Inspection on 17/01/10 for White Cliffs Lodge

This inspection was carried out on 17th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

White Cliffs Lodge 27/06/08

White Cliffs Lodge 05/12/07

White Cliffs Lodge 05/02/07

White Cliffs Lodge 14/06/06

White Cliffs Lodge 22/11/05

White Cliffs Lodge 15/06/05

White Cliffs Lodge 12/01/05

White Cliffs Lodge 25/11/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: White Cliffs Lodge Primrose Road Dover Kent CT17 0JA     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: Kim Rogers     Date: 1 8 0 1 2 0 1 0 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 32 Information about the care home Name of care home: Address: White Cliffs Lodge Primrose Road Dover Kent CT17 0JA 01304219213 01304241404 whitecliffs@beaconcaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: White Cliffs Lodge Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 15. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Caretech Community Services Ltd acquired White Cliffs Lodge Ltd In April 2008. Whitecliffs Lodge, comprises two adjacent buildings. Care and accommodation may be provided in both the buildings. The Court is a purpose built unit of 5 flats: one 1bedroom flat, and four 2-bedroom flats, providing accommodation for up to 9 service users. The Lodge may accommodate up to six service users with complex and additional physical support needs. The home is situated in a residential area of Dover with access to nearby community facilities such as shops, pubs and post office. There is a local bus service and a main line train station in Dover. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 15 Brief description of the care home The fees at this home range from £1414 to £2623 per week. Please apply to the home for more information about fees and services. Care Homes for Adults (18-65 years) Page 5 of 32 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 peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of the service. The last key inspection was 27/06/08. We carried out an Annual Service Review in June 2009. We went to the home on a Sunday morning, 17/01/10 for just over two hours. We observed and spoke to staff and spoke to service users. We went back on Monday 18/01/10 and spoke to the area manager, operational support manager, staff and service users. We had a look around the home and sampled records. This took about four hours. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved and how they intend to improve further. The AQAA gives us the information we need in detail. The manager has been in post since October 2009 following a period of inconsistent management. The AQAA shows their plans for improvement but there is little sustained Care Homes for Adults (18-65 years) Page 6 of 32 improvement to report as the manager is so new to the service. We looked at any notifications from the home about accidents and incidents. Not all incidents have been reported to us as they should be. There have been 5 safeguarding alerts since the last inspection. This means that abuse or harm was suspected and the safeguarding coordinator at social services was alerted. The safeguarding coordinator investigates suspected abuse or harm of vulnerable people. Investigations have found that abuse of two service users has been substantiated. One investigation remains open. For more information please contact the provider. Following our visit we spoke to the home manager by phone and met with the manager, senior managers and the responsible individual from the company at a safeguarding meeting with other professionals. We listened to what visiting professionals have to say about the service. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Visiting professionals has raised concerns about poor practice at the home. There remains a level 3 flag on the home which means that the local authority suspect that one or more service users is at risk of harm or abuse and so will not place new people at the home. The provider has agreed to a voluntary embargo on new admissions until outcomes for people have improved. We have made some requirements at the end of this report as we found shortfalls to some National Minimum Standards and regulations. We will be monitoring the home to make sure it improves. The Provider has given us an action plan showing that they intend to improve the service. We will be monitoring this. The assessment process must be robust so that they do not admit people whose needs they cannot meet. Compatibility with other residents must be considered so that people are not placed at risk. Not all risks have been identified, recorded and assessed. This means that staff have no strategy to follow to reduce and where possible eliminate risks to people. The manager is working to improve risk assessments. Communication is not well supported, which means that people may not have the support they need to make choices and decisions. Although referrals have been made for speech and language support, the manager agreed that things can be done while they are waiting for support. For example there is nothing to show who will be supporting people from day to day or what meal and activity choices are on offer. There are a lack opportunities for people. This means that there is a limited range of Care Homes for Adults (18-65 years) Page 8 of 32 activities on offer in house and in the community. People do not have support to be involved and take part in things like the chores and cooking. Staff need training and better shift planning in order to support people to be involved. Some peoples health needs have not been supported or monitored and there have been delays in seeking medical support and advice for some people. The