Inspection on 11/06/09 for Wilson Lodge

This inspection was carried out on 11th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wilson Lodge 04/07/07

Wilson Lodge 26/02/07

Wilson Lodge 26/09/05

Wilson Lodge 13/04/05

Wilson Lodge 24/08/04

Wilson Lodge 22/04/04

Wilson Lodge 17/12/03

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

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10 Whitfield Avenue

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: Wilson Lodge 16 Augusta Road East Moseley Birmingham West Midlands B13 8AJ     The quality rating for this care home is:   one star adequate 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: Sarah Bennett     Date: 1 1 0 6 2 0 0 9 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 34 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 34 Information about the care home Name of care home: Address: Wilson Lodge 16 Augusta Road East Moseley Birmingham West Midlands B13 8AJ 01214491841 01214492926 wilsoncare@btconnect.com www.wilson-care.com Wilson Care Resources Ltd care home 36 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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) 36, Mental disorder, excluding learning disability or dementia (MD) 36 Date of last inspection Brief description of the care home Wilson Lodge provides nursing care for up to 36 adults suffering from mental health problems. People living there may also have a learning disability but mental health illness is the primary reason for admission. As well as the registered manager the home employs a nurse manager. The ethos of the home is encouraging and supporting independence of the people living there. The home is situated within a residential area, close to the city centre and within walking distance of local shops and other amenities. The building is located at the end Care Homes for Adults (18-65 years) Page 4 of 34 36 36 Over 65 0 0 Brief description of the care home of a cul de sac. There is no off road parking for visitors. Car parking facilities for staff are situated at the rear of the property. The home has ramped access, which enables disabled people or visitors to easily access the premises and a passenger lift is available inside the home. Accommodation is spread over two floors offering a mixture of single and shared rooms. One bedroom has an en suite toilet. Communal areas include two lounges, a dining room, a smoking room and two small secluded gardens. The home has two baths and three showers, which meet the needs of the people living in the home. There are dedicated kitchen and laundry facilities on the premises. Corridors are wide and have handrails to enable the people living there to mobilise independently. A hoist and a stand aid are available and pressure relieving equipment is available for people living there who may require this equipment to prevent skin sores. Copies of previous inspection reports are available from the office and a notice is displayed to inform the people living there and their representatives that these are available. The reader is advised to contact the home for details of current charges to live there. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over one day. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home. The home did not return the Annual Quality Care Homes for Adults (18-65 years) Page 6 of 34 Assurance Assessment (AQAA) when we asked for it. This provides information about the home and how they think it meets the needs of the people living there. A Statutory Requirement Notice was sent following our inspection to require it to be returned. We case tracked the care received by three people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there, the manager and staff were spoken with. An expert by experience visited as part of the inspection. This is a person who has experience of using services. They talked to the people living there and gave their views about the home. Their views are included in this report where they are referred to as the ex by ex. Surveys were given to some of the people living there and staff on the day of our visit. We received one back from a person living there and one from staff. Their views stated in the surveys are reflected in this report. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: People should have updated information about the home so they can make a choice as to whether or not they want to live there. All people who live there must have the risks to their safety and well being assessed to ensure they can be reduced as much as possible. Staff should have more detailed information in care plans so they know how to support people to meet their individual needs. All the people living there should have regular opportunities to go out and do the things they enjoy. Care Homes for Adults (18-65 years) Page 8 of 34 Medication should be regularly audited and there should be clear guidelines in place for individuals so that people get their medication when they need it to be well. The home should be more homely and comfortable for people to live in. People should have more choice about the furnishings they have in their bedroom. Staff must have the training they need so they know how to keep people safe from harm and meet their individual needs. Records must be available to show that suitable staff are recruited to work with the people living there to ensure they are safeguarded from harm. Regular checks must be made of equipment in the home to ensure it is safe to use and people are not at risk of being hurt. A representative of the provider should visit every month and the reports of these visits should be available in the home. This will show how things should improve and ensure the home is run in the best interests of the people living there. 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have the information they need about the home so they can make a choice as to whether or not they want to live there. Individuals needs are assessed before they move in to ensure they can be met at the home. Evidence: The information available about the home for the people living there was dated 2002. It had not been updated with details of how to contact us at our current address so people may not be able to do this if they needed to. It did not state how much it costs to live there so people would not be aware of this information. It stated the rules of the home to ensure that people get on with each other as much as possible and do not disrupt each others lives. People said they thought these rules were fair and reasonable. As it was dated several years ago it was not clear whether these were the current rules. The statement of purpose of the home was dated 2004. It did not include updated information that people would need to help them make a choice as to whether or not they want to live there. