Inspection on 30/01/09 for The Cherries

This inspection was carried out on 30th January 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cherries 10/10/07

The Cherries 26/06/06

The Cherries 07/12/05

The Cherries 07/07/05

The Cherries 23/11/04

The Cherries 05/05/04

The Cherries 03/02/04

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Insight - Eastchurch

Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Cherries 30 Julian Road Folkestone Kent CT19 5HW     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: Kim Rogers     Date: 3 0 0 1 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.csci.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: The Cherries 30 Julian Road Folkestone Kent CT19 5HW 01303259561 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : the.cherries@craegmoor.co.uk Craegmoor Homes Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The home may only accommodate service users between the ages of sixteen to twenty five years of age. The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (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). Date of last inspection Brief description of the care home The Cherries is registered to provide care and support for 6 young people with learning disabilities. Residents must be within the age range of 16 - 25 years. The home is a large detached building with adequate communal space and single bedrooms. There is limited parking to the front drive but parking in the road outside. A large, well maintained garden to the rear is accessible to the residents. There is no lift or access for a person with physical disabilities. There is a high level of staff support to service users living in the Cherries; all of the six current service users have a contract for oneto-one support. The home is situated close to the centre of the seaside town of Folkestone with its varied amenities and public transport. The current fee range for this Care Homes for Adults (18-65 years) Page 4 of 37 Brief description of the care home service is about £1478 to £2015 per week. For further information please contact the provider. 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: This was a key inspection of the service, which included a site visit. The last key inspection was 10.10.07. We carried out a random inspection on 30.7.08 following concerns we received about people not having access to their money and therefore limiting opportunities. The report from the random inspection is not published but is a public report so is available on request. We found that some issues found at the random inspection have not been addressed. For example staff are still working long shifts and excessive hours and there are no plans in place to increase peoples skills. Care Homes for Adults (18-65 years) Page 6 of 37 We made an unannounced site visit to the service as part of this key inspection. One inspector spent about five and a half hours at the home. We spoke to the manager, staff and service users. We sampled records and looked around the home. We made observations. There have been concerns and complaints about the service made to us since the last inspection. The Provider has looked into most of this and where necessary the Commission have looked into some of the concerns. For more information please contact the Provider. There have been two safeguarding alerts. This means that possible abuse was suspected and reported to the adult protection coordinator at social services to investigate. There is an ongoing investigation into service users money and the homes finances. One staff has been referred to the Protection of Vulnerable Adults list as they committed an offence while out in the community supporting a service user. This means that they may not be able to work with vulnerable adults in the future. The manager has been on sick leave for three months and is part of the investigation by the adult protection team. The manager of a nearby company home is at the home on a temporary part time basis. For the purpose of this report he is referred to as the manager. What the care home does well: What has improved since the last inspection? What they could do better: There are shortfalls to the Minimum Standards that must be addressed to ensure service users are safe and protected from harm. There must be systems in place to ensure that the service is monitored and audited to ensure it improves and that service users are protected. Previous company audits have not picked up serious shortfalls and potential abuse. Each person must have a person centred plan detailing their needs and aspirations in enough detail for staff to give the right support to enable people to lead the lives they want. All potential risks must be identified and assessed so staff have strategies to follow to reduce potential risks to people. Communication must be better supported by way of aids and staff training to enable people to make choices and decisions about their lives. Staff must have the training they need to enable them to include and involve people in all aspects of the home so increasing participation and engagement. Staff must also be up to date with mandatory training so service users are in safe hands. Staff must be effectively supervised and mentored to ensure they are offering good support and respecting peoples dignity. Staff induction must be in line with the standard. Service users must be protected from abuse. There must be robust monitoring and checks to ensure this happens. Care Homes for Adults (18-65 years) Page 8 of 37 There must be an experienced full time qualified manager in post while the registered manager is on sick leave to ensure people are safe and have the support they need and to ensure the home is run in service users best interests. There must be effective quality assurance systems in place that seek peoples views and act on them to improve outcomes for people. The fire risk assessment must be reviewed and staff must be competent in evacuating the building in the event of a fire. