Inspection on 02/04/09 for The Wren

This inspection was carried out on 2nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Wren 02/04/08

The Wren 24/04/07

The Wren 20/10/06

The Wren 03/03/06

The Wren 23/08/05

The Wren 06/02/05

The Wren 22/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 The Wren 92 Carlton Road Whalley Range Manchester M16 8BE Lead Inspector John Oliver Unannounced Inspection 2nd April 2009 09:30 The Wren DS0000021630.V374888.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 Wren DS0000021630.V374888.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 Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wren Address 92 Carlton Road Whalley Range Manchester M16 8BE 0161 881 8658 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) Mrs Margaret Monteith Miss Dorna Monteith Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd April 2008 Brief Description of the Service: The Wren is a care home providing personal care for a maximum of eight people with learning disabilities who may also have a physical/sensory disability. The Wren is a detached property set within its own grounds. The home is three storey, with a basement area used for offices, storage and laundry facilities. The residents’ bedrooms are on the ground and first floors. All the bedrooms are single; three of the rooms have shower facilities. There is a kitchen and dining room on the ground floor with a lounge situated on the first floor. There is a small lounge area situated on the first floor for the use of relatives of residents when visiting. This enables the resident and their relatives to spend time together in privacy, if required. There are toilets and bathrooms situated on both the ground and first floors. These are accessible and meet the identified needs of the residents. The home is situated in a residential area in Whalley Range, within easy reach of public transport links into Manchester City Centre. The home is a family run business. The fees for the home are based on individual assessment of needs. The Wren DS0000021630.V374888.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Care Quality Commission) in relation to the home prior to the site visit. Before visiting the home, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. Although this was returned to us before the visit took place, information was minimal and not very detailed which made it difficult to determine how the manager assessed the standard of service being provided by the home. Additional information used to complete the inspection report may include incidents notified to us by the manager of the home and information provided by other people and/or agencies, including any concerns and complaints. On the day we visited in the service only one person was at home. What the service does well: What has improved since the last inspection? The manager has produced a Service User Guide and Statement of Purpose that can be given to all prospective users of the service. Care plans are now in a more consistent format and the accuracy of the information contained in each person’s file has improved. There is now an Activities File in place and all information regarding activities is now contained in this one file. Laminated photographs and pictures have been The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 6 introduced to help people using the service choose particular activities they may wish to participate in. There is now a medication policy in place to guide and support staff in the safe administration of medicines in the home. Nearly all staff have now completed training in the Protection of Vulnerable Adults (POVA). What they could do better: The new Service User Guide and Statement of Purpose could be produced in more user-friendly formats. People using the service have differing communication abilities and may find the current documents difficult to understand. It is important that people can make an informed choice wherever possible about where they want to live and the type of service they want to receive. It is important that ways of involving the people using the service in the development and review of their care plans are explored in order to maintain their rights, independence and dignity in the way they lead their lives. Information could be more detailed in the Health Action Plans that are on file for each person. At the time of our visit the information in these documents was insufficient and did not clearly identify each person’s current health needs. Lack of up to date information could mean that people’s needs are not appropriately met. The new medication policy needs to include guidelines on the use of covert medication in order for staff to understand the reason how and why medication is sometimes given this way. The complaints procedure should be made available in a user-friendly format. Some areas of the home are looking tired and in need of redecoration and replacement of furnishings. It would be good if a programme of renewal and refurbishment were put in place in order that such work could be monitored and prioritised for completion, as and when required. There was no evidence on the personnel files of new staff that they had completed induction training in accordance with the Skills for Care guidelines. It is important that all new staff have an appropriate induction into their work role so they are clear about what is expected of them and how they should carry out their work appropriately and safely. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 7 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 Wren DS0000021630.V374888.