Inspection on 07/05/09 for Stacey Drive

This inspection was carried out on 7th May 2009.

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

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.

Other inspections for this house

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report CARE HOME ADULTS 18-65 Stacey Drive 8 - 12 Stacey Drive Kings Heath Birmingham West Midlands B13 0QT Lead Inspector Sarah Bennett Key Unannounced Inspection 7th May 2009 09:35 Stacey Drive DS0000072796.V375363.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. Stacey Drive DS0000072796.V375363.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 Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stacey Drive Address 8 - 12 Stacey Drive Kings Heath Birmingham West Midlands B13 0QT 0121 441 2677 0121 444 4477 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) Midland Heart Limited Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Stacey Drive DS0000072796.V375363.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 Disabilities (LD) 12 The maximum number of service users to be accommodated is 12 2. Date of last inspection 10th April 2008 Brief Description of the Service: The home is situated in a private road off Haunch Lane, Kings Heath. Access is good and parking facilities are ample. The home is in walking distance of Kings Heath shopping centre. A range of facilities are easily accessed from the home including local shops and transport links. The home provides accommodation for twelve adults who have a learning disability. Some people have associated sensory, physical, behavioural and health care needs. The majority of people have been living in the home for a number of years. The home comprises of three purpose built, four bedded linked bungalows. Each has its own frontage that is different from the adjoining properties. Each bungalow has a lounge, kitchen/diner, four single bedrooms, WC, bathroom and laundry area. There are a number of aids and adaptations available to assist with the care of the people living there. The service users guide did not state the fees charged to live at the home. A copy of the last inspection report is available in the home for visitors to read if they wish to. Stacey Drive DS0000072796.V375363.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 one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and part of the Annual Quality Assurance Assessment (AQAA) completed by the manager. Part of this had not been sent to us and we are still waiting for this information to be provided. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by three people living there. This involved establishing individual’s experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records were looked at. The people living there, the manager, relatives and staff were spoken with. What the service does well: Relatives said, ‘It is a happy home and always has been.’ Staff spend time sitting talking to the people living in the home. Some staff have worked at the home for a long time so they know the people who live there well. Relatives said, ‘The staff are very good.’ The people who live there are supported to keep in contact with their family and friends so they can maintain relationships with people that are important to them. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 6 People can go on holiday supported by staff if they want to so they can see different places and have a break. The home is well decorated so it is a comfortable place to live. Each person has their own bedroom that they can keep their own things in. Aids and adaptations are provided so that people can be as independent as possible. What has improved since the last inspection? What they could do better: There are proposed plans to separate the bungalows into three separate homes with four people in each. This will help to ensure that people have more individual, person centred care which will improve their well being. All staff recruitment records must be kept in the home to show that suitable people had been employed to work with the people living there. Water temperatures must not be too high so that people are not at risk of being scalded. People should have the information they need about the home so they can make a choice about whether or not they want to live there. Care plans should be centred on the individual and how they want staff to help them. Risk assessments should be in place and updated often to make sure that people can take risks but be as safe as possible. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 7 People should be supported to do the things they like doing and go out in the community so they can enjoy their lives. People should be offered a healthy and nutritious diet to make sure they can keep well. Health and medication records should be kept up to date to make sure that people are getting the right healthcare so they can be well. The kitchens should be refurbished where needed to make sure they are clean and hygienic for people to use. Staff should have the training they need so they know how to help people to meet their individual needs. Regular audits should be done to make sure that the home is run for the benefit of the people living there. 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. Stacey Drive DS0000072796.V375363.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 Stacey Drive DS0000072796.V375363.