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 cannot be sure their needs and aspirations will be assessed. There is some information about the home with plans to make this more meaningful to people. Evidence: We found that a person has moved in to the home within the last year. We found no assessment of the persons needs and aspirations by the home in the persons file. We found no other assessment of the persons needs and aspirations, for example by care management. The manager said that he could find no assessment for the person but was sure one was carried out. Without a recorded assessment of a persons needs and goals the home cannot be sure they can meet the persons needs as far as staff numbers, skills, facilities etc. There is also no baseline for staff to refer back to and compare to. We found that the assessment tool used by other company homes is needs based and does not include an assessment of peoples aspirations and goals for the future. This means that goals may not be transferred to the persons service user plan and be Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: supported. We found no evidence that service users have been genuinely involved in the assessment process so may not have had a say. We found that there is some information about the home. The Statement of Purpose is in text and is displayed in the hallway although has slipped sideways in the frame so cannot easily be read. The service user guide is in text with symbols. The manager said that the content of the Statement of Purpose does not reflect what the home actually provides and needs updating. For example the manager said there is no mention that the home is registered to provide support for 16 to 25 years olds. This is basic information that should be right so people have the right information to help them make a decision about the home. The current text and symbol formats are not meaningful to everyone living at the Cherries. The manager said he plans to improve this. We found no evidence that people have a contract of terms and conditions with the home. This means that people may not be aware of their role and responsibilities and of things like how much it costs to live at the home and what should be included in the fee etc. The AQAA says that information about the home is up to date. The AQAA says people are only admitted after a comprehensive assessment is completed by the manager and kept in the main office of the home in the service users file. The AQAA says they cannot identify ways in which the service could improve in this area. If they do not identify how they can improve, outcomes for people who use the service will not be improved. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure their needs and personal goals will be supported. People cannot be sure that all potential risks will be identified and assessed so that risks are reduced. Communication must be better supported to ensure that people have the support they need to make choices and decisions. Evidence: Each person has a service user plan and we sampled one in detail. We found that some parts of the plan are blank and basic even though the manager said that this is one of the plans that has been reviewed recently. For example the page, my life story is blank, dates that are important to me is blank and the page what I can do and what I want to do is blank. This means that staff do not have all the information they need to give the right support. We found no mention of the persons hopes, dreams and aspirations for the future. This Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: means that people may not get the support they need to achieve their personal goals. We found some needs are recorded but there is no plan for staff to follow to know what support to give. For example one plan said, around people I do not know I get anxious, worried and unpredictable. The part saying assist me by X is blank. We found one plan said if I am not happy I scream and sometimes I hurt myself. We found no plan to say how staff are to support this. Without clear guidelines staff will not know how to respond to and support problem behaviours and they will continue. We found that some needs are recorded with a box ticked saying an additional care plan is required or a risk assessment is required. However in most cases there was no additional care plan or risk assessment. This means that some risks have not been assessed and reduced so people continue to be at risk of potential harm. We found some information from a previous home saying a person was at risk of absconding. We found that no risk assessment was carried out by the home until the day the person did abscond from the property, ten months after moving in. This means that although the registered manager was aware of a potential risk, no assessment was carried out and therefore no strategies put in place to reduce the risk. Subsequently the person did abscond and was at risk of harm. We found a review and evaluation sheet in service user plans. This had a signature and a date each month showing the plan had been reviewed. However, we found plans with little or no information and with things that have changed. No changes had been made to plans suggesting this review is ineffective and therefore a paper exercise. Without regular effective review staff will not know when a need or goal changes or is achieved and may be offering the wrong support. Some people have communication needs and use alternative forms of communication. We found that communication needs are recorded in only basic detail. There is some contradictory information, for example one plan said, I understand what you say, No is ticked. I understand short phrases Yes is ticked. There is no mention what the short phrases are. We found one plan says I use Makaton, a sign language. But not all staff are trained in using Makaton. The staff member in charge had not heard of Makaton when asked. One plan said I use a communication book. But the manager said this is not used. Without detailed up to date information and staff training people will not get the support they need to make choices and decisions. We found that there is some meaningful information to aid communication around the home. For example there is a board in the lounge showing pictures of activity choices. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Staff said they or service users point to things they might want to do. We found nothing on display showing who is on duty. This means people will not know who will be supporting them from one day to the next and will have to rely on staff to tell them rather than being able to find out for themselves. We found some assorted pictures of food and meals. These are kept in the kitchen that is kept locked so are not used to their full potential. This means that people may not have a choice about what they eat. 