Inspection on 06/03/09 for Swiss House

This inspection was carried out on 6th March 2009.

CSCI found this care home to be providing an Adequate 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

Swiss House 29/01/08

Swiss House 22/05/07

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.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Swiss House 41-43 Brierley Hill Road Wordsley Stourbridge West Midlands DY8 5SJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jonathan Potts     Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Swiss House 41-43 Brierley Hill Road Wordsley Stourbridge West Midlands DY8 5SJ 01384573110 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Select Health Care Limited Name of registered manager (if applicable) Mrs Linda Power Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) Date of last inspection Brief description of the care home Swiss House is situated in a cul-de-sac off Brierley Hill Road in Wordsley. The home opened in 1993 following the conversion of an existing residential property. Swiss House is close to local facilities and bus routes, allowing easy access to shops and surrounding areas. There are gardens to the front and rear of the property, although the rear patio is mainly used due to the busy road at the front of the house. There is a communal lounge and dining room with a conservatory, which overlooks the rear patio and another house owned by the same owners. There is a lift, which enables access to the first floor. Service users accommodation consists of seven single bedrooms. There Care Homes for Adults (18-65 years) Page 4 of 37 care home 7 Over 65 0 7 Brief description of the care home are no ensuite facilities. The Home provides care for persons with a range of disabilities including profound and multiple learning disabilities, severe learning disabilities with complex communication and health care needs, although the building does not always prove suitable in respect of provision of a service to wheelchair users. A statement of purpose and service user guide are available to inform residents of their entitlements. The charges for accommodation are not currently stated within these documents and as such are not available to prospective residents within them. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We carried out an unannounced visit to the home over two days, this to review the homes performance against key national minimum standards. We considered all the information we have received about the home over the last 12 months this including such as notifications from the home, information from other agencies and an annual quality assurance assessment completed by the manager and submitted before our visits to the home. At the time of the visit we tracked the care for two individuals (this involving looking at all the documentation in respect of their care and cross checking this with outcomes). We also observed practice, talked to staff, the management and reviewed a range of other documentation as well as looking around the building. We also received information from representatives of individuals living at the home and staff via questionnaires. Care Homes for Adults (18-65 years) Page 6 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Some information in care plans and risk assessments could be better managed to ensure its up to date and accurate, with individuals given copies if they wish. Arrangements for enabling individuals living at the home to engage in local, social and Care Homes for Adults (18-65 years) Page 8 of 37 community activities on a regular basis could be better, this hampered by the lack of transport, drivers and staffing levels. Some aspects of medication management could be improved such as ensuring all medication is appropriately labeled and controlled drugs records are up to date. Staff need to ensure that the way that they move individuals is as safe as possible, and that this is reflected in risk assessments and through the availability of appropriate aids. All essential safety works in respect of the building must be completed such as electrical work and servicing of lifting equipment at legally required frequencies. There is on going re decorative works to be completed, these as identified by the manager. In addition locks should be available and individuals given keys when they wish them, this in addition to the need for privacy locks on all bathrooms and toilets. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home usually have sufficient information available to allow decisions as to the continued suitability of the home to meet their needs. Evidence: The service has a statement of purpose that contains a range of information about the home and how the service will be provided, this document supplemented by a service users guide. The manager told us that they are currently reviewing this document so as to present information in such as pictorial formats, this to make it easier to understand for individuals with communication difficulties. We discussed the need for greater clarity in respect of the fees for the service with the manager who indicated that there was a flat fee charge, where as it was more likely that any new user of the service would pay a fee based on their assessed needs. As such the potential fee maybe better identified as within a range, and subject to assessment and costings. The home has not admitted any new service user for a number of years however and admissions would be infrequent as the service offers as far as possible a home for Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: life. We saw that individuals living at the home have been issued with contracts that are fairly informative and there is now additional information in respect of specific additional charges that maybe incurred. We did note that the fees for residency are not always documented in contracts. We noted that the contracts are however supported by access to some pictorial