Inspection on 20/10/09 for Warwick Road, 4

This inspection was carried out on 20th October 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Warwick Road, 4 19/09/07

Warwick Road, 4 31/07/06

Warwick Road, 4 28/11/05

Warwick Road, 4 20/07/05

Warwick Road, 4 16/02/05

Warwick Road, 4 04/08/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Warwick Road, 4 4 Warwick Road Wallsend Tyne and Wear NE28 6RT The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Gaffney Date: 2 0 1 0 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 31 Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for 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. 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 Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Warwick Road, 4 4 Warwick Road Wallsend Tyne and Wear NE28 6RT Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Learning disability Number of places (if applicable): Under 65 2 Over 65 2 Care home 4 Northern Life Care Limited T/A U.B.U 0191 2344655 Additional conditions: Date of last inspection: Brief description of the care home: 1 9 0 9 2 0 0 7 No 4 Warwick Road is a purpose built, semi-detached bungalow. The home is registered to provide care for four adults with learning disabilities who may also have physical disabilities. The home does not provide nursing care. It is situated in the centre of Wallsend and is close to all local amenities. There is a pleasant garden to the rear and a car park to the side of the building. The current range of charges for a place at the home are 994 to 1174 pounds. There are extra charges for hairdressing and private chiropody. Information about fees charged is included in the homes service user guide. A copy of the most recent inspection report is available in the main reception area. Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out. Before the visit, we looked at: * Information we have received since the last visit on 19 September 2007; Care Homes for Adults (18-65 years) Page 5 of 31 * How the service dealt with any complaints and concerns since the last visit; * Any changes to how the home is run; * The acting managers view of how well they care for people; * The views of relatives, staff and other professionals. An unannounced visit was made on the 20 October 2009. During the visit we: * Talked with some of the staff and the acting manager; * Looked at information about the people who use the service and how well their needs are met; * Looked at other records which must be kept; * Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; * Looked around the building to make sure it was clean, safe & comfortable; * Checked what improvements had been made since the last visit. The acting manager said that service users are unable to complete the Care Quality Commission easy read surveys even with the support of staff. However, two peoples relatives did complete and return surveys. We told the acting manager what we found. What the care home does well: What has improved since the last inspection? A new specialist bed has been purchased for one person. This helps to ensure their safety and comfort. Staff have received training from the local speech and language therapy team in how to support people to eat and drink safely. Care Homes for Adults (18-65 years) Page 6 of 31 Staff have worked with one persons occupational therapist to devise and implement a walking programme to help maintain their health and well being. Staff have received training in managing infection control. Service users are now supported to participate in the health and safety checks carried out by staff. The home has arranged for a male advocate to support the only male service user living at the home. With the exception of the registered managers post, the home has had a stable staff team since April 2009. What they could do better: Ensure that peoples support plans contain statements of desired outcomes, are available in an easy to read version and are reviewed every six months. This will help to make sure that staff are clear about the action they must take to meet peoples needs. Ensure that where peoples support plans identify that staff need training to carry out the stated interventions, this is provided. This will help to make sure that staff have the necessary skills and competencies to meet peoples needs. Make sure that staff follow the guidelines contained in peoples behavioural support plans. This will help to ensure that people receive consistent care in line with their agreed care plans. Carry out an assessment of each persons capacity to make decisions using a recognised tool. This will help to make sure that people are supported to make the decisions that effect their lives. Ensure that peoples risk assessments are reviewed regularly and a written record kept. This will help to protect and promote peoples health and well being. Devise an End of Life policy. Ensure that each person has an End of Life care plan that has been agreed with their family, GP and any other relevant healthcare professional. Make sure that all staff receive training in End of Life care. This will help to make sure that people receive appropriate End of Life care. Ensure that staff receive fire instruction, and participate in fire drills, at the frequency recommended by the local fire and rescue service. This will help to protect and promote peoples health and well being. Submit an application to register a manager for the home. This will help to make sure that the home is managed by a suitable person who has appropriate skills and competencies. Care Homes for Adults (18-65 years) Page 7 of 31 Ensure that at least 50 percent of the team has obtained a National Vocational Qualification at level 2 or equivalent. This will help make sure that people are cared for by appropriately trained staff. Ensure that there is always a minimum of three staff on duty throughout the working day. Make sure staff rotas contain all of the required information. Carry out an assessment to identify the