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. There are opportunities to take part in activities outside the home but opportunities at home are limited. Opportunities for skill and personal development are limited. People are not fully involved as staff do for people rather than with them. Service users do not have control or support to make real choices. Evidence: We found that a shift plan has been introduced. This plan allocates a member of staff to a service user each day. It shows what activity the staff will be supporting in the community for example, a walk, swimming, going to a cafe. Staff said that people now have the opportunity to have a drink and food when out. This is because they now have better access to petty cash and service users have better access to their own money. Each person has an activity plan, which is displayed, in the office. The Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: manager said he plans to make these more meaningful and individual and give each person their own copy. The shift plan does not show what activities staff will support when at home but allocates staff to tasks like the laundry. We found that very few activities are on offer when people are at home. We observed staff busy with tasks and doing things for people rather than with them. The manager said staff have not had training in person centred support or active support techniques so do not how to enable and empower people to do as much for themselves as possible. Staff do not have the skills to involve and include people in activities at home so the levels of engagement and participation are low. For example one staff was on her own in the laundry with the door locked doing the ironing. Two staff were in the kitchen preparing the lunch with the door locked so no service user was having support to help. This means that service users are not fully involved and do not have opportunities to learn and develop their skills and grow in confidence and ability. We found no plans in service user plans sampled to increase skills and learn new skills. For example there is no mention or opportunity of developing cooking skills. One plan said ability with money to be very limited but no plan in place to improve this with the right support. We observed service users showing signs of being bored and staff not always engaging with people. For example one staff was standing at the front window looking out while the person he was supporting on a one to one basis was in the back garden on his own. Although service users are supported on a one to one basis by staff we saw four service users in the lounge at one point for a while with no staff. This could be because staff have tasks to do which takes them away from service users. We found that records are kept of contact with family and friends although one record seen had not been updated since June 2008. We found that people have support to keep in touch with their families and people have visitors at reasonable times. We found no plans to increase peoples friendships, relationships and circles of support. This means that people may not have support to make new friends and develop relationships. We found that staff do the cooking. Two staff were in the kitchen preparing the hot cooked lunch. Staff said they try to keep people out of the kitchen rather than enabling them to come in and take part with the right support. We found that people do not know what they are having to eat until it is served to them by staff. This means that people do not have a real choice about what they eat. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: There is a board with pictures of food but this is kept in the locked kitchen behind the kitchen door so cannot be seen unless you enter the kitchen. We found that drinks and snacks are not readily available. For example the kitchen is kept locked and there is no water dispenser in the home. This means that service users have to make it known to staff that they are thirsty or hungry and have to rely on staff to interpret and support this. The manager said that the food is purchased on line and delivered to the home. This means that service users do not get the opportunity to experience the sights and sounds of the supermarket although the manager said that service users go to the local shops for smaller items. Staff reported that they now have access to petty cash to buy food items. Some people have intolerance and allergies to some foods yet staff left a tray of used breakfast dishes in the lounge and left the room. One service user ate from the cereal bowl until another service user removed it. We found that the kitchen is in need of repair and replacement. Some of the light fittings are broken and missing due to a water leak nearly three months ago. Some tiles are broken and missing on the kitchen window sill. There are new dining room tables and chairs in the dining area of the lounge. 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. People cannot be sure they will have the support they prefer with their personal care. People cannot be sure their health needs will be supported if records are not up to date and clear. The audit and monitoring of medication storage needs to improve to keep people safe. Evidence: We found that personal care needs are recorded in basic detail in service user plans. This lack of detail could mean that people do not get supported in the way they prefer. For example one plan said I need support to clean myself, but does not say how etc. This relates to intimate care and must be more detailed to afford dignity to the person and to protect them and staff. One plan said I need staff to choose my clothes for me. Service users must be supported to make their own choices about their personal care and appearance. We found that staff lack awareness of issues relating to privacy and dignity. For example one staff said to a service user in front of the inspector and other staff and service users, Do you need the toilet. Another staff asked a service user in front of Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: others if they are still dry and felt around their groin. The manager agreed that this is not acceptable and will address this poor practice with staff. We found that health needs are recorded in basic detail in service user plans. However we found inconsistent information. For example a health need is recorded for one person. There is a record that the persons medication for this health need has been stopped by the doctor appearing that the health need is no longer an issue. However no change has been made to the plan so it is not clear if this health need still needs supporting or not. One plan recorded a list of the persons medication although this does not correspond to the current medication administration record so is not up to date. The plan recorded, unable to consent to medication, but