Inspection on 17/04/09 for The Limes Blackheath

This inspection was carried out on 17th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Limes Blackheath 14/10/08

The Limes Blackheath 26/10/06

The Limes Blackheath 31/01/06

The Limes Blackheath 24/08/05

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 10/07/2009.

Key inspection report CARE HOME ADULTS 18-65 The Limes Blackheath 37 Avenue Road Blackheath West Midlands B65 0LP Lead Inspector Sally Seel Key Unannounced Inspection 17th April 2009 08:05 The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Blackheath Address 37 Avenue Road Blackheath West Midlands B65 0LP 0121 559 3935 0121 561 1333 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Mohammed Iftikhar Ali Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 8 The maximum number of service users who can be accommodated is: 8 Date of last inspection Brief Description of the Service: The Limes is registered to make provision for a maximum of eight people learning disability. The home is situated within easy travelling distance of Blackheath town centre and close to public transport systems. The home has its own transport. This is used for holidays, group outings and to take service users to appointment, where applicable. Service user accommodation is provided over two floors. There are eight single bedrooms, four of which have en-suite facilities. The communal facilities on the ground floor consist of a lounge/dining area, conservatory and kitchen. Toilets and bathing facilities are available on both floors. There is a garden to the rear of the building. The main entrance is at the front of the building and limited car parking facilities are available at the side of the property. Interested parties should make contact with the home in relation to obtaining the correct fees charged for living at the home. There are additional charges for toiletries, hairdressing and transport. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home, over a day period. The acting manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were six people living at the home on the day of the visit and the inspector arrived before people living in the home had left for the day. Information was gathered from speaking to and observing people who lived at the home. Two people were “case tracked” and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records, health and safety documentation and reports about accidents and incidents in the home were reviewed in the planning of this visit. One survey from a person who lives in the home and two staff surveys were completed and returned to the Care Quality Commission (CQC). Information from these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example, people chosen were both female and male, have differing communication and care needs. We would like to thank everyone for his or her assistance and co-operation. What the service does well: Information telling people who may be considering living at The Limes is now available in easy read formats so that individuals are able to make informed decisions as to whether the home is right for them. Copies of this information have also been given to people living at the home so they are able to be informed of their rights. People living at The Limes are supported to take part in a range of daily living activities so that they can maintain their own levels of independence and bring a sense of purpose to people’s lives. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 6 Meals are a pleasant occasion where people take it in turns to prepare and cook a meal of their choice for other people who live in the home. This provides individuals with a sense of achievement and satisfaction. Efforts are made to make sure individuals are supported and encouraged to maintain the relationships that are important to them with individuals going to spend time with their family members and joining them on holidays. In the main interactions between people living at The Limes and staff were friendly and relaxed. Also staff are sensitive to the feelings of individuals who are sad due to the personal experiences in their lives. Each person has their own bedroom which is decorated in their own styles with furniture that has been replaced where needed and is filled with personal items that people like, ‘making it their room’. What has improved since the last inspection? What they could do better: Medication administration must only be completed by a qualified member of staff who have done their medication training and have been formally assessed as being competent to do this task. This will make sure people living at The Limes are protected by robust procedures and practices in relation to medication, administration and recording. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 7 Staff must attend training in diabetes awareness if they are being instructed to observe and monitor an individuals insulin practices and check blood glucose (BM). This should ensure that people living in the home are supported and have their needs met by skilled and knowledgeable staff with their health and safety protected at all times. Staff must have completed mandatory training including refresher courses where appropriate and sufficient numbers of staff must have undertaken specialist training in order to meet individual needs. New and agency staff should receive an appropriate induction before being placed on the ‘waking’ night shifts so that people living in the home can be confident that they are in safe hands at all times. Quality assurance systems must be continued to be developed to ensure services offered are reviewed, monitored and improvements made as necessary. This will make sure people are receiving quality services whilst living at The Limes. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is made available to people before they visit the home so that they can make an informed choice about whether to move in. EVIDENCE: We looked at the statement of purpose and service user guide which holds information to tell people considering whether to live at the home what the home is like, how their needs will be met, staffing and how to complain. These information guides are also made available to people who live at the home and their family members. It was positive to see that the statement of purpose and service user guides have now been reviewed and now hold up to date information and use pictures as aids to illustrate the written word. This ensures people are able to be read the information supplied. One person who lives in the home said they have a statement of purpose and service user guide in their bedroom and it has their name on it. Also a member of staff got an information guide from another person’s bedroom and this also had their name detailed on it. These measures ensure that people are consulted about whether they wish to move in and receive information about The Limes before The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 10 making their decision. One person told us in their survey, ‘I have lived at The Limes for 11 years. I knew the people there’. There are six people living at the home, five males and one female who have learning difficulties and have lived together for a number of years. There have been no new admissions since the last inspection and there are currently two vacancies. The local authority is not making any referrals for people to live at the home at this time due to ongoing concerns that have been raised. Therefore we were unable to fully assess the outcome area which is about looking at the care needs of new people moving in to the home. However, care plans and risk assessments have significantly improved since we last visited the home. These detail individual’s needs in respect of health, personal care, social, culture, communication and leisure preferences. Therefore systems are now in place which should mean individuals’ needs are assessed before they move into the home and that people have an opportunity to visit and stay over prior to making any decisions about whether to move in. For example in the statement of purpose and service user guide it says, ‘By providing you the opportunity to visit on a relaxed informal basis, allowing you to develop a feel of the home as well as being able to chat with current service users about the service they receive. Tea visits and overnight stay can be arranged at your convenience’. A family member responded in their survey:‘I am so reassured that he is cared for so well and I am very grateful’. People told us:“It’s alright not too bad”. “I like it here”. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems of care planning and risk assessment in place to enable peoples’ needs to be understood and met. Efforts are being made to give support to people that live in the home in order to make choices and decisions about their lifestyles. EVIDENCE: Care plans were sampled for two people who live at The Limes. Both had been reviewed in March 2009 to make sure that the information was relevant to people’s current needs. Although, it was not clear how individuals are involved in the development and review of their care plans as these had been signed by the acting deputy manager but on the care plans where the person who lives in the home should sign was left blank with no explanation as to why. Therefore we recommend that individuals and or their representatives are involved in all The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 12 care planning and reviews which is then reflected on their plans. This will ensure that people living in the home are ‘having a say’ in how their care plans are reviewed and developed so that their preferences are noted together with suitable times. The sampled plans gave detailed information about how staff should support people in order to meet their individual needs in relation to health, personal care, communication, culture and social and leisure preferences. These plans have been developed with the help of the community learning disabilities team. Positively pictures are used to illustrate individual needs which help people living at the home to participate in planning their care. We looked at risk assessments for people which are put together in their care plans so that consideration is given to supporting them to take responsible risks and promote their independence. Risk assessments sampled had been reviewed on a regular basis and staff were able to describe the measures in place to reduce known risks to individual’s health and well being. We discussed with staff and people who live in the home how people are encouraged to maintain and develop their independence. Some people travel without staff support, others cook for their peers and some have taken part in training along side staff to help them prepare and cook food safely. This shows that efforts are now being made to ensure individuals are supported to make their own daily decisions. On the day we visited we saw lots of examples where individuals were, getting up when they wanted to, holding keys to their bedrooms, washing up, making hot drinks, peeling vegetables, laying tables, choosing to be in their rooms and going to the shops. A person who lives in the home responded in their survey, ‘I help with the housework and keep my room very tidy and clean’. Some people who live in the home need assistance to manage their money. There are systems in place to record individuals’ income and expenditure, which are audited for their ongoing protection. People told us:“I go to the bank with envelope with money in”. “I will go and fetch a paper in a minute”. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 & 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home experience lifestyles that promote their independence. Further improvements should be made to ensure people are supported in pursuing personalised interests that are reflective of their individual needs. EVIDENCE: People’s social and leisure preferences had been recorded in their plans of care. Daily records were sampled to check that people had regular opportunities to take part in things they enjoy doing. People confirmed that they take part in a range of activities such as going to local day centres where they meet their friends, an evening disco, shopping and trips to places of interest. There are opportunities for people to go out as a The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 14 group but there now needs to be more effort to support people in pursuing their own particular interests in the evening and during the day. For example, on the day we visited we saw people going out with a staff member to the shops other people appear to remain in the home as a small group. Also as at previous inspections there is one person living at the home that is getting older now and needs to have an activity planner that shows how staff are ensuring that activities are suitable for this person. This should include planned ‘one to one’ time for them so that they are supported to express their own social and emotional needs. We did look at activity planners but in the main activities were based on groups unless individuals went to day centres and or home to their family members for a short stay. It was good to see that people have a day where they are responsible for choosing, cooking and preparing an evening meal for their peers. Every person’s day is detailed on the menu so individuals are aware which day they are cooking. People in the home spoke with the inspector about what meals they enjoyed and with pride told us what they were going to cook. One person no longer wants to attend day centre on the day they go each week because they do not like it anymore. However, they spoke with the inspector about their ideas for working in the garden and making a vegetable patch which they are excited about doing. One person wanted to move into another bedroom and told staff they would like to be in a room downstairs. Staff helped and supported this person’s request. The person proudly showed the inspector their new room and how they have organised their own personal items. This shows that efforts are being made to ensure people are making decisions about the way in which their home is run. People said that they visit friends and relatives and that their visitors are made welcome at The Limes. The acting manager commented that relatives have regular contact either by telephone or in person. One person showed the inspector their photograph album which showed them on holiday with their family members which was illustrated nicely with small sentences of places, animals and people. We were also told that staff supported a person with the death of their father and this was done in a sensitive way which the individual told the inspector. A family member also said in the survey they completed, ‘X’s dad passed away in January this year, the staff were very supportive and done special things to help him cope’. Another person regularly visits and has short stays at their parent’s home. This person is supported to retain their own independence by travelling alone to their parents with risk assessments in place which support this individual to do this in a safe way. Menus and records of food consumed by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples’ needs and preferences. A range of food had been offered including Sunday roasts which is reflective of people’s cultural needs. Also people told the inspector what meals they liked and or disliked these included, curries, beans on toast, lasagne and so on. We also saw people take fruit from a bowl that was on The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 15 display in the dining area of the home. One person was showing us which fruit now needed throwing away. This demonstrates that people living in the home are being supported and encouraged to take part in food shopping, cooking, menu choices to ensure people are being shown and following healthy diets. People told us:“I go to day centre”. “I can see my family anytime”. “I like doing jam roly poly and custard”. “Meals are alright”. “Went to cinema yesterday”. “I’m having beans on toast and might have a pear afterwards”. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and practices around medication places some people at risk of harm. In the main the personal care that people receive is based on their individual needs. EVIDENCE: Two personal and health care plans were sampled at this visit. There was some good information about individuals’ personal care needs and preferences, which staff clearly understood so that people receive care in a manner they need and like. In the main people who live at The Limes have the skills to manage the majority of their personal care with only minimal staff support. This was reflected in their individual plans, which had been regularly reviewed to make sure they remained relevant to people’s needs. However, as mentioned earlier in this report there needs to be some recognition detailed within care plans and The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 17 risk assessments how individuals and or their representatives are participating in choosing how their care is provided including suitable times. There was evidence in daily records that personal care plans had been followed by the staff team. Individuals appeared to be supported well to maintain their personal hygiene wearing clothing, jewellery and make- up that reflected their age, gender, cultural background