information as to their contents. The home has in the past been registered to provide care for people who have a physical as well as a learning disability. The majority of individuals living at the home have a degree of physical disability although the building is not wholly suitable. This is an issue that the provider has inherited from previous providers and some consideration has been given to how to lessen the impacts of the environment, although structural changes are unlikely to be viable. These limitations have been made clear in the statement of purpose by provider. As stated there have been no admissions to the home for a number of years, this meaning assessment of the homes admission processes was based on procedures, current care reviews and and the knowledge of staff. Based on discussion around this area of practice with the manager and sight of the homes assessments for some individuals we judged these to be generally robust, and there was clear involvement of other agencies and social workers in re-assessing individual care needs. We did however note some areas where such as care plans needed further updating. Comment we received from relatives indicated that they are given sufficient information to make decisions with or on behalf of the individual, and also felt that the home usually meet the needs of people living at Swiss House. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals or their representatives are involved in most decisions about their lives, although this is limited by capacity. The home is however conscious of this and communicates with individuals through appropriate techniques, the development of pictorial individual plans an example of this. Evidence: We saw that there are individual plans in place that the staff are now developing into pictorial formats, with us having sight of some of these. The ones we saw are a simplified version of the individuals full care plan and are presented in a pictorial/widget format. Discussion with one individual evidenced the accuracy of the plan although when asked they said they did not have a copy, this a matter that the manager stated she would address. The individuals understanding of the plan did however underline that they had been involved in the care planning process, and information did reflect what we saw in assessments. Observation of staff during the course of our visits also showed that their practice was mostly consistent with plans Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: we saw. We looked at the case files for two individuals in some detail and found that the needs of individuals are documented in some detail although it was at times difficult to locate information due to the amount of information, this including some which was possibly no longer current. The manager was advised to look at ways in which current information could be presented so that the current information was easier to access, with non current information in such as a back up file. Overall we judged that care plans have improved this reflecting comments we received via questionnaires completed by staff who stated that care plans are updated regularly so any new information regarding the clients needs can be found there and a lot of effort is also put into providing good quality care plans. We looked at a number of risk assessments related to individuals care in conjunction with the care plans and in cases saw comprehensive information, but also found some other information that was contradictory with other information in the file, this judged again to be due in part to the amount of non current data. We did see other instances where such as a moving and handling assessment referred to a specific method of safe transfer for an individual, this seen not to be followed in practice. Also whilst there was a risk assessment in place for an individual that at times rushed their food, there was scope for expansion to include the action staff would take if this person was to choke. The home also needs to consider the limitations that maybe placed on individuals living at the home, this through such as deprivation of liberty safeguards. The manager said at the time of the inspection that she was yet to complete questionnaires sent to her in respect of such assessments by the local authority. We noted that written evidence of individuals or representatives agreement with plans was not always available, although comment from people and their representatives indicated that they were involved and approaches to care and decision making did involve them. Three that responded to our questionnaires said care was always given in a way that was expected or agreed. Two of the relatives stated that staff understood individuals living at the home very well, this reflecting the detail in some of the communication plans and the way we saw staff communicating with people at the time of our visits; this having regard to non verbal behaviour and cues detailed in care plans. From discussion with one individual and their key worker we have been made aware that a communication assessment has been carried out and equipment identified to assist them , this currently on order. It was also pleasing to see that the individuals communication plan was on clear display in their bedroom on the wall. We saw that the home has liaised with the speech therapy service in the development of communication plans for some individuals living at the home. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: We heard that staff have received diversity training since the time of the last inspection, one staff member commenting this as helped them with understanding how to meet the needs of the individuals at the home. It was however disappointing to hear that person centered planning training was canceled due to staff sickness. Care Homes for Adults (18-65 years) Page 15 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home has tried to improve individuals access to social, leisure and recreational activities this is hampered by the availability of staffing and transport. Support is readily available for people to maintain links with families and a choice of diets are provided with appropriate support to assist individuals to eat. Evidence: Based on information we saw in individuals assessments it was clear that the staff have tried to identify the preferred activities and preferences of people living at the home. The majority of individuals have profound communication difficulties and staff we saw do measure peoples responses to stimuli to gauge what people liked and disliked. Individuals relatives have also been consulted and two told us that the staff knew residents extremely well, with comments such as my daughter is not in a position to make decisions but the staff know her well and know her likes and dislikes, Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: needs etc. As with care plans we noted some minor inaccuracies in respect of activity plans, this again seeming to be in respect of records that had been updated with removal of earlier information which did give in some instances indicate contradictory data. We saw that all individuals living at the home have access to day care placements and the company has access to an exercise therapy worker who has commenced 1:1 sessions with two people at the home. There are two factors that limit the provision of regular and consistent stimulation for individuals the first the staffing levels at the home. Comments we received via questionnaires included such as the following service users could be offered more activities but at present this could only be achieved by providing higher staffing levels. (staff) and more staff would enable a better social life for both staff and service users (relative). Discussion with the manager also indicated that there was a cap on the maximum number of staff (this due to funding issues) that makes the provision of 1:1 activity difficult due to physical dependency levels. In addition the provision of community activity is hampered by the lack of transport (the homes is now sharing transport with another home) and only the manager is able to drive. This clearly puts an additional pressure on the manager (the home previously had an allocated driver) and impacts on the ability of the home in assisting individuals to access activities agreed on their plans. We have been made aware by the manager and an individual we spoke to that the home is trying to source more funding through mobility benefits. We saw that staff have tried to improve the provision of stimulation in house through such as the availability of a sensory area in the conservatory and such as illuminated aquariums in bedrooms that individual can watch if having bed rest. One individual told us about activities they like to have involvement in, some that require staff assistance which is not always available, although we were told staff do try to give their time where this is possible, this also seen at the time we visited. We heard that the home is good at ensuring individuals are able to maintain contact with relatives, three telling us in questionnaires that they were always kept up to date with important issues with comments such as I have in the past been informed immediately if there is any problem with my daughter and have always had their full support at these times. One individual told us the staff facilitate access to the telephone when needed and regular contact with family is supported. We saw that pictorial menus are available to assist with the illustration of meal choices of which at least two are available at each meal. We saw that there are plans in place as to the assistance and input that individuals require when eating their meals, and we saw that this was followed through into practice at meal times, food presented as Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: plans detailed and support reflecting that people needed. We saw that the home has responded to the needs of one individual who has specialist nutritional needs proactively with support for staff from outside services. We saw that staff have completed nutritional assessments and records we saw reflected the steps staff take in monitoring such as weight and nutritional intake, although we saw where B.M.I. ratings used to inform these assessments, these had not been applied consistently to all. Care Homes for Adults (18-65 years) Page 18 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual assessed needs and generally personal support is provided in a way that meets these, although care needs to be taken to ensure safety is not compromised. There are some areas of medication practice that compromise the safety of its management. Evidence: We saw in records that these showed that individuals preferences in respect of the times they rise and retire have been identified and plans carry reference to the reasoning to clarify why some people go to bed at certain times, these relating to behaviour and health issues. One individual told us that they were happy with the care and support that staff provided to them this echoing comments we received from three relatives via questionnaires with comments such as is always well cared for she is always nice and clean and well dressed , staff are always most caring and it would appear that most staff as I understand have NVQs at different levels and seem to be well chosen for their kindness and thoughtfulness. Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: We saw that moving and handling of individuals is risk assessed so that there is clear guidance available to staff, although we were concerned on the first visit to see the manager and another staff member physically lifting a person by legs and underarm to transfer to a wheelchair. There was a further issue in that the wheel chair brake was not on. This contradicted the instruction related to the moving of this individual that we saw in records. Whilst we have been made aware that there was a need to move this individual quickly for their well being, and there was a lack of space in which to use a hoist at the time the transfer of the individual in this way does compromise their, and staff members safety. Following referral to the individuals social worker as a safeguarding alert, it has become clear that there is a need for the home to have a suitable chair, which the staff could have moved the person out of that area safely without the need to lift. To this end we have been informed by social services and the manager that a referral has been made to occupational therapy and further risk assessment carried out. The manager has told us that the practice of under arm lifting will not be repeated and safer methods for meeting this individuals needs will be used in future. The manager has made the relative fully aware of the situation and they have stated that they feel the risks present from not transferring the individual were greater that that presented by moving them in this way, with comment to the fact that they felt the staff had acted appropriately. The sourcing of a suitable chair would however allow easy and quick movement of the individual, in safety, within the space available. Beyond the above issue we observed other interaction with individuals that was positive with staff taking time to initiate communication with people. People told they they felt staff had appropriate training, and if there were gaps staff would source training from such as district nursing services. We have seen that staff have obtained training in respect of specialist health needs to reflect the changing needs of one individual, this so that they can meet their express wish to continue living at Swiss House. Staff that responded to questionnaires indicated that training was appropriate. Overall health care management was seen to be proactive with the home facilitating individuals access to a range of community health care services and professionals. (such as dentist, chiropody and district nurses). We saw that there are regular appointments for people to see their G.P. From care plans we saw that there was detail as to how staff were to meet individuals assessed health care needs and people told us that care was always provided as agreed. We saw that the home has copies of priority for health screening booklets for each individual although there are still issues related to the involvement of other agencies in completing these. The home was seen to have clear records relating to the visits to the home by health services however. We saw that the home has a medication policy that was available, this reviewed since Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: the time of the last key inspection, and as a result improved, now covering the receipt, storage, administration and disposal of medication. The home has had a good record of compliance with medication management and we saw that staff that administer medication have completed the appropriate training (as evidenced by certificates). Medication storage has been improved by the acquisition of a new medication trolley. The last audit by the contracted pharmacist identified two issues, to keep an eye on excess stock (this did not seem problematic at the time of our visit) and to ensure MARs records are signed at the point of administration (we saw to be done through observation). We checked the small amount of controlled drugs the home handled (this seen to be stored appropriately) and found that there was an issue in respect of recording, with some not signed out of the controlled drugs register, although there was some evidence that these tablets had been given. In addition we found some ear drops in storage that only had a handwritten label on (the printed label seemingly removed and transfered to the medication administration record). We also noted that some prescribed creams are to be taken as directed (the frequency of application must be clear). Care Homes for Adults (18-65 years) Page 21 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals and their Representatives have access to a robust complaints procedure and concerns raised are addressed quickly wherever possible.There are procedures in place that outline safeguarding procedures but indication that there is a possible lack of understanding as to the implications of poor practices. Evidence: The home has a comprehensive complaints procedure that has been adapted into pictorial format, this we saw on display in the home. Three relatives that completed our questionnaires all told us that they were aware of the homes complaints procedure and that if concerns are raised they are dealt with appropriately, one saying that if concerns had been raised they had been dealt with there and then. In addition they also told us that the home helped individuals keep in touch with them. The manager does ensure that there are meetings of the resident group, although we were told that due to the profound communication difficulties most of the individuals have, she, or the staff do try to spend one to one with them. Staff did tell us and it was detailed in communication plans as to what behaviour indicated dissatisfaction or discomfort and we saw that staff did respond to such cues during the time of our one visit. There was clear evidence that individuals have access to other social and health care staff on a regular basis either through attendance at daycentres or contact with health care professionals, giving the opportunity for others to monitor peoples Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: progress and well being. We saw that complaints received at the home are fully documented and actions made as a result fully recorded. We saw that the home has appropriate policies and procedures available in the home in respect of safeguarding adults, with pictorial versions of the multi agency safeguard and protect, copies