we found no assessment to support this decision and no plans to increase peoples control over their medication. The plan said a specific care plan is needed for medication but there is none. This plan showed a medication was changed to a when needed basis following a medication review on 26.3.08, however the medication administration record showed a different instruction for the medication and the manager said the medication had been discontinued. Without clear up to date information people will not get the right support. We found a page in a service user plan titled when I get sick, the support I need, and this page was blank. We found that a person has not had support to attend an important health appointment. The manager said the person has now attended a well man clinic appointment. We found a health booklet with symbols in one plan sampled. Some parts were filled in and other areas blank. We found that the information did not correspond to other information recorded in the persons plan. This means that it is not clear for staff what the persons current needs are. We found that medication is stored safely although checks must be carried out to ensure it is safe and tidy. For example we found two lose strips of tablets. Medication must be kept together in original boxes so staff know what it is, who it is for and when it expires etc. There was an empty box of childrens medication that the manager thought may belong to the registered managers child. If so this should not be kept in the homes medication cupboard. The medication administration records are in order with no gaps and show a record of receipt of medication into the home. We found that some people have allergies but this is not recorded on the record. The manager agreed to address this. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: An acting team leader administered medication to service users on the day of the visit. We found that he has attended a one day course on medication administration but has not had his competency checked to ensure he is safe to administer to people at the home. We found that staff control all medication and there are no plans to increase service users control with the right support. This means that people will not increase and develop skills and will have to rely on staff. The AQAA said that it is difficult to identify what could be better in this area. 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. People cannot be sure their complaints will be heard and acted on. Systems must improve if service users are to be protected from harm and abuse. Evidence: There is a written complaints procedure available. This is not meaningful to everyone who uses the service so people may not be aware of the procedure. We found that staff do not all have the communication skills and training needed to effectively support communication. This means that complaints may not be recognised, understood and sorted out. We observed a service user getting upset and trying to complain about a staff raising their voice. Staff did apologise, saying the person does not like noise and lowered their voice. However it happened again and the service user became upset again. This was not recorded or interpreted as a complaint so it was not addressed but happened again. Since the last inspection the Commission have had several complaints and concerns raised about the service and the management of the home. The Provider has investigated most of the complaints and concerns, it was necessary for the CSCI to investigate some of the concerns and complaints. This was done at the random inspection and this key inspection. Please contact the Provider for more details. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: Because of the amount of concerns and complaints, we carried out a random inspection on 30.07.08. This report is not published but is available to the public on request. The focus of this random inspection was that we received information that service users do not have ready access to their money, especially at weekends, so limiting opportunities. Since the last inspection there have been two safeguarding alerts. This means that concern was raised about possible abuse and reported to social services adult protection coordinator. One alert was made by CSCI following the random inspection of 30.07.08. We found that the way service users were being charged for things is ambiguous and inconsistent. We found that service users could not always access their own money. We found that staff do not always have access to petty cash so might run short of things. We found that people do not have the support they need to take control of their money and increase their skills. For example in one plan sampled it said understanding of money is very limited. So the help I need, this is blank. These issues had not been picked up by the Provider organisation. At the time of the random inspection the registered manager agreed to improve systems to ensure that people could access their money and therefore have more opportunities. She also agreed to review what people are charged for. Since then the manager has been on sick leave for the last three months. Adult protection and the police are currently investigating concerns about service user finances. Staff say they now have access to petty cash so can buy provisions rather than run out. Staff report that they can support service users to access their money so people now have the opportunity to have a drink or meal when out. The audit and monitoring of the service must improve so this does not happen again and to ensure that service users are protected. The Provider has referred one staff member to the Protection of Vulnerable Adults list. This means that the person cannot work with vulnerable people. This followed an incident when the staff member committed an offence while they were supporting a service user. There is an adult protection policy and staff attend training in how to recognise and respond to abuse. Systems for checking practice must be improved to keep people safe. We found that problem behaviors are not supported in a positive way with no clear Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: guidelines for staff to follow. Staff said that some people have problem behavior and are subject to restraint. We asked staff about how they support these behaviors and staff said the training they had is about how to control people and what positions to put them in. Although staff said they have never had to do this they have the belief that this is acceptable when there is no guidelines, assessments