risks posed when there are only two staff on duty. The assessment should clearly state what control measures have been put in place to minimise any risks associated with only having two staff on duty. This will help to make sure that peoples needs are satisfactorily met. Ensure that a full employment history is obtained for each member of staff and a reference is obtained from their previous employer. This will help to ensure that only suitable staff are employed to work in the home. Ensure that staff files contain documentary evidence of any mandatory training they have completed. This will help to demonstrate that staff are able to meet peoples needs in a safe and competent manner. Ensure that staff receive regular practice based supervision. This will help to make sure that people are cared for by staff who are appropriately supervised and know how to carry out their job. Ensure that the good practice recommendations stipulated following the providers internal audit of money management arrangements within the home are implemented. A weekly reconciliation of money in held in the safe against balances recorded on peoples financial records is carried out. This will help to ensure that peoples financial rights are safeguarded. Ensure that the homes safeguarding policy and procedures are updated to reflect current developments within the field of adult safeguarding. This will help to protect people from harm and abuse. Ensure that the MUST nutritional risk assessment recommended by the Care Quality Commission is completed for each service user. This will help to promote peoples health and well-being. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our websitewww.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 10 Individual needs and choices (standards 6 – 10) ................................................... 11 Lifestyle (standards 11 – 17) .............................................................................. 13 Personal and healthcare support (standards 18 – 21) ............................................. 15 Concerns, complaints and protection (standards 22 – 23) ....................................... 17 Environment (standards 24 – 30) ........................................................................ 18 Staffing (standards 31 – 36)............................................................................... 19 Conduct and management of the home (standards 37 – 43) ................................... 22 Outstanding statutory requirements..................................................................... 24 Requirements and recommendations from this inspection ....................................... 25 Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People who use 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 suitable arrangements for making sure that peoples needs are assessed before they move into the home. These help make sure that staff know how to meet peoples needs when they move into No 4 Warwick Road. Evidence: There has only been one admission into the home since last inspection. This persons care records show that the home obtained detailed information about their needs from their family and social services. The persons family completed the providers Getting to Know Me information booklet. This provided staff with valuable information about the persons life experiences before their admission into No 4 Warwick Road. The booklet also includes information about the risks the person faces in their day-to-day life. The home also obtained a copy of the persons social services assessment, which provided details of their support needs and how they should be met. Care Homes for Adults (18-65 years) Page 10 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting peoples individual care needs and goals are not fully satisfactory. Because of this, people using the service cannot be confident that their assessed needs will be well met. Evidence: Support plans have been devised for each person setting out what support they require. Peoples support plans cover such areas as help needed with medication, managing personal finances, continence, and morning and evening routines. However, the following concerns were identified in one persons care records: * None of the support plans looked at contain statements of desired outcomes; * Some support plans indicate that staff require training to carry out the required interventions. It is not clear whether this training has been provided; * None of the support plans are available in an easy to read version; * Six monthly reviews of their support plans have not always taken place. Where support plans have been reviewed, there is no information recorded about review outcomes. Also, staff are not following the guidance contained in this persons support plan about how to manage some aspects of their behaviour. Care Homes for Adults (18-65 years) Page 11 of 31 Where people have identified communication needs, support plans have been devised. However, none of the records looked at contain more in-depth information such as a Communication Passport. Staff support and encourage people to make simple everyday choices. However, the home has not carried out a formal assessment of peoples capacity to make decisions using a recognised tool. A range of risk assessments has been completed for each individual covering areas such as money management, susceptibility to choking and use of the kitchen. Those assessments looked at provide staff with clear guidance about how to promote independence whilst also keeping people safe. However, some risk assessments have not been reviewed and where appropriate, updated on a regular basis. This may place people using the service at risk if staff do not have up to date information about how to keep people safe. Both of the relatives who completed surveys said that the care team at No 4 Warwick Road meet their family members needs and keep them up to date with important issues affecting their well being. Care Homes for Adults (18-65 