of these seen in communal areas and one individuals bedroom. Staff told us they knew what to do if people had concerns. We made a safeguarding referral at the time of our visit to the home in respect of moving and handling practices that we observed. In discussion it was clear the manager was aware of the steps this involved, and based on feedback from social services she did work with them to resolve the issue. Whilst there were issues in respect of need to move the individual quickly for their well being, what was of concern was that the use of such lifting methods had not been seen as potentially dangerous to the individual at the time, and that other alternatives had not been explored prior to this alert. This raises concerns as to whether staff would recognize an issue that had safeguarding elements. Comment from the individuals relative in this instance was clear that they felt that staff had acted in the persons best interests. Discussion with the manager on the second day of the visit has indicated that she understands why we raised a safeguarding alert and has stressed inappropriate lifting techniques will be avoided in future. We looked at management of individuals monies in safekeeping and carried out a sample of monies against records, these found to be accurate. Records we saw to be recorded appropriately. Care Homes for Adults (18-65 years) Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We saw that whilst the building is homely the layout and structure is a potential barrier when providing care for individuals with physical disabilities. There are also factors that have the potential to compromise safety. Evidence: The provider took over control of Swiss house as an existing home and due to the issues the environment presents in respect of size and layout agreed at the time not to admit any further people with physical disabilities. The layout of the home does present issues in respect of meeting the needs of the current resident group in that there is limited space, bedrooms are of a limited size for wheelchairs and corridors are narrow, and various parts of the building are on differing levels, meaning steps preclude access to some areas. Examples of how we saw this impacting on individuals movement include observation of a staff member taking on individual into the bedroom, and issues around having to manually lift an individual, this in part due to limited space. The staff we saw have tried to provide the best possible environment within the restrictions they are faced with and we saw that the building was reasonably decorated and the provision of such as a sensory area in the conservatory have been provided to help meet some of the needs of the people living there. There are no shared rooms and attempts have been made to minimize the impact of room sizes by Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: allocating the larger rooms to those individuals that require use of such as hoists to transfer. There are still noticeable difficulties in that the upstairs toilets are not large enough for easy use by a person with disabilities. We also received comment from a relative that they were concerned as to the approach to the house which is sloped and makes pushing wheelchairs more difficult. Comment was also made to the fact outside facilities could be better, this confirming what we saw. We checked the servicing records relating to equipment and fabric of the building. These we found acceptable with the exception of the following: A recent check on the buildings electrical wiring indicated there were safety issues as detailed on the report shower switch exposed cables - incorrect light fitting and generally acceptable but some urgent repairs are required. We asked for but saw no evidence of these repairs. In addition we noted that there was no current and up to date evidence of the servicing of hoists, although there was for the slings used with these devices and prior to this they had been serviced at six monthly intervals. We have received no confirmation that this has been carried out post inspection. We saw that the manager has been proactive in identifying works that need to be carried out to maintain and improve the physical environment, this such as areas that need redecoration, and refurbishment. We have seen that a new adapted bathing facility has been fitted since the last key inspection. We also saw that there is a new wall mounted flat screen TV in the lounge which has freed up some space. Some areas of the home have been redecorated such as the main downstairs bathroom. General decor around the house is acceptable and we saw that some rooms present as comfortable, this enhanced by the personal possessions individuals have in their rooms. Discussion with one individual indicated that they would like a key to their bedroom door, at present we noted that there is no lock fitted. We also noted that there are no locks fitted to some toilet and bathroom doors, these possibly compromising privacy. Generally we saw that the home was clean and the home has appropriate infection control procedures available. We saw that the home has a new washing machine, this a commercial type with sluice cycle, and an improvement over the previous machine. We saw personal protective wear for staff use was readily available and we saw equipment was appropriately stored. There was no unpleasant odours noted at any time during our visits to the home. There has only been one incident of a possibly contagious condition over the last year and from notification we have seen that the home responded appropriately to this, and also contacted the health protection agency Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: for advice. We noted that the flooring in the laundry is still to be made good where a toilet has been removed. Care Homes for Adults (18-65 years) Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are better trained than previously, have the confidence of people that