or agreement by service users. This attitude of control places service users at potential risk. Care Homes for Adults (18-65 years) Page 24 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. The home is generally well maintained and homely. Evidence: We found that the home is generally well maintained and clean. There has been some redecoration including the lounge. The manager said there are plans to replace some carpets and install a new kitchen. We found that improvements to the kitchen are needed as some light fittings and tiles are missing or broken. We found that broken blinds hang at the back windows in the lounge. The manager said he has purchased new curtains to put up. We found that the boiler has been repaired and a water leak has been addressed. Some remedial work is now necessary due to the leak. We found that the house was warm as extra plug in oil filled radiators have been provided in addition to the central heating system. Staff said the home is warmer now. People can get out into the garden when they wish to get fresh air. The kitchen, laundry and front door are kept locked. The manager said he is not sure when these imposed restrictions were last reviewed. Imposed restrictions should be kept under Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: review to ensure that they are still necessary, the least restrictive option and made in every ones best interests. Each bedroom is single. There are shared toilets and bathrooms and communal space. The lounge and dining room feel homely as pictures and photographs of service users have been put up. 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. There are enough staff on duty but staff need more direction and training to engage with people and enable service users to do more for them selves. The culture must change if outcomes for people are to improve and staff need support and training for this to happen. Shortfalls in mandatory training and training related to service users needs must be addressed so service users get better support and are kept safe. Evidence: We found that there are usually five staff on duty at the home. Staff from other company homes are supporting the regular staff team. We found that staff are working long shifts and long hours each week. For example one staff said they were tired having just worked ten days in a row with some sleep ins in between. They said most of the sleep ins had been disturbed as some service users get up on the night. The manager said that there are some vacancies and they have recently recruited some staff who are due to start soon. The manager says they plan to have separate waking staff rather than sleep in staff due to peoples needs at night. We found that a shift planner has been introduced that allocates a staff member to a task like laundry, to a service user for the shift and notes what activity the person will Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: be supporting. As mentioned when at home service users do not do very much. Staff do the cooking, cleaning and laundry. We saw some staff not engaging with service users so service users were wandering around or watching the television. We found that staff do things for service users rather than with them. Staff need training, support, coaching and mentoring if this culture is to change. We found that not all staff are mindful of peoples dignity. For example asking people loudly in front of others if they need the toilet and feeling someones groin area and asking if they are dry in front of others. This does not afford people dignity and respect. We found that there are shortfalls in staff induction. A new staff of nine months said he was sort of in charge on the day of the inspection. We found that this staff who is new to working in care, has not completed an induction. The staff said they shadowed another staff for two weeks and read peoples care plans. We found that there is very little information about this staff member on site. For example no application form, no proof of his identity. The manager said he has found that some documents are missing from staff files and is in the process of auditing the files with head office. We found that one persons CRB check is over five years old. The provider may wish to follow good practice guidance and ensure the person is still safe to work with vulnerable people. We found that the staff member is working alone at night but has not had fire training or attended a fire drill. We found this staff has had no supervision meetings. This means that he has not had the opportunity to meet with a line manager for coaching and support. We found that other staff have not had the minimum amount of supervision. Staff raised concerns to the Commission about the lack of supervision in August 2008. The provider investigated this and said it had been addressed. We found that only four staff meetings were held in the last year. This is short of the minimum standard and means that staff do not have the opportunity to get together and discuss work related issues, concerns etc. We found some shortfalls in mandatory training. The manager said that there are some refresher courses booked to address the shortfalls. We found that staff do not have the skills to empower people to develop skills and lead the lives they want. Training in areas relating to peoples needs is very limited. For example no staff has had training about person centred active support or positive behavior support. 10 percent of the staff team have had one days training in person centred thinking. Not all staff have had training in alternative forms of communication like Makaton that some service users use. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: Without proper training and the support of an experienced qualified full time manager outcomes for people whom the service will not improve. 