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, 4 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. Prospective service users do not have all the information they need to make a choice about living there. Individual’s needs are usually assessed to ensure they can be met there and people visit to see if they would like to live there. EVIDENCE: The statement of purpose and service users guide had not been updated since 2007. Since then the manager details and our contact details have changed. These should be updated so that people have the information they need to make a choice as to whether or not they want to live there. The service users guide did not state the fees charged to live there. Since we last visited three people have moved into the home. The manager said that one person was able to make a choice as to whether or not they wanted to live at the home and an assessment of their needs was completed. However, the other two people came from a home nearby that closed and they were not able to choose where they moved to. One of these two people is only staying at the home until accommodation that will better meet their needs can Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 10 be found. The other person had settled into the home well and their needs could be met there. We looked at the assessment records for the first person that moved in. This showed that their needs were assessed before they moved in to ensure they could be met there. They had visited the home initially with their relative to look around. When they said they wanted to move there they visited again several times so they could meet the other people living there and staff. The person’s community nurse was involved in their move and completed assessments about what sort of accommodation the person would need to meet their needs. Stacey Drive DS0000072796.V375363.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, 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. Arrangements do not always ensure that staff have the information they need to be able to meet individual’s needs so ensuring their safety and well being. EVIDENCE: The records of three of the people who live there were looked at. These included an individual care plan. Care plans detailed how staff are to support the person to meet their health needs but contained little information about what the person liked to do or how they wanted to be supported as an individual. This is important so that staff know how to meet all the person’s needs and ensure their well being. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 12 Care plans had been reviewed monthly and updated if the person’s needs had changed. Most care plans had not been reviewed in April. The manager said this was due to staff sickness and holidays so key workers and nurses had not been able to do this. A ‘high risk’ folder has been introduced for staff to look at. This includes care plans and risk assessments for some people who live there that staff must know about to help keep people safe. This is important as with twelve people living there it is not always possible to know all the changing needs of individual’s and should ensure all staff know how to keep people safe from harm. People told us that they have meetings where they talk about the things they want to do, where they would like to go on holiday and choose the decoration and furnishings for the home. Minutes of these meetings showed that people had a choice as to whether or not they wanted to attend. People talked about holidays, activities and the decoration of their bedrooms. In a meeting in February this year people were asked what they thought about separating the home into three separate bungalows, minutes stated that people were happy with this. Some people are unable to express their views so records showed that their family was also asked about this proposal. They said that they had no objections to it. Records included individual risk assessments. These detailed how staff are to support the person to take risks whilst ensuring their safety as much as possible. Some people living there are unable to communicate verbally either because of their learning disability or ill health. The risk of the person becoming unwell or being in pain and not being able to communicate this had been assessed. This helps staff to know how to monitor the individual so to ensure their well being. Most risk assessments had been regularly reviewed and updated where needed. One person’s had not been reviewed since November last year but their needs had changed since then and so the risks to their safety may have also changed. We were told about an incident where one person had left the home without staff. Because of their needs this is a big risk to their health and safety. They were returned to the home safely. Their records showed that since this incident their risk assessment for this had not been reviewed to ensure that all the risks are reduced as much as possible. One person’s risk management plan for reducing the risks of them choking stated that it was written in January this year. When looking at it we found that it was a copy including the typing errors of a plan written in 2005. From looking at the person’s records it is evident that several of their needs have changed since then so this should be looked at to ensure all risks are reduced. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 13 At previous inspections it was found that people did not have a key to their bedroom so they could lock it if they wanted to and had never been asked about this. Since our last visit individuals had been asked this. Some people said they did not want this or would let staff decide for them. One person said they would like it but the manager said that this person does not have a key as they would not be able to use it. Risk assessments should be in place to assess whether or not the person is able to use a key and if so a record should be made of whether or not they choose to have one. The manager said that one person does have a key to their bedroom but this can be a risk as they shut themselves against the door so staff would not be able to access in an emergency. Risk assessments should be in place for how these risks are minimised. Stacey Drive DS0000072796.V375363.