and the time of year. A family member in the survey they completed told us:‘he is now totally independent with his personal hygiene it is a pleasure to see him looking so well’. We observed on the day we visited people were deciding when to get out of bed and how they wished to start their day. We also saw in care plans the times people liked to go to bed together with their normal routine at this time. However, on some care plans there were instructions about checking on individuals through the night but we could not find any specific care plans and risk assessments that would inform staff the reason for night checking. Therefore we recommend that care plans and risk assessments are reviewed to ensure that people’s privacy is not encroached upon during the night period. Keeping healthy plans were seen to be implemented, these are personal plans that describe what a person needs to stay healthy and the healthcare services they need to access to do so. The plans sampled showed that individual’s had been referred to specialist healthcare professionals such as physiotherapists so that people have access to advice and support in accordance with their needs. Records showed that people have regular appointments with healthcare professionals and the outcome of this contact had been documented so that staff had accurate information about individuals’ state of health. One person told us that they have attended their diabetes clinic appointments with a member of staff to support them. This is good to hear as this person’s diabetes has been unstable in the past. This person also showed us their bedroom. We found their door to be left wide open and their medications on show. This is an ongoing issue that was highlighted at the previous inspection visit and places other vulnerable people who live at the home exposed to risk. We asked the acting manager if a social worker or advocate to support the person to make decisions about whether their medication should be in the homes locked medication cabinet. However, it was positive to see that where people are able to take their own medication this is encouraged to retain individual’s levels of independence. One family member in a survey said, ‘the staff encourage and support X to manage his diabetes very well. X is able to take his own blood sugar, staff records it for him, he is then supervised but able to administer his own insulin’. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 18 The system of storing, administering and recording medicines kept in the home was looked at to establish that people are protected by robust procedures. Medicines were securely stored in a locked cabinet. We sampled records and peoples medications with the acting manager which did not show that any errors had occurred, which indicates that medicines are being given as prescribed. However, we were told by a member of staff that they had been on a shopping trip with two other staff and people who live at the home. The staff member was asked to give a person their medications whilst spending the day out but said to the acting deputy manager that they did not want to do this as they had not received any medication training. However, another member of staff said they would give medications to this person and observe another person who lives in the home take their diabetic insulin. The staff member also checked the individual’s blood glucose (BM). This persons diabetes had been unstable over the last six months although we were told that it has now improved. This member of staff had also not received any medication and or diabetes training. Staff were told to telephone or text the acting deputy manager so that this could be recorded on the Medication Administration Records, (MARS), once medications had been given. We looked at the MARS and it had been signed by the acting deputy manager on the day in question but without the acting deputy manager having given the medication. All members of staff were fairly new to the home, two having started work at The Limes in December 2008 and one only a few weeks before the shopping trip. We discussed this practice with the acting manager and acting deputy manager. The acting manager said that they could not see a problem with staff who have received no medication training giving medications to people but could see a problem may have arose with the staff member observing the person with their insulin. The acting deputy manager said that the staff member who gave the medication was competent to do this as they had watched the administration of medications being done in the home. The decisions’ made and actions taken show a lack of regard for individual’s health and safety. This shows that people who live in this home are not always protected from the risk of potential errors so that individuals receive their medication safely. Due to our concerns we issued an immediate requirement form instructing that action be taken immediately to ensure individuals receive medication from trained and competent staff. We also copied documents under Code B of the Police and Criminal Evidence Act and informed the acting manager that the commission may consider enforcement action. The local authority were contacted whilst we were at the home and a safeguarding referral was made due to the risk of harm posed to people living at The Limes. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 19 The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures in place to listen to peoples’ concerns and complaints which should safeguard them from the risk of harm. EVIDENCE: We were told that no complaints have been received about the home since the last inspection and in the AQAA the acting manager has left the section blank which records the numbers of complaints the home has dealt with stating, ‘cannot fill in’. However, the Commission has received a number of complaints from staff members who work at the home which in the main range from employment issues to some practice issues, such as, medication being given by untrained staff which has been discussed earlier in this report. Staff have been advised to contact, Advisory, Conciliation and Arbitration Service, (ACAS) which is an impartial service for employee issues and have also told us they have discussed these issues with the acting manager. It was good to see an easy to understand complaints forms. This form had telephone numbers of people outside of the home should they have a complaint about any of the staff or the provider. People confirmed that they understood their right to raise concerns and were confident that staff would listen and “put it right”. Some people living in the The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 21 home seemed particularly worried about the concerns they had raised about staff members and the acting manager is aware of this. There was one safeguarding referral that had been made to the local authority. On the day we visited it was confirmed that this has now been closed by the local authority. Staff development records showed that some staff had received training in safeguarding vulnerable adults so that allegation or suspicion of abuse could be responded to in accordance with the home’s policies and procedures. It is now recommended that all staff receive safeguarding adults training so that any new staff members understand and are able to follow procedures. Efforts have been made to improve recruitment records but we did find one recruitment file of a new staff member that indicated that they began working at the home without a POVA and CRB checks in place. We did find a risk assessment that had been completed by the manager which confirmed that the member of staff would be supervised. However, without POVA checks in place, whilst awaiting CRB checks, then people living at The Limes are not fully protected from harm, (this is discussed further in the staffing section). One survey from a person living in the home said, ‘I know who to talk to if I am not happy or if I have a problem’. Other people living in the home told us:“Speak to Sharon”. “Tell staff”. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people live in a clean and comfortable environment that meets their needs. EVIDENCE: The Limes is situated near to Blackheath town centre. There are a range of shops, cafes, pubs and public transport routes within walking distance. This is important to the people who live there as they make regular use of those amenities. The environment within the home has improved with redecoration, flooring and some furniture being replaced. The home is suitable for its intended purpose, of providing small-scale domestic style accommodation and care in an ordinary environment. The home looks no different to others in the area and is not distinguishable as a care home. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 23 Shared space consists of a lounge; kitchen, dining area, conservatory, bathrooms and laundry room and each person has their own bedroom. The lounge area has leather sofas, television and individuals were seen to relax and chat as they wished. Some bedrooms were looked at with the permission of individuals who showed the inspector their rooms together with some personal items. For example, family photographs, keyboard, desks, pictures on their walls of film and pop stars. All reflected the individual’s tastes and preferences and were warm, clean and well furnished. The garden area has some lawn and shrub borders with a small fish pond. People who live in this home want to develop the garden further with vegetables. Attention had clearly been made to cleanliness and hygiene in the home. There were adequate hand washing facilities for staff so that the risk of the spread of infection could be reduced and there was no evidence of poor cleansing routines on the day we visited. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are not always supported by staff with sufficient knowledge and skills to meet their individual needs. This could result in people receiving inconsistent levels of care and place individuals at risk of harm. Recruitment practices must be further improved and consistent to offer protection to people living in the home. EVIDENCE: The home has a small, well established team of staff who clearly know people well and have formed relationships with them. There are also some new staff that people living in the home are getting to know. People said, “the staff are alright” and “they help me”. We were told two members of staff cover all shifts and the acting manager and deputy manager are also noted on the staffing rota. The staffing rota confirmed what we were told and in the main staffing levels were being The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 25 maintained. During the night there is a staff member who remains awake and one who sleeps but can be called upon if any assistance and or support is required. Agency staff are used in the home and we were concerned that they mainly worked during the night time period as a ‘waking’ member of staff whilst another colleague slept. However, we were told that one agency worker had not received an adequate induction in the home to include getting to know people living there prior to working night shifts. We discussed this with the acting manager and they told us the staffing rota would now be looked at and rearranged so that more senior staff who have good knowledge of individuals needs were working the ‘waking’ nights shifts. This should ensure that people receive consistent care as needed through the night period by staff who know their care needs and any emergencies during the night will dealt with by knowledgeable and skilled