years) Page 12 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for making sure that people are supported to engage in a range of appropriate activities within the local community are not fully satisfactory. Because of this, people do not receive appropriate support to take part in a range of activities within the local community. Evidence: Since the last inspection of the service, the local council has expressed concerns that service users are not being sufficiently supported to engage in culturally and age appropriate activities, or make use of community based facilities. The care record of the person most recently admitted into the home shows that staff obtained information about the persons social interests and preferences, and the places they enjoy visiting. Staff have also recorded what support they will provide to help the person access their preferred activities. A weekly planner has been devised but includes limited opportunities to engage in meaningful and fulfilling activities, and engage in stimulating social experiences. Although the person was admitted into the home in April 2009, there are no support plans providing guidance to staff on how to meet their social care needs. Staff who returned surveys said the home should enable people to try different social outings within the community and lead a more active lifestyle. Care Homes for Adults (18-65 years) Page 13 of 31 People are supported to maintain contact with family members. Peoples records contain important information about their previous life experiences as well as details about the relationships that are important to them. However, there is no support plan setting out the action that staff should take to help a person recently admitted into the home to maintain the relationships they value. One persons relative commented that that they would appreciate more feedback during their visits to the home about their family members health and welfare. Since her appointment, the new manager has introduced person centred menu planning. Staff are now expected to consult service users about what they would like to eat for the week ahead. A detailed record is now being kept of each persons daily food intake. The care record of a person recently admitted into the home contained limited information about how staff support them to maintain and develop independent living skills. However, two service users were observed helping out in the kitchen with staff support. Also, staff support service users to participate in shopping trips to purchase food for the home. It is evident that service users enjoy these outings. Staff make sure that if people have special dietary needs, these catered for. On the day of the inspection the kitchen was clean, hygienic, tidy and well equipped. The meal time that was observed was a pleasant social occasion. Care Homes for Adults (18-65 years) Page 14 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience Judgement: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements to meet peoples personal and healthcare support needs are satisfactory. However, the arrangements for managing medication are not robust enough. Because of this, peoples health and well-being is not being protected and promoted. Evidence: Service users care records show that they receive healthcare as and when needed. For example, the majority of service users have seen an optician, dentist and GP during the last 12 months. Support plans have been devised for each person to promote their health and well being. These cover such areas as support required when attending medical and healthcare appointments and taking medication. Checks of peoples weight are usually undertaken monthly. None of the records looked at contained a Health Action Plan or a completed MUST nutritional risk assessment. Support plans setting out how staff should meet peoples personal care needs have been devised. For example, in one persons care records, there is guidance describing the support they need with personal care, oral hygiene and bathing. Support plans covering assistance required with continence care and shaving have been put in place for another service user. Care Homes for Adults (18-65 years) Page 15 of 31 Of the four staff that returned surveys, all said that they are always or usually given up to date information about the needs of the people they care for. They also said that the way information is shared within the home works well. There are records covering the administration and disposal of medication. All medicines are kept safely locked away. The cabinet is kept clean and tidy. Staff administered medication in a safe and professional manner. Staff have received in-house medication training and documentary evidence is available to confirm this. However, the training provided to staff does not appear to be accredited. Although the provider has a system for assessing staffs competency to administer medication, there was no evidence that some staff had undergone this process. The home does not have an up to date medication reference manual. There are arrangements for ensuring that the homes day to day medication practices are checked by an experienced pharmacist. The last visit took place during the inspection. Care Homes for Adults (18-65 years) Page 16 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People who use 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 using the service can feel confident that their complaints or concerns will be listened to, taken seriously and acted upon. However, the arrangements in place to keep people safe from abuse are not fully satisfactory. Evidence: Previous inspections have confirmed that each service user has been supplied with a copy of the homes service user guide which contains details of the providers complaints procedure. Most of the people living at 4 Warwick Road have a support plan that sets out how staff will support them to make a complaint. Neither the home nor the Commission have received any complaints since the last