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Since we last visited two people have moved into the home and their records were looked at. These included an assessment that was completed before they moved in to ensure their needs could be met at the home. Records showed that staff visited the people before they moved in to do the assessment and get to know them. Where possible the person had visited the home before they moved in. This gave them a chance to have a look around the building, to get to know the staff and the other people living there. Care Homes for Adults (18-65 years) Page 12 of 34 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. Staff do not have all the information they need to support people to meet their individual needs and keep them safe. Evidence: The records of three of the people who live there were looked at. These included individual care plans to give staff information about how to support the person to meet their needs. These had been developed from an assessment that was completed when the person moved into the home. For one person it stated that some things were a potential or actual problem but there were no comments written as to why this was so. This makes it difficult to write a care plan as to how staff should support the person if it is not known what the persons needs are. People had signed their care plan where they were able to, to show they had been involved in it. One persons care plan included good detail as to how staff are to look for signs of their change in mood, which could indicate that their mental health is deteriorating. It detailed how staff are to respond to this to ensure the persons well being as much as Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: possible. Staff were observed during the day talking to individuals and monitoring their well being and mood. The manager said they are doing monthly care plan audits to ensure these are regularly reviewed and include the information that staff need. Care plans had mostly been reviewed regularly. They often stated that there were no changes to be made. One persons care plan about their physical health would have benefitted from clearer and more detailed review. It said in the care plan that the persons weight was to be monitored and they were to have regular tests of their cholesterol and the glucose levels in their blood. There was no mention in the reviews of their weight or any tests being done. This does not indicate that the review is considering any monitoring of the persons needs. Staff said that there had not been any recent meetings held with the people who live there. The manager showed us minutes of regular meetings over the last few months. These showed that people talked about smoking, doing activities, menus, peoples birthdays and how they were to be celebrated and staffing. The manager said that these meetings will be held more regularly now as this is part of the new activity workers role. Records for two people included individual risk assessments. They stated how staff are to support the person to take risks whilst ensuring that the risks to their safety and well being were reduced as much as possible. These did not state all the risks for the individual. For example, one persons daily records indicated that sometimes their behaviour could challenge other people in the way they spoke to them. There was not a risk assessment as to how staff are to manage this behaviour to ensure that the person, other people living there and staff are safe. One persons records did not include any risk assessments. Their records indicated that there were risks such as smoking, their behaviour and their communication needs, which could put them and other people living there at risk of harm. Care Homes for Adults (18-65 years) Page 14 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle and have a healthy and varied diet so ensuring their well being. Evidence: Some people go to day centres or attend college. The ex by ex said, People told me that they attended a nearby day centre, some of them went every day, so obviously there were plenty of opportunities for stimulation for those that want it. One person told me that they go swimming a lot and that the home provides Passport to Leisure cards that give them all cheap entrance at the local leisure centre. Recently, an activity worker had been employed to co ordinate activities for the people living there. Records showed and people said that this had improved the range and amount of activities that were offered. The ex by ex said, There was great excitement about the new activities assistant who had recently joined them and was Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: introducing lots of new things to do. They had had some exercise classes and had played music together. The manager said and records showed that the exercise group is a regular activity that people who want to join in. This involves either a local walk or an exercise session in one of the lounges. One persons records showed that they went to the cinema in December and again in January and had really enjoyed this. There was no further mention of this or the person doing many more activities outside the home. The manager said that they hope with the activity worker this will now improve. The hairdresser visits for a day every fortnight and people can have their hair cut or styled if they want to. A member of staff on their day off was also assisting the hairdresser so that more people could benefit from this. The ex by ex said, While I was there the hairdresser was in one of the rooms giving the lady residents a hair do. The room was like a little salon with a mirror and magazines, obviously the ladies were enjoying the pampering. People were observed in small groups during the day playing games with staff and enjoying interacting with each other. There is a large cupboard of different games to suit all interests and abilities as well as art and craft activities so that people have activities they can do at home. There are several books around the