staff. In the main recruitment records sampled showed that practices and procedures have improved. For example we could find risk assessments that have been complete whilst awaiting CRB checks. However, the file sampled of a new staff member confirmed that they had started their employment on the 30 March 2009 but their POVA check was dated the 1 April 2009 and risk assessment was dated the 2 April 2009. This shows that this member of staff started work at the home prior to a POVA check being in place. Also this person’s induction was only partially completed and puts into question whether they had received any care plan and or risk assessment information. This shows that although some recruitment records had improved the recruitment of some staff continues to place people living at The Limes at risk. The staff present during this visit took an active part in the inspection process and were able to answer our questions about people’s care and support needs with confidence. The interaction between staff and people who live in the home was relaxed and friendly, which indicates that positive relationships have been formed. We asked to view a staff training matrix or other documentation that would give us an insight of training undertaken by the staff team as a whole. We were given training booking lists which show when staff have been booked on to training. However, as at the previous inspection, we recommend that a training matrix or suitable documentation is available at the home so that it tells the acting manager which courses staff have attended, in what numbers and when refresher courses are needed. This will give greater control and monitoring in respect of making sure suitable numbers of staff are qualified in all mandatory training areas and refresher courses will not be missed. The staffing rotas told us that eleven staff are working at the home which includes the acting manager and acting deputy manager. The training booking overview document details 4 staff having undertaken health and safety, 4 basic fire awareness, 8 moving and handling, 6 food hygiene, 6 infection control, 6 basic first aid, 8 staff having achieved a National Vocational Qualification (NVQ) level 2. The acting manager and deputy manager have received medication The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 26 training. Although, some of the practices and procedures in relation to the safe handling of medications we were given information about bring into question if this knowledge is being put into good practice, as already discussed earlier in this report. This means peoples health and safety is not always met by staff who have the necessary training to protect people living at The Limes from potential harm. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all management practices ensure the health and safety of people living at The Limes is maintained. Monitoring systems do not always identify shortfalls in service provision. EVIDENCE: The previous registered manager is no longer working at the home and as at the previous inspection Ms Sharon Martin is in the position of acting manager at The Limes. Ms Martin has achieved their, NVQ Level 2, 3 and 4. Ms Martin also has the registered manager’s award. It was positive to see that the acting manager now has a reference from her former employer which was outstanding at the last inspection visit. Ms. Martin told us that she had The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 28 contacted her former employer by telephone herself but confirmed, “registered proprietor was in the room at the time”. The acting manager also showed us they have a contract of employment. We were told by the acting manager that they are not receiving regular supervision from the registered proprietor and only one has been recorded since our last inspection visit. This is concerning as evidence cited in this report confirms that some management practices are placing people at risk of serious harm. For example, unqualified staff who have worked at the home since December 2008 had administered medications to one person. The staff member was also instructed to observe another person giving themselves their diabetic insulin and check their blood glucose (BM). The acting manager’s response was that they did not see a problem with this. Also we found that this same member of staff has received formal supervision from the acting deputy manager who they know personally. This puts into question the decision making processes in regards to practices and procedures within the home that are designed to safeguard individual’s health and safety so that they do not come to harm. There are some staffing issues at The Limes which we mentioned earlier in this report which continue to be ongoing and put into question some of the management practices within the home which include the safe handling of medications. Also individuals living in the home shared with us their worries about how some staff members have reacted to them. The acting manager and registered proprietor are aware of these issues so that staff disputes and low staff morale should not affect the quality of services that people living in the home receive. Staff told us:‘I feel I have the experience and knowledge but have no support from management or owner’. ‘My manager always offers support and knowledge when needed’. ‘I do not feel supported’. In the main people living in the home told us the acting manager was friendly and helped them when needed. Prior to the inspection the acting manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, were taken into consideration. However, we did find that some of the AQAA had been left blank, for instance all the equalities and diversity sections, complaints and safeguarding data and dates of health and safety inspections, such as, gas, electric and so on. Also