of individuals is compromised through the inadequate training and awareness some staff have with regards to the specific health care needs and by not following the homes policies and procedures. EVIDENCE: We wanted to find out how individuals living at the home are supported with their personal care and whether their health care needs were met. We looked at the care plans of four people, which detailed what support each person required with regards to their personal care, which were supported by risk assessments. Care plans are regularly reviewed, but we could no find no evidence as to whether this had included speaking with the person themselves, as no evidence was recorded as to their views of the care and support they receive, which leaves us to believe that the opinions of peoples lifestyle is not valued. Daily records recorded involvement of health care professionals, including their visits. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 17 We received information from Leicester Housing Association prior to our key inspection, the information provided was a report undertaken by them following recent incidents within the home. Their report identified that ‘communication within the home was poor, with some colleagues being unaware of the organisations policies and procedures’. Our own evidence supported this. We noted when we looked at one persons daily records that the person had become unwell, and that an out of hours General Practitioner had been called, who had advised requesting an ambulance, whilst an ambulance was contacted, their was a significant time delay. We spoke with the Responsible Individual who advised that the policy and procedure was not followed, and that an ambulance should have been requested immediately. When looking at this incident we also found that the person who had written up the daily records was not the person involved in the incident, which is against the policy and procedure for home, as advised by the Responsible Individual, and by reading the information in the ‘handover book’, found that the entry differed to that written with the daily record of the person who became unwell. Whilst staff continue to ignore policies and procedures, the welfare of people living at the home is compromised. Skelton Court works closely with health colleagues who provide additional support to people with Huntingdon’s Disease or an Acquired Brain Injury. We sent surveys to health and social care professionals and asked them for their views about the care and support provided by staff at Skelton Court. Surveys told us that people living at the home are treated with respect and that their dignity is promoted. Surveys told us that staff generally support people well with some staff having a very good understanding of Huntingdon’s Disease, but commented that this was not the case for all staff. Surveys contained additional comments:‘Some staff have a good understanding of symptoms and behaviour re: Huntingdon’s Disease and provide appropriate care based on this knowledge. However all staff should have a clear understanding and act on fulfilling their roles and responsibilities in a professional manner.’ One person we spoke with told us that they have a low fat diet, as a while ago they were found to have a high Cholesterol level, they told us that they feel a lot better now, as they have lost weight as well as reducing their Cholesterol level, the person was very well informed about their health, and said they staff had helped them to sick to the diet which they found difficult to do at times. Specialist equipment is provided for people who require assistance when moving from one place to another, this includes hoists, there are a number of assisted baths and shower facilities at Skelton Court, enabling people with a range of needs to be supported. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 18 We looked at the medication of four people living at the home and found the medication and medication records to be in good order; staff responsible for the administration of medication have received the appropriate training. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 19 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 quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals concerns are not always acted upon therefore their rights to being protected could be compromised. EVIDENCE: We wanted to find out how peoples rights were supported, and whether people living at the home know how to raise concerns, we also wanted to find out whether people felt safe. We sent surveys to people who live at the home, information gathered from surveys told us that people are confident in raising concerns; however they do not in all instances feel that staff listen and act on what they say, for many this is related to smoking and being able to access activities outside of the home. Surveys we sent to relatives told us that they are confident in raising concerns, and believe staff listen and act on what they say. We spoke with several people who live at Skelton Court, who said they were happy to raise concerns and talk about things which were important to them, but that the response they receive is dependent upon which member of staff they speak with. We were informed by the home that they had made a referral to Social Services about someone who lives at the home under safeguarding Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 20 procedures, and that this is currently being investigated by them. Skelton Court took appropriate action following the allegation and managed the situation well. Previous incidents in the home show that staff understand the importance of raising concerns, when they are aware of poor practice. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Skelton Court enables people to live in a safe, well-maintained and comfortable environment. EVIDENCE: Skelton Court has a small car parking facility to the front of the property, and access to the front door is via an access level ramp. Mechanisms on the front door prevent individuals entering or leaving the building who do not have the access code. Individuals sitting in the home near main entrance and communal areas can hear the front door bell and staff call bell, this was very loud on the day we visited, and was disruptive to people living at the home, several people living at the home commented it was loud, and sometimes made them ‘jump’. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 22 Skelton Court has an on-going programme of refurbishment and maintenance. All accommodation and facilities are provided on one level. People living at the home have access to a central courtyard, with matures trees, shrubs and plants, which has seating, throughout the day several people chose to walk in the courtyard, some to smoke a cigarette. All bedrooms have an en-suite facilities consisting of a wash hand basin and toilet, communal bathing and showering facilities are adapted to meet the needs of individuals with a physical disability, there is a central laundry for the laundering of clothing, and a hair dressing salon for the visiting hairdresser. The layout of Skelton Court has a ‘horseshoe’ shape, with the front doors and offices being in the centre, which then lead into an open plan dining and living space. Each side of the ‘horseshoe’ is referred to as Redwood and Yellow Acre, both providing lounge and bedroom facilities along with bathing and shower facilities. The two areas provide support for people specific needs, but are not exclusive, in that people are encouraged to utilise all areas of the home. The lounge located in Yellow Acre is designated as the lounge for people who live at the home who wish to smoke. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 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. Individuals’ are supported by staff who have undergone a robust recruitment process, however the lack of training and awareness of some staff with reference to individual needs and their roles and responsibilities impacts on the care and support individuals receive. EVIDENCE: We wanted to find out whether the care and support people receive is provided by staff who have the relevant training and experience, and who have been recruited using a robust recruitment process. We received information from Leicester Housing Association prior to our key inspection, the information provided was a report undertaken by them following recent incidents within the home. Their report identified concerns as to the ‘integrity and professionalism amongst staff at all levels, and found that the general attitude of colleagues towards each other must have a negative Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 24 impact on service users’. Care practices can institutionalise staff in the delivery of care. We sent surveys to health and social care professionals and they included comments about staff at the home that were reflective of the report produced by Leicester Housing Association, surveys also included comments with regards to training in specialised areas, and the impact of care on people living at the home. ‘Some staff have a good understanding of symptoms and behaviours re: Huntingdon’s Disease and provide appropriate care based on this knowledge. However all staff should have a clear understanding and act on fulfilling their roles and responsibilities in a professional manner.’ ‘Ensure all staff understand their roles and responsibilities and act in a professional manner, and improve the cohesion of staff.’ ‘Ensure all staff have an understanding (some do) of how to care for people with Huntingdon’s disease and follow advise given by professionals.’ ‘Concerned about the conflict between staff members and how this impacts on service users.’ We spoke with staff at the home; they confirmed their recruitment included completing an application form and attending an interview. A Criminal Record Bureau disclosure was in place prior to their commencing work at the home, and satisfactory references were sought. Staff confirmed they had undergone an induction process. We sent surveys to staff but none were returned. The information we receive in the self assessment tool prior to our visit told us that 95 of staff have attained a National Vocational Qualification in Care; we were unable to view training records at the home when we visited. The report carried out by Leicester Housing Association, which we received a copy of prior to our visit, identified areas of staff training, which included safeguarding adults, communication and interpersonal skills, dealing with challenging behaviour, administering medication, and training related to record keeping. We observe positive interaction between people living at the home and staff, with staff responding to individual requests, and found that staff did spend time with people, conversing and encouraging them to take part in activities in the home. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 25 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, 38, 39, 40, 41 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. Shortfalls in the management of Skelton Court have meant that the care and support individuals receive is not as they would always expect and wish, and the rights and choices of individuals have not in all instances been recognised. EVIDENCE: We received information from Leicester Housing Association prior to our key inspection, the information provided was a report undertaken by them following recent incidents within the home. Their report identified serious ‘concerns in the management of Skelton Court, which had resulted in a staff team with little or no discipline and leadership’; the report goes on to say that Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 26 there is a ‘lack of integrity and professionalism at all levels, and that communication is poor, with some colleagues being unaware of the organisations policies and procedures’. Our own evidence supported this. The information received from Leicester Housing Association, included information as to what the organisation needed to do to improve the service, which focused on staff training, review of management, involvement of service users including determining their views, and line management of colleagues in senior positions. We found that whilst Leicester Housing Association had identified that people who ‘act up’ that is to say take on the responsibility of managing the home, in the absence of the Manager need to have their competencies assessed, they continue to be left in a position of ‘being in charge’, and we found an instance of where they had not followed the policies and procedures of the home which had the potential of putting someone at risk. Skelton Court when we visited was being overseen by Dawn Cooke the Responsible Individual, who will share the role with a Manager from another home within the Leicester Housing Association group. Through the reviewing of records and discussions with the Responsible Individual we identified that referrals need to be made with regards to the deprivation of peoples liberty, consistent with the Mental Capacity Act, as decisions are being made by the home that people are unsafe to retain ownership of their cigarettes and/or lighters, and are therefore kept by staff. We also discussed that ‘smoking breaks’ could be considered a deprivation of a persons liberty. We wanted to find out how people living at the home were consulted about the day to day running of the home, and how they were supported to bring about change. We asked to see the minutes of meetings held for people living at the home, we found that a meeting had taken place in August 2009, however prior to this meetings were not regularly held. The minutes of the meeting held in August 2009, identified that some people would like to accompany staff on the weekly shopping trip to the supermarket for groceries, whilst some people had expressed an interest in attending Church. We found no evidence that issues discussed in the meeting had been acted upon, which undermines the respect shown to individuals, in not listening and acting on what they say. We were told that questionnaires had been circulated to people living at the home by Leicester Housing Association to find out their views, they had not been collated at the time of our visit, and therefore we were not able to view the outcome of the consultation. Information submitted prior to the site visit detailed the regular maintenance of health and safety systems within the home, including fire systems and Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 27 equipment, environmental health visits, central heating systems and emergency call systems. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 28 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 X 2 1 3 X 4 X 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 1 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 3 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 1 1 1 1 1 3 X Version 5.3 Page 29 Skelton Court DS0000006312.V378169.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 YA2 Regulation 14(1) Requirement The registered person to ensure that a comprehensive and up to date assessment is carried out prior to someone moving into the home. To ensure that an individuals needs can be met prior to their moving into the home. To ensure that the home is registered to provide the care and support the individual requires. The registered person to ensure that care plans are up to date, and where practicable signed by the individual. Care plans should be reflective of the individuals’ situation, and support their goals and aspirations. Care plans should be reviewed with the individual and their comments recorded. The registered person to ensure that staff that are put in a position of authority are DS0000006312.V378169.R01.S.doc Timescale for action 26/11/09 2 YA6 15 26/12/09 3 YA32 19(5) 26/11/09 Skelton Court Version 5.3 Page 30 competent, experienced, and trained to undertake and fulfil their duties as their role requires. To promote and ensure the health, safety and welfare of individual’s living at the home. The registered person to ensure that staff have the appropriate training and skills to support people effectively and well who have an Acquired Brain Injury and Huntingdon’s Disease. To promote the well-being and health of people with specialist needs which include an Acquired Brain Injury and Huntingdon’s’ Disease. The registered person to appoint a Manager to who is competence and qualified. To promote the well-being of individuals who use the service. The registered person to enable and encourage people living at the home to express their views and opinions, and have their views and opinions once sought acted upon. To enable individuals’ to influence the service they receive. 4 YA35 18(1) 26/12/09 5 YA37 9 26/01/10 6 YA39 24 26/12/09 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 OP12 Good Practice Recommendations Care plans to include individuals’ aspirations and goals DS0000006312.V378169.R01.S.doc Version 5.3 Page 31 Skelton Court 2 YA24 with regards to employment, education, work placements and work training schemes. The call bell system to be replaced so as the noise generated by the activation of the system does not have a negative impact on the lives of individuals living at the home. Skelton Court DS0000006312.V378169.R01.S.doc Version 5.3 Page 32 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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