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: 12, 13, 14, 15, 16, 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. Not all the people living there experience a meaningful lifestyle or have a healthy diet, which could affect their well being. EVIDENCE: Three people go to day centres on different days of the week and some people go to college where they do cooking and computer skills. The manager said that some computers are being donated to the home from a local college so people will have more access to these at home, there is one computer that people can use now. The home does not now have a dedicated activity worker but as part of their role care staff involve people in activities. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 15 One person’s activity record for the week stated they would have a manicure and go to the snoozelen (sensory) room. There is a snoozelen room in the home but this is no longer used as it is not maintained adequately. The manager said that people can have access to a snoozelen room locally but this needs to be booked sometimes up to three months in advance. Therefore, it is unlikely that this person would have been able to go to the snoozelen room twice that week. Staff said that the person had been out shopping but this had not been recorded. During the day people were observed going out in small groups for a walk or to the local café with staff, playing bingo, watching TV and listening to music. Records showed that people go to church, for drives in the country, to the hairdressers, to cafes and for walks. Records also showed that entertainers sometimes visit the home. One person’s activity records sampled for March showed that they did not go out of the home. They watched TV and DVD’s, did some ‘light’ exercises, helped make their bed, cleaned their bedroom and listened to music. In April their records also showed that they had not been out of the home although they had been asked if they wanted to go out but they refused this. Their records showed that they can often refuse to go out but it was not often indicated that they were offered the opportunity to do so. They are unable to access the minibus due to their limited mobility and the minibus does not have a tail lift. A relative said that their relative goes out a lot if there are staff on duty who can drive the minibus. The manager said there are only a few staff who can drive this but they hope to recruit a driver to the vacant staff post. The manager said that two people were going to Blackpool with staff on holiday in October and that three people are going to a cottage in Tewkesbury with staff. No other holidays had yet been planned but records showed that people had been asked about whether or not they want to go on holiday and where they would like to go. Records showed and people said that they are supported to keep in contact with their family and friends. Some relatives visited during the day. They said they were always made welcome by staff and had a good relationship with the staff which they felt was essential to the well being of their relative. Records sampled showed and it was observed that people are encouraged to do things for themselves and help with jobs around the home. This helps to ensure their independence skills are developed so helping to maintain their self esteem. Food records sampled showed that people are not being given a healthy diet that includes five portions of fruit and vegetables a day. One person’s records Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 16 showed that out of fourteen days there were only six days when it was recorded that they had eaten fruit and vegetables. On none of these days it stated that they had eaten the recommended five portions. Records showed that people are offered a varied diet. People were observed being offered a choice of what they wanted to eat and drink. Stacey Drive DS0000072796.V375363.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, 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. Arrangements do not always ensure that the health needs of individual’s are met, which could impact on their well being. EVIDENCE: The people living there were well dressed in clothes that were appropriate to their age, gender, the weather and the activities they were doing. When people spilt food or drink on their clothes staff supported them to change so helping them to feel comfortable and maintaining their dignity. Records sampled included an individual health action plan. This is a personal plan about what a person needs to be healthy and what support they need to access healthcare services. The manager said they are looking at introducing pictorial plans so to make them easier for the person the plan is about to be involved. Two people’s plans were undated so it was not possible to assess Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 18 whether these were the current health needs of the person. This could mean that staff do not support them appropriately to meet their health needs. Records sampled showed that where appropriate other health professionals were involved in people’s care. One person had sore skin and the District Nurse visited them regularly to help staff to ensure the person was more comfortable. Their records showed that the District Nurse was decreasing their visits as the person’s skin was improving. Health appointments were not always recorded. One person’s records indicated that they had not had a check up with the dentist since 2007 and had not had any chiropody although this had been identified as needed. The manager said that this person had been to the dentist and had regular chiropody but staff had not recorded it. One person’s records showed that they had no input from health professionals in 2009 despite their daily records showing their health needs had changed. Relatives said that they were always informed if their relative was unwell so they felt involved in their care. Relatives said that people are well looked after and the staff