inspection of the service. Of the five staff that returned surveys, all said that they would know what to do if someone had concerns about the home. Of the two relatives who completed surveys, one said that they would know who they should speak to if they were not happy with something. The other relative said that they had not been told about the homes complaints procedure. A recent safeguarding investigation conducted by the provider and local council showed that robust arrangements were not in place to protect peoples financial rights. Following the safeguarding investigation, the provider reviewed financial practices within the home and implemented a range of improvements. For example, the arrangements for accessing the safe and ensuring that there are robust procedures for handing over service users money between shifts, have been strengthened. Also, the provider has not updated its safeguarding policy to take account of recent changes in legislation. Care Homes for Adults (18-65 years) Page 17 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People who use 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. The standard of accommodation is generally satisfactory. This means that people are able to benefit from living in a home which is well-maintained. Evidence: The home is clean, tidy, hygienic and there are no unpleasant odours. Lighting levels are good and the home is warm throughout. However, the provider and staff are concerned about the condition of the central heating system which does not work satisfactorily in some areas of the home. The layout and design of No 4 Warwick Road enables people to live together in a homely domestic environment. Each person has their own bedroom, which reflects their needs and personal preferences. People share a lounge/dining room and kitchen. However, some corridor and bedroom walls were damaged and scuffed and in need of redecoration. Also, the grouting in the wall tiles in the shower room was stained and looked unhygienic. Following a requirement made in the last inspection report, the provider ensured that the corridor and lounge/dining room carpets were either cleaned or replaced. The provider was also asked to complete the Department of Health infection control self-assessment checklist for care homes. Shortly following the inspection, the registered manager forwarded a copy of the completed self-assessment and action plan. The home has been adapted to meet the needs of the people living there. A range of specialist aids and equipment has been provided, such as hoisting equipment and pressure relieving mattresses. The home has an infection control action plan and the majority of staff have completed relevant training. Care Homes for Adults (18-65 years) Page 18 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People who use 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 arrangements for ensuring that people are in safe hands at all times are not satisfactory. Because of this, people cannot be confident that they will be cared for by staff who are suitable to work at the home and who are competent to do their jobs. Evidence: A range of pre-employment checks are carried out before staff can start work at the home. Criminal Disclosure Certificates and PoVA First checks have been obtained for all staff. There is documentary evidence that each member of staff has completed an application form and undergone a recruitment and selection interview. Staff have been supplied with a contract of employment and the provider has obtained a health declaration from all staff. However, some staff have not provided reasons for gaps in their employment history. Also, a professional reference has not been sought from some staffs previous employer. Only 27 percent of the staff team have obtained a National Vocational Qualification (NVQ) at Level 2 or above. This means that the home has not complied with the National Minimum Standard which states that 50 percent of care staff must obtain this qualification. The majority of staff have completed a specialist induction for people who work with individuals who have a learning disability. Some staff have also completed more specialised training covering such areas as epilepsy and managing peoples eating, drinking and swollowing needs. However, not all staff have completed training in person centred planning, carrying out risk assessments, using Makaton, the use of physical Care Homes for Adults (18-65 years) Page 19 of 31 intervention and working with people whose behaviour is challenging. Most staff have not completed equality and diversity training. Staff have completed training in moving and handling and first aid. However, some files do not contain documentary evidence that staff have completed mandatory training in health and safety, food hygiene, infection control and fire safety. Following a requirement made in the last inspection report, the provider was asked to ensure that staff update their moving and handling training every 12 months. All of the staff whose files were checked had received moving and handling training within the last 12 months. Since the last inspection of the home, the local authoritys contract and care management teams have expressed concerns about staff sickness levels, the frequent use of agency staff and staff turnover. In the Annual Service Review report issued in 2008, the Commission for Social Care Inspection expressed concern that this could potentially have a negative impact upon the quality and consistency of care provided at the home. During the inspection, an audit of staff personnel records showed that 70 percent of the staff team have left their employment since the last inspection. This includes three managers who have been appointed and then left their employment. Of the seven staff on duty at the time of the inspection, six had worked at the home for between eight weeks and nine months. The seventh member of staff had been employed for over 18 months. Seven care shifts were covered by agency staff