use the service but are not available in numbers to support the full range of diverse needs of the individuals living at the home. Evidence: The home currently employs twelve support staff and a manager, this based on the staffing numbers at the point of the last key inspection a decrease in numbers. We looked at the homes duty rotas and these were consistent with the staffing we saw at the home at the times of our visits. We were told and saw that there is three staff on duty per daytime shift which whilst sufficient for meeting the basic needs of individuals living at the home and ensuring their safety does not allow sufficient time to provide holistic care that meets all needs. All individuals living at the home have been assessed as high dependency and all require one to one support in the community. The fact that the home no longer has a designated driver also means that when transport is available there is only the manager that can currently drive. We discussed staffing levels with the area manager for the home and she told us that there are still on going discussions with funding authorities in respect of accommodation fees, with current funding levels said to be restrictive. The area manager was also aware that it was the services responsibility to provide sufficient staffing, and as such they need to Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: demonstrate clearly to the funding authority where additional needs require additional staff input. Comments we received from 3 staff in respect of staffing indicated that current staffing levels where only usually or sometimes sufficient. They told us that at present we are running on a maximum of three carers per shift, this is only really adequate when some of the service users are out of the home. At busy times and when all service users are in the home it can be hard with only three carers. The service users are never neglected in any way but running on only 3 staff means that we do not have the amount of time to spend with each service user as we would like. I feel that this also has a strain on the staff team. We do not have a driver at present either which puts a limit on outings etc. and we dont have a driver to enable the mini bus to be used as often as we would like Comments we received from three relatives and others showed that they felt the staff team were good at their jobs, and cared well for the people living at the home, with statements such as all the staff are pleasant and appear to be kind and thoughtful to me and my daughter and everything and oh they make lovely tea We looked at the homes training plan this we saw updated since the time of the last inspection, although still needs further update based on what the manager told us. We did see that staff have received appraisals in respect such as individual of training need, these on staff files. There have been areas where the staff have received training in the last 12 months with all staff now holding an NVQ, either at level 2 or three (this evidenced by our sampling of certificates). We saw that staff have received training in most mandatory areas of practice or are booked do do refreshers in such as moving and handing and infection control. We saw that the home has sourced training in such as management of PEJ reflecting the change in need for one individual. Discussion with the manager showed that she has considered the on going training needs of staff and is looking at sourcing accredited dementia care training. There has been little staff turnover, which is good for consistency, with only one new member of staff having been employed in the last 12 months. We looked at the file for this staff member and found that the home had followed its recruitment procedure, protecting individuals living the home in the process. The only omission we noted was that the application form held no record of why the person had left their last employer, although we did see evidence that the home had obtained two references. We saw that the home has an induction that complies with national standards although we saw no evidence that the new member of staff had completed this. The manager told us that they had been given a copy of the induction, although we saw no evidence of this in supervision notes or through their signature to evidence receipt. The manager told us that she was conscious that individuals at the home are not Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: currently involved in recruitment and was talking to one individual with the intent that they may be involved in the interview of potential staff when more were employed. Care Homes for Adults (18-65 years) Page 29 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are clearly developing and becoming more robust although there is still scope for improvement in a number of key areas that have the potential to compromise the health and safety of individuals living at the home. Evidence: The manager of the home has worked in social care since 1988 and holds an NVQ level 4 in care. She is still yet to attain a management qualification but told us she is currently studying towards completion of the same. We have been told that she is receiving very good support from her line manager (line management arrangements having changed over the last 12 months) and feels that she is now more involved with decision making, this fitting in with what the area manager told us in that she is supporting her in a more enabling way. We are aware that there have been difficulties in communication with other agencies which the management have been open about although we have been told that they have tried to improve this through 3 way meetings with social workers. Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: The manager is supported by a deputy that is also undertaking an NVQ level 4. Comments we have received from supporters of individuals living at the home via questionnaires have indicated a confidence in the manager and staff with comment such as The manageress discusses with me any projects or ideas for improving (individuals) lifestyle and I am happy about most things she suggests. (individual) has been more contented there than the two previous placements. Three staff that responded to questionnaires told us that they felt that they receive support but one felt more regular meetings with the manager would be useful. Comment was also made to the fact that communication between staff could sometimes be better, this due to other staff forgetting to document information. We discussed supervision with the manager and saw evidence that this has improved since the last inspection, although the manager said it still needs to be better. We did see that she has now drawn up a schedule for the planning of supervisions with staff. The home we saw is developing its quality assurance monitoring and the manager showed us documentation that was to be introduced to assist this process. The home does listen to individuals and their representatives and we saw that changes are made based on comments made, although there are issues in respect of such as staffing (and consequently activities), mobility (lack of drivers/transport) and the environment where changes would be difficult due to the financial constraints under which the service currently operates, this due to current income. We discussed the financial viability of the service with the manager and this did highlight some concerns in respect of the areas where there is scope for improvement (such as staffing) these areas of some cost and problematic when considering current income levels. We are aware that the company is supporting the home and the area manager stated that profit margins are not an immediate consideration. We saw that the home has introduced pictorial feedback cards for informing its quality monitoring and we saw records of regular management monitoring visits. We saw that the home has a health and safety policy that meets legal requirements and we saw that a new audit system that is in the process of been introduced is detailed and based on a clear auditing system, these systems produced by an external consultant. The manager has identified where the staff need training updates in respect of safe working practices. It was pleasing to see that after the last Environmental Health inspection of the home they were awarded three stars which means they have good standards of food safety and hygiene and there was a high Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: standard of cleanliness. There are however some areas of concern in respect of safety detailed earlier in this report. Care Homes for Adults (18-65 years) Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 16 The registered persons are 31/08/2009 to make arrangements to enable individuals living at the home to engage in local, social and community activities on a regular basis. This is to ensure all individuals are stimulated through provision of regular access to the community. 2 18 13 The Registered persons must ensure that moving and handling directions within risk assessments are followed. This is to ensure identified risks to service users are so far as possible eliminated 30/06/2009 3 20 13 Controlled medication must be signed out in the appropriate records as it is given, this so as to show a clear audit trail. 30/06/2009 Care Homes for Adults (18-65 years) Page 34 of 37 This is to ensure medication is managed in a way that safeguards service users. 4 20 13 The Registered persons 30/06/2009 must ensure that medication is appropriately labeled, this with a printed label from the supplying pharmacist. In addition labels must not be placed on medication administration records. This is to ensure medication is managed in a way that safeguards service users. 5 42 23 The registered persons must 30/06/2009 ensure that urgent electrical repairs are completed. This is to ensure there is no risk to individuals living at the home. The registered persons must 30/06/2009 ensure that all lifting equipment is serviced at intervals that ensure it is safe for use. This is to ensure equipment is safe to transfer individuals living at the home. 6 42 23 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 To look at ways that the involvement of individuals or their Representatives can be evidenced, such as signed agreement with individual plans. Care Homes for Adults (18-65 years) Page 35 of 37 2 6 To ensure that care plans and risk assessments are accurate and reflect the current practice and objectives staff follow, this to be assisted by better control of non current documentation. To ensure individuals have a copy of their plan if they wish. To review the arrangements in regard to the transport facilities available to individuals living at the home To provide individuals with lockable bedrooms doors and keys where it is their wish to have these. The Registered manger must ensure that there is appropriate follow up from the occupational therapy team in respect of the supply of a suitable chair so that one individual can be moved quickly and safely as and when needed. To ensure that that staff have training that reinforces the implications of poor personal care practices, and how poor moving and handling techniques can endanger vulnerable adults and staff. To look at ways in which there can be more staff available that can drive the companies transport. Sufficient staff should be made available to allow the service to meet the full range of individuals diverse needs. To ensure that application forms contain detail of why prospective staff have left their last social care employer. To address the works the manager has identified including such as laundry to be tiled, replacement of one bedroom window and carpet and further re decorative work. 3 4 5 6 6 13 16 18 7 23 8 9 33 33 10 11 35 42 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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