are good. One person’s records showed that they had been weighed regularly and when it was identified that they were losing weight staff had taken them to see the GP. One person had not been weighed since October last year. The manager said that they did not have suitable weighing scales in the home to weigh them and they were unable to go to the weight clinic as they could not access the minibus. Measuring the circumference of the person’s arm was discussed as this can indicate weight loss or gain if unable to weigh. Another person’s weight had not been recorded since November last year. The manager said the person had been to the weight clinic but staff had not recorded this. It is important that records are kept of people’s weights as losing or gaining a significant amount of weight can be an indicator of an underlying health need. A local pharmacist supplies the medication for the people living there in individual pre packed trays. This helps ensure that staff know what medication each person has and when to give it so reducing errors. At the front of each person’s Medication Administration Record (MAR) there was a photograph of the individual. This helps unfamiliar staff to know who to give the medication to. The qualified nurses employed at the home give out the medication. Some people take their medication with yogurt because of their swallowing difficulties. A protocol was in place to ensure that staff knew this and the pharmacist had checked that giving it in this way would not affect how effective the medication was. This stated that this was discussed with professionals but was not signed by any of them. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 19 All MAR had been signed appropriately indicating that medication had been given as prescribed. Copies of all prescriptions are kept so staff can check what the doctor has prescribed is what is being given. Some people are prescribed as required (PRN) medication. Protocols were in place for each of these stating when, why and how much of the medication is to be given. This helps to ensure that people get the medication they need to meet their health needs. Some medication cannot be stored in the trays as it is liquid or being in the tray will affect how effective it is. It was not possible to audit this medication to ensure it was being given as prescribed. Staff had not recorded when and how much of the medication had been received and when the box or bottle had been opened. For example, on one person’s MAR it stated 28 tablets had been received on 17th April, the MAR stated that 17 had been given to the person but there were 22 left in the box. This only indicates that 6 tablets had been given so it is not clear that the person is getting the medication they need. One person was prescribed a liquid to be given as required. They could be given half or a whole spoonful depending on how much they needed for pain relief. It was not stated on the MAR how much had been given. This should be stated so the doctor prescribing it knows how much is needed for it to be effective for the person. A few years ago an agreement was made with the home that one person could be given an injection by the registered nurses employed at the home if staff were assessed by the manager as being competent to do so. A protocol was developed on how staff were to give this injection. This was because the person became very anxious with people they did not know as well as the staff resulting in them not always getting the injection they needed to be well. It was found at this visit that registered nurses were also administering injections to three other people living there. A detailed protocol was in place for one person. Individual protocols should be in place to ensure that the ‘best interest’ of the person have been considered in making the decision for them to have the injection at home. The competency of nurses giving the injections should be assessed and updated training should be given to ensure their competency in this. Separate MAR were available for injections and these showed that the injection site was alternated so that it reduced the discomfort to the person. It did not state on the MAR how many ampoules of the injection were in the home. Staff said they do not have a running total of these, which does not ensure they know if any should go missing. Stacey Drive DS0000072796.V375363.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, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from abuse. EVIDENCE: Relatives said they knew how to complain and if they did staff would listen to what they say and try to put things right. The complaints procedure was available in the service users guide so that people had this information when they moved into the home. One person’s records sampled included a care plan that stated they may make allegations about other people living there and staff if their mental health is poor. The care plan stated that staff should report this to the local authority safeguarding team if necessary. It is the responsibility of the local authority to decide whether allegations made are to be investigated and so all allegations should be reported to them. The manager said they would amend this care plan. The person had recently made an allegation about another person living there and this had been reported appropriately. Steps had been taken to safeguard the person after a meeting of professionals took place instigated by the home as the local authority had not contacted the home about this. The Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 21 manager said they would telephone the local authority to ensure all steps had been taken to safeguard the person. Staff training records sampled showed that staff had received training in safeguarding. This helps them to know how to safeguard the people living there from abuse. The manager has attended training in the Mental