during the three months leading up to this inspection and ?? hours have been lost to sickness. The Care Quality Commission is concerned that the provider has struggled to build an experienced care team at No 4 Warwick Road. We are concerned that, when combined with the high level of staff turnover, this has the potential to result in service users, who all have complex care needs, not receiving satisfactory care and support. The sample of staff rotas looked at showed that between three and four staff are usually rostered on duty to care for four people. The night time period is covered by a member of staff who sleeps-in and a waking night worker. All domestic tasks are carried out by staff, with service user involvement wherever possible. However, the rotas also show that there are times when only two staff on duty. This is of concern as one of the people living at the home requires one or more staff to assist with mobilising. Another service user requires constant supervision to ensure their safety and well-being. Social services have also expressed concerns about staffing levels and are currently reviewing their contract. In the meantime, extra funding is being provided to enable safe staffing levels to be provided. The rotas looked at did contain the name of the designated senior covering the shift, staffs full names and their designations and the hours worked by waking night staff. Staff files do not contain documentary evidence that staff receive appropriate work based supervision. The National Minimum Standards state that staff should receive supervision at least six times a year. Staff records are kept secure and treated Care Homes for Adults (18-65 years) Page 20 of 31 confidentially. Of the five staff who returned surveys, all said that their employer had carried out preemployment checks. They also said that their induction training had generally covered everything they needed to know to do their job. They confirmed that the training they receive is relevant to their role, helps them to understand the needs of the service users they care for and keeps them up to date with new practices. Care Homes for Adults (18-65 years) Page 21 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People who use 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 number of changes in manager has meant that the home has not had clear leadership and direction. Because of this, there have been shortfalls in practice, for example: staff not receiving appropriate supervision and satisfactory recruitment systems not being in place to ensure that only suitable staff are employed at the home. Consequently, the management of the home is inadequate and the service is not being run in the best interests of the people who live there. Evidence: A requirement set in the last inspection report stipulated that the manager should obtain a recognised qualification. This requirement is no longer valid as the manager to whom it applied has since left their employment at the home. A new manager has just been appointed and is undergoing induction training. The manager is experienced in working with adults who have learning disabilities. She has obtained relevant qualifications, including the Registered Managers Award. The new manager has a clear view of the improvements she would like to see introduced at the home and how she intends to go about this. However, although a new manager has been appointed, there have also been three different managers in the past year. Also, there has been a recent serious adult protection concern, and the Care Quality Commission and the local Authority have had concerns about inadequate staffing levels. Care Homes for Adults (18-65 years) Page 22 of 31 Because of this, and the failure to provide staff with regular supervision, it is our view that the home has not been providing satisfactory outcomes for people living at No 4 Warwick Road. Arrangements are in place to monitor the quality of care and services provided at the home. For example, the provider carries out monthly monitoring visits to check that peoples needs are being met and that the home is being run in a satisfactory manner. Quality monitoring surveys are issued to peoples relatives and an analysis of the outcomes is produced. This helps the provider to find out what peoples families think about the quality of service received by their relative. However, the arrangements for making sure that concerns identified during the providers monitoring visits are addressed, are unsatisfactory. For example, the provider identified that there was a problem with the way that service users money was being handled at the home. But, there is no evidence that the home took action to address the concerns raised by the provider. Also, because staff do not receive regular supervision, the provider is failing to use staff supervision as an additional means of monitoring the quality of care service users receive. The premises are generally safe and free from hazards. A sample of health and safety records was checked. This showed that the home has a current gas safety certificate. All electrical equipment has received a safety check during the last 12 months. Hoisting equipment has been serviced on four occasions in 2009. A range of workplace risk assessments have been completed and recently updated. Fire prevention checks are carried out. For example, current certificates of inspections were available for the homes emergency lighting and fire alarm systems. A fire risk assessment has been completed and recently updated and reviewed. However, some staff have not received fire instruction, or participated in fire drills, at the frequency stipulated by the local fire and rescue service. Care Homes for Adults (18-65 years) Page 23 of 31 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. h Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 17 Ensure that a record of all 14/12/09 money or other valuables deposited by a service user for safekeeping, or received on a service users behalf, includes the date on which the money or valuables were deposited or received, and the date on which they were returned to the service user. The record must also state the purpose for which the money or valuables were used. This will help to promote and protect peoples financial rights and well-being. 