information supplied was lacking in examples of practices and procedures. Therefore we recommend that when the AQAA is next completed it does hold all the information requested with examples of practices and procedures. This The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 29 provides confidence that the home is open and transparent and has the best interests of the people living at The Limes at heart. Quality assurance systems continue to need to be developed. We were told that there are resident meetings weekly but saw no documentation to support this. Reports completed by the registered provider are not completed on a regular basis with clear examples of improvements made and what could be improved further in the home to ensure good outcomes for people living in the home. We looked at the accident records and found eleven in January 2009 and one in February 2009. In the main these reflected one person who lives in the home that is having some falls. This has been an ongoing issue and we discussed this with the acting manager who has sought reviews on this person’s physical health from external agencies. The acting manager told us that they will ensure this individuals needs are reviewed so that we can be confident that staff are still able to meet this persons needs at The Limes. A number of checks are made by staff to make sure that peoples’ health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. Fire drills had been conducted on a regular basis to enable staff and people who live in the home to practice evacuation in the event of an emergency; each drill had been recorded. This should ensure a safer environment for the people who live in the home. Some staff have undertaken health and safety, fire safety, first aid and infection control training as detailed earlier in this report and it is recommended that all mandatory training is continued to ensure all staff working at the home have received this. This should ensure people living at The Limes are in safe hands at all times. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 2 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 2 X X 1 X Version 5.2 Page 31 The Limes Blackheath DS0000063539.V375023.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 12(1) Requirement An action plan must be submitted to CSCI Birmingham no later than 09.00 hours on the 25 April 2009 detailing how medication systems will ensure residents health and wellbeing is not compromised. With immediate effect systems for the management of medication must improve in order that residents receive medication to ensure that residents are protected from harm. With immediate effect management and administration of medications must be undertaken by suitably qualified and competent staff. To provide specialist training for all staff who are expected to support and assist people with their diabetes. To ensure that risks are fully explored with regard to starting new staff whilst awaiting the completion of a satisfactory POVA and CRB checks and this practice is maintained consistently for all new staff. DS0000063539.V375023.R01.S.doc Timescale for action 25/04/09 2. YA20 13(1)(2) 17/04/09 3. YA32 18(1)(c) 17/04/09 4. YA32 18(1)(c) 30/05/09 5. YA34 19(6) 15/05/09 The Limes Blackheath Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA14 Good Practice Recommendations That care plans contain specific timescales for action and evidence the involvement of residents and/or their representatives. Work should be undertaken to ensure residents can undertake activities on an individual basis in order that their individual needs and preferences are recognised and met (promoting a person centred approach to care). To review the practice of hourly checks undertaken during the night for residents. (If this level of monitoring is deemed necessary it must be discussed and agreed as part of a multi-disciplinary team with outcomes and guidelines for staff to be documented in individual care plans). Suitable numbers of staff should receive training in adult protection and aggression in order to reduce risks to residents. The first floor shower/toilet room now requires some maintenance to ensure that the shower cubicle tiles are regrouted, ceiling is repainted and mould on the crevice of the window is removed so that this room is well maintained for the use of residents. To ensure that agency staff receive an induction suitable for the work they are to perform whilst undertaking waking night shifts, and in order to meet the specialist needs of the residents. A written record must be maintained at the care home. A training matrix should be developed in order that the home can monitor that suitable numbers of staff have up to date training to meet resident’s needs. Staff to receive regular supervision and appraisals from a suitable person that is not known to them personally so that they are able to understand their roles and able to discharge their duties. That greater care should be taken when completing the Annual Quality Assurance Assessment in order that it remains factual with clear practices and procedures DS0000063539.V375023.R01.S.doc Version 5.2 Page 33 3. YA18 4. 5. YA23 YA24 6. YA35 7. 8. YA35 YA36 9. YA39 The Limes Blackheath examples provided. 10. YA39 Effective quality assurance systems must be developed by the home. This must include an annual development plan must be devised based on a systematic cycle of planningaction-review, reflecting aims and outcomes for people living in the home. Quality monitoring processes should continue to be implemented in order that the home can measure if it is achieving its aims and objectives. 11. YA39 The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 34 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. The Limes Blackheath DS0000063539.V375023.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!