Capacity Act 2005. This Act came into force in April 2007 and requires an assessment of the person’s capacity to be completed when making a decision about their welfare if there is any doubt that they lack capacity. If they lack capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. The manager is to do training at the end of the month in the Deprivation of Liberty Safeguards. These are linked to the Act and ensure that people who live in a care home are not being cared for in a way that deprives them of their liberty. All staff that work at the home should have training in these so they know the possible implications of this legislation for the people living there. Following our last visit we were told that some people’s bank statements had gone missing from the safe. The manager said that it was not found who took these so all staff had been given official counselling in response as part of the disciplinary process. Duplicate statements had been received from the bank. Since then the Primary Care Trust (PCT) had updated the financial procedures so to help ensure that this does not happen again. The manager said that an auditor from the PCT did a financial audit in December last year and found that the systems were good. The previous manager was still the signatory for most people’s bank accounts, although they were contactable, the manager was trying to change this so that people had access to their money when they wanted. Where people had relatives that were willing to take on this responsibility they were the appointee. Finance records sampled showed that each person had their own bank accounts that their benefits were paid into. Bank statements showed money going in regularly and where money was withdrawn a record was available in the home that stated what the money was spent on. Records matched the amount that was kept securely in the person’s purse or wallet. Receipts are kept of all purchases. People’s money had been spent on personal items not on things that should be provided by the home as part of the fees that the person pays. Stacey Drive DS0000072796.V375363.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, 26, 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are continuing so that the home is comfortable, safe and clean for people to live in. EVIDENCE: Since we last visited a number of rooms had been redecorated to a good standard and new furniture had been provided. New carpets had been fitted throughout. The manager said that Midland Heart had increased the petty cash float so they are able to buy more things for the home. They ask the people living there what they would like then staff support people to go out to buy things. This made the home more comfortable for people to live in. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 23 In the dining room in bungalow 8 there were heaters stored. The manager said that there was a problem with the heating system so these were used temporarily and had been asking for them to be removed for months. This is important as people were observed to use the dining room during the day and apart from them being in the way they could also present a hazard. Currently the home is managed as one home and people generally eat their meals and these are cooked in the kitchen and dining room of bungalow 10.The manager said that there are proposals to make the homes individual so there will be four people living in each bungalow and meals will be served in the individual kitchens. This will give people the opportunity to live in smaller groups and help staff to be able to give more person centred care to individuals. If these proposals go ahead the kitchens in bungalows 8 and 12 would need to be refurbished. The cupboards were worn and would need to be replaced so they are more hygienic. There is a snoozelen (sensory) room, which is no longer used as Midland Heart or the PCT would not take responsibility for maintaining it so it was safe to use. The manager said that currently only one person enjoys using it. As stated under the ‘Lifestyle’ standards staff need to support this person to use snooozelen rooms in the community more often as this is something they enjoy. The manager said they are going to use this room for storage space. The garage is also used for storage but was not that organised, which could put staff at risk when they are accessing it to get things. In the dining room of bungalow 12 and the garden there was old furniture stored. The manager said they were waiting for this to be removed. The bedrooms of the people case tracked were looked at. These had been personalised to individual tastes and interests. Two had recently been redecorated in the colours that the person had chosen. One needed redecorating as it was looking worn. The manager said this was planned. Some of the paintwork and lower walls around the home was worn and had been damaged by wheelchairs. The manager said that they planned for Perspex to be fitted to the lower walls to protect them from this and make the home more comfortable. As stated earlier in this report two people are unable to access the vehicle as it does not have a tail lift. Several of the people who live there are older so in the future this vehicle may also be inaccessible to others. This makes it difficult for people not only to be able to go out in the community for activities but also to access health facilities so impacting on their well being. Consideration should be given to providing a vehicle that all the people living there can access. The home was clean and free from offensive odours so it was a pleasant place for people to live in. Stacey Drive DS0000072796.V375363.