2 34 19 Ensure that:  A full employment history is obtained for each member of staff; A reference is obtained from the staff members previous employer. 04/01/10  This will help to demonstrate Care Homes for Adults (18-65 years) Page 25 of 31 that only suitable staff are employed to work in the home. 3 35 19 Ensure that staff files contain 1/04/10 documentary evidence of any mandatory training they have completed. This will help to ensure that staff are able to meet peoples needs in a safe and competent manner. 4 35 19 Ensure that staff files contain 1/04/10 documentary evidence of any mandatory training they have completed. This will help to ensure that staff are able to meet peoples needs in a safe and competent manner. 5 23 17 Ensure that a record of all 14/12/09 money or other valuables deposited by a service user for safekeeping, or received on a service users behalf, includes the date on which the money or valuables were deposited or received, and the date on which they were returned to the service user. The record must also state the purpose for which the money or valuables were used. This will help to promote and protect peoples financial rights and well-being. 6 24 23 The grouting in the shower room wall is replaced. 04/01/10 Care Homes for Adults (18-65 years) Page 26 of 31 This will help to ensure that people are able to benefit from living in a well maintained home which meets their needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Ensure that peoples support plans:    Contain statements of desired outcomes; Are available in an easy to read version; Are reviewed every six months. 2 6 Ensure that:  Where peoples support plans identify that staff need training to carry out the stated interventions, this is provided; Staff are following the guidelines contained in peoples behavioural support plans.  3 6 Where appropriate, work with speech and language therapy staff to devise a communication passport for each service user. Carry out an assessment of each persons capacity to make decisions, using a recognised tool. Ensure that peoples risk assessments are reviewed regularly and a written record kept. Ensure that: 4 6 5 9 6 12 Care Homes for Adults (18-65 years) Page 27 of 31  Service users have opportunities to access culturally appropriate activities and engage in stimulating social experiences; Each persons weekly planner reflects their personal preferences as well as the expectations of their care manager; Sufficient staff are rostered on duty to enable service users to access their preferred activities and interests.   7 19 Ensure that the MUST nutritional risk assessment recommended by the Care Quality Commission is completed for each service user. Obtain a copy of each persons Health Action Plan. Ensure that:   The provider has an End of Life policy; Each person has an End of Life care plan that has been agreed with their family, GP and any other relevant healthcare professional; End of Life care plans are subject to review by the multidisciplinary team, the service user and their carers/family, as and when peoples condition, or wishes, change; End of life care plans are available to all people who have a legitimate reason to access it; All staff receive training in End of Life care. 8 9 19 21    10 20 Ensure that:    Staffs competency to administer medication is checked and a written record kept of the outcome; Staff have access to an up to date medication reference manual; Staff complete accreditted medication training. 11 23 Ensure that: Care Homes for Adults (18-65 years) Page 28 of 31  The good practice recommendations stipulated following the providers internal audit of money management arrangements within the home are implemented; A weekly reconciliation of money in held in the safe against balances recorded on peoples financial records is carried out.  12 23 Ensure that the homes safeguarding policy and procedures are updated to reflect current developments within the field of adult safeguarding. Ensure that peoples relatives are given clear written information about how to make a complaint. Ensure that the good practice advice set out in the Commissions publication about how to handle service users money and valuables is followed. Ensure that all staff complete infection control training. Ensure that at least 50 percent of the staff team have obtained a National Vocational Qualification at Level 2 or equivalent. Ensure that:   There is always a minimum of three staff on duty throughout the working day; Staff rotas include the following information: staffs full names and their designations; the name of the staff member acting as the shift senior and the hours worked by waking night staff. 13 22 14 23 15 16 30 35 17 32 18 36 Ensure that all staff receive at least six supervisory sessions every 12 months and an annual appraisal. Ensure that staff complete training in equality and diversity, person centred planning; carrying out risk assessments, physical intervention and Makaton sign language. Page 29 of 31 19 32 Care Homes for Adults (18-65 years) 20 32 Carry out an assessment to identify the risks posed when there are only two staff on duty. The assessment should clearly state what control measures have been put in place to minimise any risks associated with only having two staff on duty. Ensure that staff receive fire instruction, and participate in fire drills, at the frequency recommended by the local fire and rescue service. Submit an application to register a manager for the home. The provider must ensure that concerns identified during their monitoring visits are addressed and rectified. 21 42 22 23 38 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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