manager is introducing a health action plan for each person so health needs are clearly recorded and monitored. People are not having the support they need with their personal care. This means that people do not have support to wear clean and ironed clothes and may give a negative self image. Some service users have suffered harm and abuse due to the poor practice of some staff. Some service users have suffered harm from other service users. The provider must make sure that staff have training, supervision, guidelines and coaching so they know what good support is and what abuse is and how to recognise and respond to it. Staff must have the competencies they need to support problem behaviour so people are safe. When incidents do occur staff must know how to record and report them properly. There has been a lack of effective audit and monitoring of the home. We have asked that the provider send us copies of the reports they make following monthly monitoring visits. We have asked that the manager send us fortnightly summaries, from 1/02/10 until the next key inspection, detailing any issues and remedies. 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. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment and admission procedure must ensure that the service is suitable for people that want to move in. There is information available to help people decide about moving in. Evidence: We looked at the assessment procedure that finds out about peoples needs and aspirations for the future. The AQAA says that thorough assessments are carried out before a person moves in so that they get a full picture of a persons needs. They say that the assessment tool has been improved and that they listen to current service users views about who moves in. They offer trial stays and visits so people can get a feel of what it is like to live at White Cliffs Lodge. Some of this is not consistent with what health and social professionals visiting the home have told us. We looked at the support plans or service user plans of two people who have moved in within the last year. Both plans have an assessment of needs in them. One has an assessment by the provider in a typed format. The other file has four pages of hand Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: written information called initial assessment with no signature or date. A senior manager was not sure who this was by but felt it would be by someone from Caretech. There were no assessments from placing authorities in the files sampled. On the hand written assessment some needs and risks are recorded including a significant risk to the person. There was no mention of this risk in any other part of the care plan and no supporting risk assessment to show staff how to reduce this risk. This means that staff have no plan to follow to ensure they are giving the right support and managing risks to people. The manager sent us some risk assessments for the person after our visit. This particular risk was not assessed. The manager said she felt it was no longer relevant and no longer a risk to the person and agreed to reassess it to make sure. Visiting health and social care professionals have reported concerns to us about the assessment process, about home admitting people whose needs they then struggle to meet. Professionals have reported to us that they are concerned that compatibility issues are not considered which places service users at potential risk. A service user told us that they do not get on with another service user and they appeared visibly on edge when that person entered the same room. They said that (the other service user) always has a go at me. They said they are happier now they have their own flat rather than having to share a flat with the person they did not get on with. The AQAA says that they ask current service users about their views when someone plans to move in. There has been one placement breakdown in the last year. The Provider has agreed not to admit anyone to the service until the current issues are resolved and outcomes for people are improved. There is information available about the service. Service user guides are with service user plans and tell you about what the home has to offer. The guide is in text with some symbols and pictures. The AQAA says they plan to improve the information to make it more user friendly. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager acknowledges improvements are needed in the service user plans. Not all risks have been identified and assessed so people are safe. The environment could better support communication, choice and decision making. Evidence: Each person has a service user plan called My Plan, which the AQAA tells us is a new introduction to the home. The manager has been working on these plans with service users to make sure they contain information about peoples needs and personal goals. Care managers told us that the plans are improving in that they have more information in them that is better organised. We looked at two service user plans. Peoples needs are recorded with what action staff should take so people get the support they need. In one plan a goal is recorded as, I want to go out more, but there is no support plan in place, so it may not happen. There were no risk assessments in one plan we looked at even though the person is at Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: risk in several areas. A serious risk identified for this person in an initial assessment is not mentioned anywhere in the individual plan. The manager sent us some risk assessments the day after our visit. A care manager told us that the risk assessments for their client have improved. Another care manager said she is still waiting