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): 33, 34, 35, 36 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 arrangements for staffing, their support and development are variable, which could impact on the well being of the people who live there. EVIDENCE: The AQAA did not provide the information about how many staff have completed National Vocational Qualification (NVQ) level 2 or above in Care. Therefore, it is not clear whether staff have the skills and knowledge from achieving this qualification to meet the needs of the people living there. The manager said that staff continue to be employed by the PCT and they continue to have access to the PCT’s Human Resources and training. The manager said extra staffing was agreed for two people who live there so their needs can be met. The manager’s hours are in addition to the rota so they have the time to complete their management tasks. The manager said that in August a ‘Development’ (newly qualified) nurse was starting work there and Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 25 their hours would also be extra to the rota. There were two student nurses on placement there. Staff said this was good as it helps them to keep updated with ‘best practice’ and challenges them about how they are meeting the needs of the people living there. There was one vacancy for a support worker and the manager said they hoped to recruit a driver. One relative said that their biggest concern is when there are bank nurses on who don’t know the people living here. Most vacancies have now been filled so this should help to reduce the amount of bank staff used. Relatives said, ‘We have a good relationship with the staff here and that is essential’ ‘We do worry that there will be different staff if the home is taken over by a housing association.’ Staff meeting minutes showed that regular meetings are held so that staff know about any changes to the needs of the people living there and within the organisation. The records of three of the staff that work there were looked at. They did not include the required recruitment records to show that staff are ‘suitable’ to work with the vulnerable people who live there. The manager said that the required recruitment checks have been done but these records are at the Human Resources Department of the PCT. It was a requirement at the last inspection for the required recruitment checks to be completed before staff start working there and the manager assured us that these have been done for all staff. However, as she had recently been appointed the new manager has not yet had the opportunity to address this and obtain the records from the PCT. The manager said that a representative from the PCT had visited recently to update Criminal Records Bureau (CRB) checks for all staff to ensure they are still ‘suitable’ to work with the people living there. Records sampled for nurses showed that they had current registration with the Nursing and Midwifery Council (NMC) indicating that they are ‘fit’ to practice as a nurse. Staff records sampled showed that they had an induction when they first started working there so they knew how to meet individual’s needs. Training records sampled showed that staff had training in food hygiene, fire safety, safeguarding adults from abuse, medication, moving and handling, infection control, managing behaviour, menu planning and basic first aid. None of the records indicated that staff had specific training in meeting the needs of individual’s that live there such as dementia, person centred planning, epilepsy and mental health needs. Staff should have specific training so they know how to meet individual’s needs. Records sampled showed that staff had regular supervision with their manager. This helps them to be supported in their role and know how to meet the needs of the people living there. Stacey Drive DS0000072796.V375363.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, 41, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not always ensure that the views of the people living there are considered and their health, safety and welfare is protected, which could impact on their well being. EVIDENCE: The previous registered manager has left and the manager has been ‘acting manager’ for the past few months and was appointed at the beginning of May. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 27 The manager said that she would be applying to be registered with us and had an application form to do this. The Annual Quality Assurance Assessment (AQAA) was forwarded to us by the area manager when we asked for it. However, it only included half the information needed as the ‘Dataset’ part was missing. We informed them of this and asked for it to be forwarded but it still had not been. The manager said that this would be done but at the time of writing this report this had not been received. Visits from a representative of the provider had not been done since October last year to audit how the home is meeting the National Minimum Standards and the needs of the people living there. The manager said this was because there was some confusion as to whether this should be done by a representative from Midland Heart or from the PCT. This had now been resolved and a representative from Midland Heart visited the week before and these would now be monthly. We found from looking at records that several had been filed in the wrong place so it was not always clear to see how to support an individual. Some confidential information about individual’s had been filed in other people’s records. A ‘Clinical handbook’ had been started from March. It was not clear what the purpose of this was as it often recorded the same information that was included in people’s daily records so it seemed to be a duplicate. Some work should be done on ensuring that records are clear so all staff know the current needs of individual’s and how to meet them. Staff had tested the water temperatures weekly to make sure they are within the recommended temperature so that people were not at risk of being scalded. Several temperatures were too high. The manager said that this had been reported several times but not