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 Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 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. Systems are in place to assess people’s needs before being offered a placement at The Wren. Information provided to prospective users of the service is insufficient. EVIDENCE: The manager told us that no new people had been admitted into the home To inform people about the services on offer in the home the manager has produced a Service User Guide and Statement of Purpose and both documents were dated February 2009. On reading through the documents we noted that both contained a number of inaccuracies, which need to be addressed, for example, “Fees and contracts are in accordance with CSCI and Manchester City Council, they reflect the type of care you require”. The Commission for Social Care Inspection (CSCI), now the Care Quality Commission (CQC) have no involvement in deciding the fees charged by the home. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 10 Also, it was stated, “You will need to purchase for yourself personal products, personal clothing, hairdressing, chiropody, arts and crafts, wheelchairs and your spending money”. This information could be misleading to potential users of the service. The usual community resources should be contacted for example, the National Health Service, for obtaining resources such as chiropody and the provision of wheelchairs before any charges are made directly to the person using the service. It is important that all information in these documents is correct so that people considering coming to live in the home are fully aware of their responsibilities and the homes responsibilities before any contracts are signed. Consideration should also be given to further developing these documents in a format that is more suitable for the people for whom the home is intended, for example, use of plain English, pictures and audio. This will help enable the individual person to be as involved in their own decision making, as their capabilities will allow. Lack of such important information being available in suitable formats could make it difficult for someone to make a considered choice about coming to live in the home. We looked at the files of those people living in the home and saw evidence that Community Care Assessments (CCA) had been carried out prior to their admission into the home. The manager also told us that she would visit the person to assess their needs before arranging any new admission and would also look at the compatibility with other people already living in the home before arranging things such a trial visits. The Wren DS0000021630.V374888.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 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessment contain insufficient detail to fully enable staff to support people in the most appropriate way. EVIDENCE: The manager told us that she has the responsibility for developing the care plans and that the format of the care plans has been developed from a standardised template provided by a professional consultancy. Since our last inspection visit in April 2008 the way in which care plans are developed and written has shown some improvement and the accuracy of information contained in each person’s file has also improved. Although Person Centred Plans have also been started, talking to the manager and observing how staff work with people demonstrated that the knowledge that The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 12 staff have in how they work with and support people was not fully reflected within the individual care plans. There is some evidence that individuals are involved in some decision making about the home, such as choosing when to go shopping and what they would like to eat using pictures to aid them. People living in the home with more diverse needs may find it harder to have their opinions listened to as communication methods are still basic and individual communication styles have yet to be explored with the help of the Speech and Language Therapist. It is important that all ways of involving the individual in the development and reviews of their care plans are explored in order to maintain their rights, independence and dignity in the way they lead their lives. Risk assessments are in place but not robust enough and further work is needed. For example, one risk identified was for a person when dressing/undressing but no actual risk assessment was in place. Others identified the risk but not how the risk was to be managed for the person. Most risk assessments seen were basic and appeared to be focused on keeping the person safe. Lack of risk assessments being individualised could mean that a person may have their independence and choices limited. The Wren DS0000021630.V374888.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: 12,13,15,16 and 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s involvement in the daily activities within the home is insufficient to fully maintain their choice and independence regarding their daily lifestyles. EVIDENCE: Of the four people currently using the service, we were told that three regularly attend day care facilities provided by the local authority. This means that the number of people in the home ranged from one to four on any particular day of the week and the routines and staffing of the home were based on this factor. On the day we visited the home one person was in the house, one person was attending day care and two people were out for the day doing personal shopping and enjoying the good weather. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 14 There is an Activities File in place and all information regarding activities is now contained in this one file. Laminated photographs and pictures have been introduced to help people using the service choose particular activities they may wish to participate in. At the time of our visit risk assessments were being added for each person to cover such things as using public/private transport. This is good practice and these assessments should enable staff to allow individuals to be as independent as their abilities allow. People using the service have use of a motor vehicle owned by the home, which is used for such things as transport to day care centres and outings into the local community. Since the last key inspection visit in April 2008 there was further evidence that people living in the home have become more involved in purchasing their own clothing and are actively involved in shopping for food and carrying out simple household tasks. Again, this helps the individual person to maintain dignity, choice and independence wherever possible. Mealtimes in the home are catered for on a daily basis, although menus are in place. We saw that a wide variety of choices were available and the use of different pictures of food enables those people with limited communication to make some choices for themselves. To monitor peoples dietary intake it would be good if a record were kept in the daily log of the meals/food each person has. The manager told us that relatives continue to visit the home on a regular basis. Although the manager and staff of the home try to be flexible in their attempts to provide a service that meets each person’s individual needs further improvements could be made. Not all people using the service are consulted on how the home can work to provide them with a flexible lifestyle or where they could be involved in independent living arrangements to match their capabilities. The manager did confirm that she has contacted a Speech and Language Therapist to assess each person’s communication abilities and hopefully, further develop this area. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Details in some records and in the way medication is administered is insufficient to support people using the service in the most appropriate way. EVIDENCE: During the visit we saw that people living in the home appeared to have good relationships with the staff on duty. Care plans contained information relating to the individual support needs of the person and since the last key inspection visit the accuracy in the way this information is recorded has improved. Each person also has a Health Action Plan that should clearly reflect the health needs of the people using the service. At the time of our visit the information in these documents was insufficient and did not clearly identify each person’s current health needs. Lack of availability of such important information for staff could lead to inappropriate support/assistance being given. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 16 Medication is administered in the home using a Monitored Dosage System (MDS) that is provided by a local pharmacy. Since our last key inspection visit improvements have been made in the way in which medication is stored. All medication in now stored in one, lockable steel cabinet and the person in charge maintains the responsibility for holding the key to this cabinet. A new medication policy dated 11/08/08 was in place to support staff in the administration of medicines. There was evidence that each person using the service required some medicines to be given covertly and letters confirming this were on file from each person’s GP. There are no guidelines within the new medication policy regarding the use of covert medication and care plans also failed to indicate whom, how and why individuals have medicines administered covertly. The rights of the people using the service could be infringed if such important information is not made available to relevant staff. A number of people also need to take some medication on a basis of ‘as and when’ required and we randomly selected a number of this type of medication to check. We found that in most instances balances of such medication could not be checked as no record was being kept of whether one or two tablets had been administered each time. It is important that all medication can be accounted for at all times and a clear audit trail be in place to minimise the risk to people using the service from inappropriate practice being carried out. The manager told us that all staff with the responsibility for administering medication had received training in the safe handling of medication from an external trainer and we saw evidence of this on one staff file we examined. Following on from training no competency assessments had been undertaken to make sure staff were still able to administer medication appropriately. It is important that the skills of staff are regularly assessed and training sought as necessary to ensure people using the service as safeguarded. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about how to complain is insufficient to make sure people know how to complain and to be confident that their concerns will be listened to. EVIDENCE: The manager told us that no complaints had been received by the home since the last key inspection visit in April 2008. Information about how to make a complaint was available to people using the service in the service user guide. This information was basic and was difficult to understand in places for example, “Manager will check the circumstances and respond in writing of the information gathered. If check may take more than 28 days, we will let them know in writing”. It is important that information made available to people living in the home is in a user-friendly format that can be understood by those with varying communication abilities. All but one member of the staff team had completed training in the Protection of Vulnerable Adults (POVA) and a copy of the local authority’s guidance on protecting vulnerable people, ‘No Secrets’, was available for staff. Discussion with the manager and supervisor on duty at the time of our visit demonstrated they had a clear understanding of the procedure to follow should an allegation of abuse be made. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 18 No complaints or safeguarding referrals had been received by the Commission for Social Care Inspection (CSCI) or the Care Quality Commission (CQC) since the last key inspection visit in April 2008. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements could be made to the environment to make sure it is clean, pleasant and comfortable. EVIDENCE: During our visit we had a walk around the home to see if any improvements had been made since our last key inspection in April 2008. We saw that some minor improvements had been made where we had previously made requirements for example, to replace the carpet in the upstairs lounge and one of the bedrooms. Another requirement that was made at the last key inspection visit was that the furniture in the upstairs lounge be replaced with adequate and appropriate numbers of chairs/seating for those people who use this lounge. Although this The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 20 had been done, the replacement furniture has previously been used elsewhere in the home and is showing signs of wear and tear. Consideration should be given to replacing this furniture sooner rather than later as part of the rolling maintenance programme. This will help to make sure people who spend a lot of their time in the lounge can be seated comfortably when watching TV or carrying out other activities. A number of radiators had new covers fitted on them and a new dining room table and chairs had been provided. These improvements will help to maintain the comfort and safety of those people using the service. We saw that bedrooms had been personalised to varying degrees, one in particular expressing the person’s enjoyment of football. Furniture in each bedroom varied in standard and in one bedroom the person’s clothing was showing out of the back of the wardrobe where the back panel was coming away. It is important that furnishings in the home are appropriately maintained/replaced to minimise any risk to people using the service from potential hazards. Most beds had duvets on them and we looked at the bedding on one particular bed. The bottom sheet was worn in places and had small holes in it and the duvet was very lightweight. When pointed out to the manager she said she was aware that the bedding needed to be replaced and would be doing this ‘very soon’. There is a television in the downstairs dining room as a number of people choose to sit in this area throughout the day. The reception on this television is poor and makes the pictures difficult to see. The manager told us that this was in the process of being fixed. Household equipment such as televisions should work properly to make sure people using the service can enjoy the activities that are important to them such as watching TV. All areas of the home such as communal areas, bedrooms, corridors and bathrooms and toilets have painted walls. The colours are the same in most instances and offer little in the way of individuality in areas such as bedrooms. We saw that some redecoration was needed for example, around doorways and skirting boards and discussion with the manager confirmed that this would be a good opportunity to involve people living in the home in choosing colour schemes. Involving people using the service will help to maintain their choice and independence in how they choose to live wherever possible. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 21 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): 32,34,35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements can be made in the recruitment and training of staff to ensure that people are cared for and supported safely. EVIDENCE: We looked at staff rotas and these demonstrated that enough staff appeared to be deployed to meet the needs of those people using the service at the time of our visit. The manager confirmed that staffing levels were flexible according to the needs of the people and were reviewed on a daily basis. Each member of the staff team has an individual training record on his or her personnel file and there was evidence that training was taking place for example, Moving and Handling, Safeguarding Adults and Emergency First Aid. Not all individual training records had been fully completed and it would be good if a training matrix were developed to show all training each member of staff has completed. It is important that all staff receive regular training that helps them carry out their job safely and efficiently. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 22 We looked at the personnel files of three staff that have been employed in the home since the last key inspection in April 2008. We found that the files included all relevant and appropriate documentation including an enhanced Criminal Record Bureau (CRB) check. One application form did show some gaps in dates relating to previous employment and discussion with the manager confirmed that she had spoken to the person about this but had not recorded the details. It is important that any gaps in employment or any other areas are checked out to ensure an informed decision can be made about employing new people to work in the home. Since the last key inspection visit in April 2008 the manager has developed a Recruitment and Selection policy and procedure for the home. This will provide information and support to those people with the responsibility for employing staff to work in the home. Although there was evidence of training on individual files we could find no evidence of completed induction training for the new staff as recommended by Skills for Care. To enable new staff to understand what is expected of them in their new job it is important that they complete induction training that has been developed to the specification of Skills for Care and the General Social Care Council. The manger told us that staff were receiving formal supervision but not on a regular basis. We saw evidence of supervision notes on those personnel files we examined but timescales for supervision taking place was not consistent and ranged from 3 – 5 months between each session. It is important that each member of the staff team has regular, formal supervision to provide them with support in the jobs they do and to afford them opportunities to discuss any training or personal needs they may have. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 23 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 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements could be made in the way the home is managed to ensure the home is run in the best interests of those people using the service. EVIDENCE: The manager has done very little training in relation to her management role in the past 12 months but did tell us that she is waiting to start the Registered Managers Award. It is important that the manager regularly updates her skills and knowledge through training to enable her to manage the home in the most appropriate way. The manager was part of the working rota and worked The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 24 different shifts during the week and is supported by a ‘supervisor’ who takes charge in her absence. At the time of our visit the manager told us that she was looking at ways of arranging meetings for people who use the service to talk about any concerns and raise any issues they may have. This is particularly difficult to do as each person living in the home has differing communication abilities. The manager has contacted a speech and language therapist to assess each person in order to develop a communication method that is most appropriate to the individual. This should help the person to be more involved in the running of the home and in the decision making process. Information in relation to health and safety issues was gathered on site and via the Annual Quality Assurance Assessment (AQAA) provided by the home. The supervisor continues to have the responsibility for health and safety throughout the home and also does much of the cooking, food purchasing and maintenance. Within the AQAA the manager told us that regular servicing and maintenance of equipment was taking place. We randomly selected a number of records to check and found them to be correct. Things such as the fire alarm were tested on a weekly basis and staff were involved in fire drill training. Good maintenance records and regular checking of equipment used in the home is important in order to minimise potential risks to both people living and working in the home. Information provided by the manager in the AQAA returned to us before the inspection took place was brief and gave very little information about the service. Minimal evidence was used to support the claims made and overall, the AQAA does not give the reader a reliable picture of the service or service delivery. This was fully discussed with the manager. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 3 x Version 5.2 Page 26 The Wren DS0000021630.V374888.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. YA20 Standard Regulation 13 (2) Requirement Timescale for action 29/05/09 2. YA35 18 (1) © Where medication is administered to people who use the service it must be clearly and accurately recorded and records must clearly demonstrate that all medication can be accounted for. All new staff must receive 26/06/09 structured induction training (within six weeks of appointment) and foundation training (within six months of appointment) in accordance with Skills for Care specification. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Information in the Service User Guide and Statement of Purpose should be accurate and should be available in formats suitable to meet the differing communication needs of people using the service. a) Information in care plans should clearly reflect the current identified needs of the person using the DS0000021630.V374888.R01.S.doc Version 5.2 Page 27 2. YA6 The Wren 3. 4. YA9 YA16 5. 6. YA19 YA20 7. 8. YA22 YA24 9. 9. 10. 11. YA26 YA35 YA36 YA37 service. b) Ways of involving each person using the service in developing and reviewing their care plans should be explored. Risk assessments should clearly identify how any known risk should be managed and should link directly to the care plan. People using the service should be consulted about how they spend their days and how they could be involved in independent living arrangements to match their capabilities. Information contained within each person’s Health Action Plan should clearly reflect his or her current health needs. a) The medication policy should provide staff with clear guidelines about how and why it may be necessary to give some medicines covertly. b) Where it is necessary to give medicines covertly, this should be detailed in the individuals care plan. c) Regular competency assessments should be carried out with those staff with the responsibility for administering medicines. Information regarding complaints should be correct and suitable formats of the complaints procedure be made available to those people using the service. a) The seating in the upstairs lounge should be replaced as soon as possible as part of the maintenance and renewal programme. b) Consideration should be given to redecorating/repainting those areas of the home that are showing signs of wear and tear for example, around doorways and skirting boards. c) Arrangements should be made to make sure the TV in the dining area has suitable reception and can be watched in comfort by those people wishing to do so. Suitable and adequate bedding of good quality and design should be provided in each room occupied by a person using the service. A training matrix should be available to show all training each member of staff has completed. All staff working in the home should receive regular, recorded supervision meetings with their line manager. The manager should participate in regular training that helps her to update her knowledge and skills regarding the management of the home. The Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Wren DS0000021630.V374888.R01.S.doc Version 5.2 Page 29 - 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!