for all potential risks to her client to be identified and assessed. The manager agreed to make sure that all areas of potential risk have been identified and assessed for everyone so that where possible, risks are eliminated or reduced. In both service user plans sampled the monthly review section is empty. Monthly reviewing is the policy of the organisation. For one person, there are formal six monthly reviews meeting minutes by the placing authority and the home but no regular review by staff. This means that changing needs may not be identified and acted on. The manager has agreed to ensure that plans are more regularly reviewed. Information about how people prefer to communicate is recorded in individual plans. The manager has made referrals for communication support to the local community team speech and language department. The manager said she hopes to improve the information about how people prefer to communicate so that it is more detailed. One staff member told us that they have had no training in alternative forms of communication. The environment does not promote communication. For example, there is nothing to say or show who will be on duty, what the meal choices are for the day or what activities are on offer. This means that people have to rely on staff telling them as they cannot find out for themselves. The manager said that staff do have pictures on key rings of activities, however we did not observe this being used over the two days of our visit. The manager agreed to look at systems that will aid communication and control for service users. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for activities in house and in the community are limited. Levels of participation and engagement are low so people have limited opportunities to increase and learn skills. People need better support to be involved in planning and preparing meals and in the day to day running of the home. Evidence: We looked at one service user plan in detail and found that although there was an activity listed for each day of the month, there was no evidence to suggest the person or their known interests had been involved in drawing this up. We saw that activities are not broken down into time slots, so, for example, activities such as, in the kitchen, rest and relax and drive out are filling the majority of the individuals time. When we crossed checked these daily activities against the daily records we found they had not happened. There was no mention of what alternative activity had taken place. We Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: observed the person during a Sunday morning and saw no opportunity offered for the person to be involved or to take part in any activity. So, there is little evidence of the person being offered opportunities to take part in meaningful, fulfilling activities either in house or in the community. There is no shift plan used so staff have no direction about who will be doing what with whom. This means that any activities offered are ad hoc and up to staff to organise. Staff said they have to do the cleaning as no domestic staff are employed and we observed staff cleaning and cooking. As there is no plan in place to actively involve people in taking part in chores, it limits the time staff spend with service users. The manager confirmed that staff have had no training in how to engage, enable and include people and how to develop and teach skills. The manager said she has been coaching and mentoring staff and plans to increase the range and amount of activities that are offered in house. The manager said she has developed an activity planner for the person we sampled. The AQAA says they plan to support people to apply for college and work placements. One person is able to go out on their own and they said they like going to the local shops. Another person said they wanted to go to church but there are no drivers on duty to take them, which staff confirmed. The person said they have a bus pass but said they felt more confident travelling in the homes mini bus. Details about family and friends are recorded in individual plans. There is a record kept of family contact and family members are invited to review meetings if service users want them to be there. There is a large kitchen dining area in the Lodge part of the home. In the Court side there are flats that have their own kitchen areas. A service user said that staff do the cooking and we observed this. There is little evidence that everyone is involved in planning and preparing meals. For example the manager said that talk time is held between service users and staff to gain service users views. However in two plans sampled, the talk time sheets are blank. With the current lack of communication support and the lack of staff skills and competencies to engage people in everyday things like cooking and cleaning staff are doing for people rather than with them. People usually eat together at the Lodge. A support requirement for one person, who has meal time related behaviours has not been assessed. As there are no interventions in place, this behaviour as a negative impact on other people living at the home and means that mealtimes may not be a pleasant experience for some people. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: There are records about nutrition and weight monitoring where needed. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant health needs have not been supported as they should be. People cannot be sure their personal care needs will be met. Medication storage and records are in order. Evidence: Peoples personal care needs are recorded in individual plans. We observed people not having the support they need with their personal care. For example, we observed that staff did not support people to wear ironed and clean clothes and did not support a person to get changed when the need had arisen. Visiting professionals have told us that peoples personal care needs have not been met. They have told us that they have to prompt staff to meet peoples needs properly, including helping someone to change their T shirt so it is not inside out. This means that basic personal care needs are not met so people may have a negative self image and are not clean. Visiting professionals have told us that they are concerned about peoples health needs not being met, placing people at risk. They have told us about delays in staff seeking medical advice for people on more than one occasion until prompted to do so by the visiting professional. Some people have health needs, such as Diabetes and epilepsy Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: that require direct support form staff. Not all staff have had training about supporting people to manage these conditions. Not all health needs are recorded in individual plans. For example one person has epilepsy but there was not much information about this, about what seizures look like and what staff should do to give the right support. There are guidelines about how to administer medication but when we asked staff about it, this did not correspond with what is recorded. This means that the person may not get the support they need. There is no monitoring of one persons seizures even though staff said they have had two seizures recently. One person has a pressure sore and staff recorded that this should be monitored following a visit from a nurse a few days before, but there is no monitoring in place. This means that staff will not know if things are improving or getting worse. The manager is developing health action plans for everyone. We sampled two plans. Some health needs have been identified and recorded. Not all health needs have been recorded with plans in place to say what staff support is needed. The manager said she continues to improve and update plans and has made some referrals for health related support. Medication records are in order with no gaps. The storage of medication is safe and there are records to show what medication people take and how they prefer to take it. The manager said that staff have training before they administer medication and have regular competency assessments to check they are still competent. Visiting professionals have told us they are concerned about staff knowledge about medication especially the use of when needed medication. The service has reported three medication errors to us since the last inspection. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have suffered harm and abuse. The complaints procedure is not meaningful to everyone so not everyone can use it. Evidence: There is a safeguarding adults policy and procedure and a whistle blowing policy. During recent safeguarding investigations this procedure has not been followed by staff. Staff have delayed reporting incidents of possible harm and abuse. Staff have not reported a recent incident of possible harm and abuse until prompted to do so by us. There have been five safeguarding alerts in the last 12 months. This means that suspected harm or abuse was reported and the local social services safeguarding team who investigated. Two investigations remain open. Three are closed and have found that on the balance of probability service users have suffered harm and abuse. Two staff have been disciplined and one staff has been dismissed having been charged with common assault. One staff has been referred to the protection of vulnerable adults list. For more information please contact the provider. Not all of the staff have had training in how to recognise and respond to abuse. This means that staff may not know how to recognise what abuse is and what to do about it. Visiting professionals including nurses and care managers have told us that they are Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: concerned that service users have been harmed and abused and continue to be at risk of harm and abuse. Some people have been placed in potentially risky situations as their known support needs have not lead to clear support plans. The local safeguarding team have placed a flag on the home to alert care manages about the serious concerns they have about the service. The provider has agreed not to admit anyone else to the home until the issues have been resolved and outcomes for people have improved. There is a complaints procedure. The AQAA says they plan to make this more user friendly as at present it not meaningful to everyone. The lack of support with communication means that not everyones complaints may be listened to and acted on. For example some people who have disrupted mealtimes may wish to complain that little is being done about the situation. Some people have problem behaviours. We sampled one persons plan and found no behaviour support plan to show what support the person needs to prevent the range of behaviours from happening. There is a narrative describing some behaviours but nothing to tell staff when behaviours are most likely to occur, what techniques and strategies they should use to prevent the behaviours from happening and what they should do when behaviours need managing. Visiting professionals have told us that behaviour support plans have been lacking. The manager said she is working with a community nurse to develop a plan for one person and she intends to then develop plans for other people who might need them. Care managers have told us that there have been delays in reporting incidents to them so they have not been