resolved. An engineer had visited earlier in the week but they found that a plumber was needed so were arranging this. Staff were ensuring that they tested the temperature of the water before people had a bath or shower to reduce the risk. However, some people are able to run the taps themselves so could be at risk of being scalded. Engineers had tested the gas and electrical equipment when needed and stated that they were safe to use. The fire risk assessment had not been updated since January 2008. This should be reviewed annually to ensure that the risks of there being a fire are reduced as much as possible. Fire records showed that staff tested the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to make sure it is well maintained and in good working order. Regular fire drills had taken place to ensure that staff and the people living there could practice what to do if there was a fire. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 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 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 1 35 2 36 3 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 2 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X 2 2 X Version 5.2 Page 29 Stacey Drive DS0000072796.V375363.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 YA34 Regulation 19 Requirement The required recruitment records for all staff employed there must be available in the home. This will ensure that ‘suitable’ people are employed to work with the people living there. Water temperatures must be within the recommended limits so that people are not at risk of being scalded. Timescale for action 31/07/09 2. YA42 13 (4) (ac) 07/06/09 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. 2. 3. Refer to Standard YA1 YA1 YA6 Good Practice Recommendations The statement of purpose and service users guide should include the information people need to make a choice as to whether or not they want to live there. The service users guide should state the fees charged to live there so that people have all the information they need. Care plans should be person centred and include all the individual’s needs. This will ensure staff know how to support the person to ensure their well being. DS0000072796.V375363.R01.S.doc Version 5.2 Page 30 Stacey Drive 4. 5. 6. 7. 8. 9. 10. 11. 12. YA9 YA9 YA12 YA13 YA17 YA19 YA19 YA19 YA20 13. YA20 14. 15. YA20 YA20 16. YA23 17. 18. 19. YA24 YA24 YA24 Risk assessments should be regularly reviewed and updated to ensure that all risks to individual’s safety are reduced as much as possible. Risk assessments should be in place for all the risks to the people who live there so their health, safety and welfare is protected. People should be supported to do the things they enjoy so improving their quality of life. A vehicle that all the people living there can access should be provided so that staff can support them to go out in the local community if they want to. People should be offered a healthy diet so ensuring their well being. Health action plans should be dated so it is clear that staff know how to support the individual to meet their current health needs. Health appointments should be recorded to ensure that individual’s are being supported appropriately to meet their health needs. Individual’s weight should be recorded regularly to ensure their health needs are met. Professionals involved in discussions about how people take their medication should be asked to sign to agree to this so to ensure that people’s health is not being put at risk. Staff should record how much medication is received into the home and when it is started to be given. They should be aware of how much medication is kept in the home. This will ensure that medication is given as prescribed to the person it is prescribed for. Where doses of medication vary staff should record how much is given to ensure the person’s health needs are met. Individual protocols should be in place for people who are given injections. The competency of nurses who give the injections should be regularly assessed so to ensure that individual’s health is not put at risk. All staff should have training in the Mental Capacity Act and the Deprivation of Liberty Safeguards so they are aware of the possible implications of this legislation for the people living there. The heaters should be removed from the dining room in bungalow 8 so that people are not at risk of hurting themselves. The kitchens in bungalows 8 and 12 should be refurbished so they are more hygienic and safe for people to use. Storage space should be better organised so to reduce the DS0000072796.V375363.R01.S.doc Version 5.2 Page 31 Stacey Drive 20. 21. 22. 23. YA29 YA29 YA35 YA39 24. 25. 26. YA39 YA41 YA42 risks to the safety of the people living there and staff. Arrangements should be made to protect the home from being damaged by people’s wheelchairs so the home is comfortable to live in. Consideration should be given to providing a vehicle that can be accessed by all the people living there. All staff should have training in how to meet the specific needs of the people living there to ensure their needs can be met. The dataset of the AQAA should be returned to us to ensure that the home knows how it is meeting the Regulations and National Minimum Standards and what needs to be done to improve the service. A representative of the provider should visit the home monthly to ensure they are meeting the needs of the people living there and their views are being considered. Some work should be done on ensuring that records are clear so all staff know the current needs of individual’s and how to meet them. The fire risk assessment should be reviewed to ensure that action is sufficient to reduce the risks of there being a fire. Stacey Drive DS0000072796.V375363.R01.S.doc Version 5.2 Page 32 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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