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. The home needs a full time, experienced, qualified manager in post while the Registered manager is on long term sick leave. There must be a system of gaining peoples views about the service and acting on them to improve. People cannot be sure their health and safety will be protected. There must be sound robust systems in place to audit and monitor the service to ensure that service users are protected. Evidence: The Registered manager has not been at the home for three months. As mentioned there is an ongoing adult protection investigation into service users and the homes finances. A Registered manager from another company home is overseeing the day to day management on a part time basis. The manager has identified shortfalls at the service and is trying to address some of the issues. However, the manager is also responsible for managing another home so has other demands. We found the manager is making Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: himself accessible to staff, parents and other stakeholders for advice and support. He said he has support from the area manager and the business support manager. The company are trying to recruit a temporary replacement full time manager while the registered manager is on sick leave. We found that staff morale is better than at the random inspection last year however, staff need permanent full time support and coaching from a good manager if the service is to improve for people. We found that the area manager or the business support manager carry out monthly checks at the home. However past audits and checks have failed to pick up irregularities found recently following the safeguarding alert. These checks have also failed to pick up things like shortfalls in care planning, assessments and opportunities and shortfalls to meeting some of the Minimum Standards. The business support manager completed the Annual Quality Assurance Assessment or AQAA. This document must be completed each year and should give information how the home has improved, what could be better and how they intend to improve. The AQAA does not reflect what is actually happening at the home. For example in two outcomes areas, choice of home and personal and healthcare support, the AQAA says they cannot identify how the home can improve. Yet we found some serious shortfalls to what the National Minimum Standards require. The AQAA does not identify any barriers to improvement yet the lack of a manager, lack of staff skills, supervision and support as well as an ongoing adult protection investigation could all be barriers to improvement. If barriers are not identified there will be no plans to overcome them so the service will not improve. The manager said there is mitigation in that the AQAA was filled out at short notice by a person who at the time did not know the service well. However, such a large organisation should have support structures in place to ensure managers complete a full detailed AQAA each year as the law requires. We found that the range of ways service users views are sought is limited. For example there are no planned one to one meetings with key workers so no time set aside to get service users views. Some staff lack the skills to communicate effectively with service users so the ability for service users to effect change is limited. The manager has recognised this shortfall and held a trial service user meeting on 6.1.09 to try to get people more involved. The manager said the company send out surveys to stakeholders like parents and care Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: managers but is not aware of any responses or action plans for development. We found that the home is generally safe and well maintained. We found some shortfalls in training related to health and safety and this must be addressed to keep people safe. For example the staff working alone at night who has not attended fire awareness training or taken part in a fire drill. This staff has only attended a one day first aid course rather than the four day appointed person course. The Provider must ensure staff who are lone working are up to date with training and competent in all areas so service users are in safe hands. We found some gaps on checks of fire equipment. For example the record for weekly fire door checks stopped on 17.10.08 and started again on 7.01.09. The last recorded check of fire extinguishers is dated 17.10.08 and the emergency lights were not checked between 6.10.08 and 7.1.09. We found that three fire drills were held last year but with no attendees names recorded we cannot easily establish who took part. We found that the fire risk assessment of the building is dated 20.01.07 with no review evident. The manager said he would review this. The AQAA shows that some health and safety checks of equipment and premises have been done. 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 1 13 The Provider must not admit 31/03/2009 anyone to the home unless their needs and goals have been assessed with them and recorded. A copy of the assessment should be kept at the home. To ensure that staff know about the persons needs and goals. To ensure the home has the staff and facilities to meet the persons needs. 2 6 15 Each person must have an 30/04/2009 up to date service user plan that records their needs and aspirations. There should be enough detail to give staff the information they need to give the right support. Plans must be reviewed regularly with service users To ensure that people have the support they need to lead the lives they want. To ensure staff know what support to give to help Care Homes for Adults (18-65 years) Page 34 of 37 people achieve and meet their needs. 3 9 13 All potential risks must be identified and recorded with strategies recorded to reduce potential risks. To ensure that staff have an assessment to follow to keep service users safe. 4 23 13 There must be effective monitoring of staff practice and other systems including financial systems to ensure service users are not at risk of harm or abuse. To protect service users from harm and abuse. To ensure that behaviors are supported in a positive way. 5 32 18 Staff must have the skills 30/06/2009 and competencies to meet peoples needs. This includes all mandatory courses and training relating to service users needs. This includes person centred planning, active support and communication. To ensure that the staff have the skills to support people to develop and increase skills, make choices and decisions and increase levels of participation and engagement. 6 39 24 There must be an effective 30/04/2009 quality assurance and quality monitoring system in place that takes service 30/04/2009 30/04/2009 Care Homes for Adults (18-65 years) Page 35 of 37 users views into account and acts on them. To ensure service users views underpin the review and development of the service. To ensure people are kept safe and that the service improves outcomes for people. 7 42 12 The fire risk assessment must be reviewed. Staff must be competent in evacuating the building in the event of a fire. To ensure that everyone is kept safe from harm. 28/02/2009 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 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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