aware that their clients have been involved and may have been harmed. In a service user plan sampled is a one page report called a behaviour observation chart about an incident on 11/01/10. We saw this on 18/01/10 and there was no incident report to give more detail about it and it had not been reported to care managers, the local safeguarding team or to us. The manager and area manager said they did not know about the incident. We told them to report it appropriately and they did. Not all staff have had training in how to respond and support problem behaviours. We saw that one person became anxious and upset as they could not get into their bedroom as new flooring was being fitted. Staff said they like to spend time in their bedroom. There had been no advanced planning even though the maintenance was planned. There was no plan in place to give the person something else to do or somewhere else to go while the flooring was being fitted. Staff did recognise this after Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: some time and offered the person the use of an empty bedroom. The manager said that there are plans to train all staff in how to support problem behaviours. Some staff have had training about the Mental Capacity Act. No staff have had training about Deprivation of Liberty Safeguards or DOLS. No one is subject to a DOLS authorisation and no DOLS authorisations have been applied for. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained but must be kept clean so it is pleasant place to be. Evidence: On the first day of our visit the home did not smell clean or fresh. There was a foul odour throughout the house. There was no bad smell on the second day of our visit. Staff said that no domestic staff are employed so they have to do the cleaning. Night staff do some cleaning and the laundry. One service user told us that they do not get involved in the cleaning or laundry. This means that they do not have support to be involved and increase their skills. All bedrooms are single and one person told us they are happy with their accommodation. There are plans to redecorate some parts of the home. There is a garden at the back of the home which is grassed with some chairs. The garden is overlooked by windows of several houses so is not very private. There are some restrictions to the environment that are imposed. For example the kitchen in the Lodge is restricted to everyone due to the behaviours of one person. This restricts all service users from the kitchen. The manager agreed that some parts of the kitchen could be restricted, like the fridge rather than locking the whole room off to everyone and she will now review this restriction. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is inconsistent support from a staff team who lack the skills and competencies they need to meet peoples needs. Evidence: On each day there were a total of four staff on duty. Three staff in the Lodge for three service users and one staff in the Court supporting two service users. There are three staff on duty at night. They are using temporary staff from an agency to cover some shifts. The AQAA shows that over 350 shifts in the last three months have been covered by temporary agency staff. This means that service users are supported by staff who do not know them very well and could lead to inconsistent support. Some people are funded to have one to one and/or two to one support. There is no record of how and when this support is provided and by whom. This means that service users may not be getting the hours of support they need and are paying for. Care managers have raised this as a concern to us. Staff do the cooking and cleaning as no domestic staff are employed. This means that not all of their time is spent with service users. Staff work half days from 07.30 to 14.30 or 14.30 to 21.30. Some staff work long days of 07.30 to 21.30. An agency staff and a permanent staff was covering a long day of 14 hours on the first day of our visit. This has the potential for staff being tired and stressed leading to bad support. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Visiting professionals have questioned the lack of staff skills and competencies. They have reported that staff lack the ability to answer simple straightforward questions and have not supported peoples basic personal care needs and more complex needs. The culture of the staff team has been questioned, as mentioned in the complaints and protection section. The manager said that she cannot rely on staff to provide a good service when she is not there. Because of this we went to the home on a Sunday morning and observed staff for just over two hours. We observed staff cooking and cleaning and not really engaging with people in a meaningful way. No activities were offered and we saw no service user at the Lodge having support to be involved in anything. At the Court staff encouraged a service user to show us around and to be involved in our visit. There are shortfalls in training especially training related to peoples needs like Autism, alternative communication, learning disabilities, skills teaching and person centred planning. The provider says they plan to give staff extra training and support. Staff said that the frequency of staff meetings and supervision meetings has improved since the new manager has been in post, about three months. The AQAA shows that recruitment checks are carried out before a person starts work at the home. The area manager confirmed that the human resources department checks references and that other checks are made. Staff confirmed that they had an induction when they started and showed us an induction booklet. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being adequately managed but has no sustained track record of improvement. People cannot be sure their views will be listened to and lead to any change or improvement. Staff must be trained and supervised to ensure peoples health and safety is protected. Evidence: There is a new manager in post. She has been running the home for about three months. There have been a number of different managers managing the service in the past two years so the management has been inconsistent. The manager has experience in managing services for people with a learning disability. She has the qualifications required by the Minimum Standards but told us she has no qualification in learning disabilities or challenging behaviour. The manager has ideas about how to improve the service and produced a detailed AQAA about this. Visiting professionals say she is enthusiastic and they have some confidence in her ability. The manager recognises that she cannot improve the service alone and needs support and time to show sustained improvements. The safeguarding team have told us that there has been little or no improvements found between recent monthly safeguarding meetings Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: and they are concerned about the slow progress to improve outcomes for people. The Provider has agreed to ensure that the manager is supported to improve the service. The majority of incidents and accidents have been reported to us but some have not. A recent serious incident on 11/01/10 was not recorded properly and not reported until we found a record of it and prompted staff to do this. The manager and area manager said the incident had not been reported to them. Care managers have told us that there have been delays in reporting incidents to them and in some cases incidents have not been reported to them at all. Monthly monitoring visits are carried by a senior manager who writes a report of findings. We asked for copies of the last few reports and found that they are not really outcomes focussed. The provider has acknowledged a lack of effective audit and monitoring of the service and says they will look into improving this. We will ask that the provider continues to send us the monthly monitoring reports and that the manager sends us fortnightly summaries giving us an overview of any issues and remedies that have been put in place. The deputy manager told us that group meetings between service users are not held. The manager later told us that group meetings are held. We found talk time sheets in two service user plans sampled are blank. With a current lack of communication support and staff skills, opportunities for service uses to air their views are limited so service users cannot effect change in the service. The providers action plan shows that they plan to send out surveys to service users and stakeholders to gain their views about the service. There are some shortfalls in training relating to health and safety. The manager says she is applying for training so that all staff are up to date with mandatory training. Some service uses have been moved and handled roughly causing some injuries and redress for staff including dismissal. The AQAA shows that the required health and safety checks are carried out on the premises and equipment. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 14 They must ensure the admission procedure is robust so that they do not admit people whose needs staff do not have the skills to meet. To ensure that people are compatable and happy to live with each other. 28/02/2010 2 9 13 All potential risks must be 28/02/2010 identified assessed and managed so people are safe. To ensure that there are strategies for staff to follow to reduce and eliminate risks. 3 19 12 The Provider must ensure that health needs are assessed, recorded , supported then monitored. Staff must know to seek advice without delay. To ensure that poeple are healhty and safe. 28/02/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 4 23 37 The Provide must ensure that all accidents and incidents are recorded and reported properly. To ensure that the CQC are kept informed and aware of accidents and incidents and action taken. 28/02/2010 5 23 13 Staff must be competent in how to recognise and respond to abuse so service users are protected. Staff should be supervised, coached and trained to ensure they are providing good, safe support. This is to ensure that people are safe and get good support. 28/02/2010 6 32 18 The Provider must give us assurance that all staff are up to date with mandatory training courses and are competent at recognising and responding to abuse. To ensure that service users are in safe hands. 28/02/2010 7 32 18 The Provider must send us a 28/02/2010 robust training plan related to service users needs. To ensure that staff will have the skills and competencies they need to Care Homes for Adults (18-65 years) Page 30 of 32 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 support service users to lead fulfilling meaningful lives. 8 39 24 Due to the lack of audit and 01/02/2010 monitoring over the past few months we ask that the manager send us fortnightly summaries of issues and remedies from 01/02/10. To ensure that the manager and provider are monitoring practice at the home so it is safe for service users. 9 43 26 The Provider must send us reports from their monthly monitoring visits until the next key inspection. To ensure that monitoring is carried out and effective protecting service users. 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 28/02/2010 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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. 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