home that people can take if they want to. There is a TV in one lounge and in the other lounge people can sit quietly. Several of the people living there smoke. Some people are unable to smoke without staff supervising them to ensure they do not burn themeslves or put others at risk of there being a fire. Records indicated that if some people are given a packet of cigarettes they are likely to smoke one after the other. Some people told us they would do this and would then not have enough money to buy any more or they would smoke too many, which would increase the risks to their physical health. For these people there are set cigarette times. People who have their cigarettes at set times said it helped them not to smoke as many and they always get them from staff at the times stated. Care plans sampled showed that this had been done to safeguard the person and not as a restriction on their rights. Some people are able to go out on their own and people said they can go out when they want to. People are asked to tell staff when they go out and what time they expect to be back. A note is made of what each person is wearing to ensure that if the person should go missing this can be reported to the police. The front door is locked so that people whose safety would be at risk if they went out on their own cannot do Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: so. It was observed throughout the day that people who are able to go out without staff, were able to do so when they wanted to. The manager said that the people living there had the opportunity to vote in the elections the previous week if they wanted to. However, some staff at the polling station had discriminated against some of the people living there and questioned their right to vote. The manager said that on behalf of the people living there they had made an official complaint about this. A cook is employed to cook the meals. There are two sittings for the main meal of the day so to reduce the amount of people in the dining room at any one time and allow staff to support people who need help to eat. People said they can choose what sitting they go for. There are small tables around the dining room so that people do not have to all sit together. People said they liked the food and had a choice of what they ate. The ex by ex said, All the food was freshly cooked on the premises. There was a choice of menu of either a cooked meal with meat and vegetables or sandwiches. There was pizza as a vegetarian option. There was also a choice of puddings and fruit available. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the personal and health care needs of the people living there are met, which could affect individuals well being. Evidence: Records sampled included care plans so that staff had the information they need to support individuals to meet their personal care and health needs. The people living there were dressed in individual styles that were appropriate to their age, gender, the weather and the activities they were doing. The ex by ex said, All the residents were presentable, their clothes clean and of course lots of ladies sported smart hair dos as it was the hairdressers day. They had their hair done every two weeks. Records about people going to the optician, chiropodist, dentist or hospital and GP visits were held in separate files from the individuals records. This made it difficult to track what health checks each person had and when these were due again as all peoples records are together in one file, for say, the optician. So if staff need to check when a person is due an eye test they need to look through the Optician folder for all people to check for that person. One persons records did not indicate that they had their eyes tested recently. One person had blood tests but there was no outcome of Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: these recorded. The manager said they do not always get the results from the GP if there is nothing to address. This was not clear in their records and should be stated to show that staff follow up any tests that people have so that if further treatment is needed this would not be missed. One person complained to staff of having toothache in the morning. Staff made them an appointment with the dentist and supported them to go that afternoon. One person was having daily treatment for a health condition. Staff were supporting them to go to the hospital for this. The person said that the support they had from staff was good, which helped them during their illness. The ex by ex said, The residents were alert and interacting, whether they were just sitting quietly or chatting in their groups, everyone looked perfectly relaxed. One of the nurses runs a healthy living group in the home for people to attend if they want to. There was information on the notice board about this. There is also a walking group and some people said they go swimming. This helps people to have regular exercise so helping their health and well being. One person had gained weight since living at the home and another had lost weight. There was no indication in either of their records that this was planned. The manager gave reasons why this had happened and said that they were ensuring that individuals got the nurtition and advice they needed to be of a healthy weight. Neither of the records indicated this so it is not clear that all staff are aware of how to ensure individuals are not gaining or losing a significant amount of weight, which could indicate an underlying health condition. Medication is stored in locked cabinets or trolley in a locked room. Only the qualified nurses give medication to the people living there. A couple of years ago the home designed their own Medication Administration Records (MAR), which suit the needs of the people living there and the medication systems in the home. At the front of each persons MAR there is a photo of the person so that unfamiliar staff would know who to give the medication to. A pharmacist from the Primary Care Trust (PCT) had visited in March this year to do an audit of the medication. They found that recommendations from their previous visit had been met and there were no further recommendations made. The home last audited the medication in 2007. This should be done more regularly to ensure that all people are getting their medication as prescribed. Staff sign each persons MAR when they give them their medication. There were some Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: gaps noted in the MAR sampled so it was not clear that all people were getting their medication as prescribed. On one persons MAR it stated that 92 tablets should be left to take but there were only 70 in stock so it was not clear why the records did not match the amount of tablets left in the home. The room where the medication is kept was warm. Staff said it gets very hot in there on warmer days. Staff did not monitor the temperature of the room so that action could be taken to reduce this if the medication was being stored at too high a temperature. This is important, as the temperature may affect how effective the medication is. Some medication is kept in the fridge. Staff monitor the temperature of this to ensure the medication is stored at the correct temperature. Some people are prescribed as required (PRN) medication. There were not protocols in place that stated why, when and how much of the medication should be given to the person. Often it stated that the criteria for giving the medication was if the person was agitated. The interpretation of this by staff for each individual could be very different and may result in people receiving their medication more often than they should, which could affect their well being. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the views of the people living there are listened to and acted on, which could affect their safety and well being. Evidence: The complaints policy was dated 2004 and included our old contact details. This means that people would not know how to contact us if they wanted to. The complaints log stated that no complaints had been made since 2001. However, last year an allegation was made about the home which resulted in a safeguarding referral being made. This was investigated by the local authority and no further action was taken. All concerns and complaints should be recorded to show that they are being dealt with and people are listened to. We have not received any concerns or complaints about the home in the last 12 months. The ex by ex said, I asked several residents if they knew how to complain if something was wrong. Several of them said that if anything was wrong they told the manager and he dealt with it. The manager said that only six staff had received training on the Mental Capacity Act but arrangements were being made for other staff to have this. This Act came into force in April 2007. All staff should be aware of this legislation and the implications it has for the people living there. The manager said that they have started using a mental capacity assessment with some people who live there to assess if they need any further input in making decisions about their health and welfare. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The manager said that two staff would be attending Train the Trainer training on the Deprivation of Liberty Safeguards the following week. They would then train all staff in this. These safeguards are part of the Mental Capacity Act legislation and ensure that the care and treatment that people who live in care homes receive does not deprive them of their liberty. As stated earlier in this report some people have set cigarette times. This is done however, to ensure their health and financial well being and not as a way of depriving them of their liberty. If there are doubts as to peoples care and treatment, referrals are made to the Local Authority who assess whether or not a person is deprived of their liberty. The adult protection and abuse policy was dated 2003 and stated that staff would be regularly trained and updated so they knew how to safeguard the people living there from abuse. Staff training records showed and the manager said that staff had not had this updated training. Some peoples relatives look after their money, some peoples placing authority look after it, some people look after their own and for some people the home has responsibility. We visited the home in November 2007 following concerns from one persons placing authority that all peoples money was pooled into one account. Many people for whom the home take responsibility for their money, do not have any ID so it is difficult for them to open individual bank accounts. For this reason there is a residents bank account that all peoples individual benefits are paid into. Records sampled showed that records are kept of what each individual pays in and what they spend. An admin worker had recently been appointed who is to ensure that these records are up to date and clear. The manager said that the accounts were currently being audited. When they are returned they intend to separate individuals money within the residents account so that individuals deposits and withdrawals show on bank statements as their name, currently they are numbers, which makes it harder to track each person. Finance records sampled showed that people had money when they asked for it and had signed to say they had received it. Some things such as hairdressing and chiropody are invoiced to individuals and records showed that people had these treatments on the day they were invoiced for it. Care Homes for Adults (18-65 years) Page 22 of 34 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 safe and clean but not always homely and comfortable for people to live in. Evidence: The home is large but considering this, some of the communal areas looked homely. In some rooms, however, the decoration looked worn and a little dated so it did not look that comfortable for people to live in. The ex by ex said, The decor in the home was clean and comfortable, although a little run down in places. The lino in the corridors was worn. There were pictures on many of the walls helping it to look homely. The ex by ex said, There were pictures on the wall and plants and flowers dotted around. The premises needed some updating. Some peoples bedrooms were looked at, if they agreed to this. One person has their own toilet, no other rooms have en suite toilet or bathing facilities. Rooms seen were generally personalised and people said they could choose what they had in their room. People who are able to had a key to their room, doors are like front doors of houses helping them to look more personal. Some people still share a bedroom. There is one vacancy in a shared room. The manager said it is unlikely that this would be filled as people who do share know the other person and a new person is less likely to want a shared room. They do not feel under any pressure from the owner to fill this vacancy. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: Plans are being developed to extend the home in the future. This would provide each person with their own bedroom with en suite facilities. Some rooms did not have lampshades. Some people said they chose this but for one person it was not clear they had been asked whether or not they wanted a lampshade. All rooms had lino on the floor. The information for residents about the home said that if people wanted other flooring than this they would be expected to pay for this. This should not be the case. People should be provided with a flooring type of their choice at a standard price and if they wanted anything that was above the standard price they should be expected to pay this. It is not acceptable that all people have lino in their rooms, which does not help to make it homely and comfortable for them. All the beds had metal frames and were of hospital type. This does not help peoples rooms to look homely and comfortable. People said their beds were okay. Some of the decoration in rooms was worn and in need of redecoration. The manager said that since the Primary Care Trust infection control audit they had completed a lot of work to upgrade the home. The home had scored quite high in this audit but the manager thought it was important that improvements were made. The staff toilets had been upgraded. New flooring and tiling had been provided in the laundry areas and tiling was being renewed at the time of our visit in the tea room, off the dining room. Hand wash and alcohol rub was provided in all areas where this did not put the people living there at risk of harm. There is a domestic washing machine and dryer as well as industrial ones. This provides an opportunity for people to do their own laundry so as to regain their independence skills. In the laundry people had separate boxes for their clothes that did not need to be hung up. All clothes that needed it were ironed and clothes were hung in individual sections to reduce the risk of people getting clothes that did not belong to them. The ex by ex said, The manager also showed me the laundry room and explained how they go to great lengths to make sure that residents clothes do not get mixed up. I was impressed to see separated laundry boxes with each residents name on. The home was clean throughout. Separate staff are employed to clean the home so that care staff do not have to do this. The ex by ex said, There was no offensive smell. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their recruitment, support and development are variable, which could impact on the safety and well being of the people who live there. Evidence: The manager said that three staff had nearly finished and one staff had recently started National Vocational Qualification (NVQ) level 3 in Care. They said that over half of the staff had completed NVQ level 3 and this should ensure that staff have the qualifications and skills to meet the needs of the people living there. Staff said and the homes statement of purpose stated that during the day there are usually two nurses and four care staff on duty. The manager is always in addition to the rota and not counted as one of the two nurses. In addition to care staff there is also a housekeeper, laundry assistant, a cook and kitchen assistant on duty during the day. This means that care staff can spend time with the people living there. Recently, an administrator and an activity worker had also been appointed and both had started working there. Rotas showed that on some days there was only one nurse on duty. The manager said this was generally due to qualified staff being on maternity leave. The manager had not done an analysis or risk assessment as to how many qualified staff were needed Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: on each shift. This should be done to ensure that sufficient staff are available to meet individuals needs. Staff said there were sufficient staff on duty. The manager said that using agency staff is detrimental to the people living there and they do not use or intend to use any. The home has its own bank staff who know the people living there. Records of staff meeting minutes were not available. The manager said that these had been written but could not be found in the home that day. Staff said that they had regular staff meetings and a schedule was seen that showed these were held regularly. These should be available in the home so that staff who are not able to attend can read them and be updated. Throughout the day we observed staff interacting with the people living there in a way that was positive and respected them as individuals. Staff supported people to attend health appointments. People said that they liked the staff that worked there and felt supported by them. The records of four of the staff that work there were looked at. These did not include all the required recruitment records so to ensure that the people living there have staff who are suitable to work with them to ensure their safety and well being. One of the four records did not include evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed . Two of the four did not include references to show the persons suitability to do the job they are employed for. The manager said that these records were available but he did not know where. He said that these would be forwarded to us after the inspection. At the time of writing this report we had not received these. Staff said that they liked working at the home and got the training they needed to meet the needs of the people living there. Records showed that several staff needed updated training in safeguarding and first aid. The manager said that staff did not do much training last year as the staffing budget needs to be increased so that staff can go on training without this affecting the people living there. Records sampled showed that some staff had training in infection control and moving and handling. All staff had training in fire safety. Care Homes for Adults (18-65 years) Page 26 of 34 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 management arrangements do not always ensure that the people living there benefit from a well run home, which could impact on their health, safety and welfare. Evidence: The registered manager has managed the home for many years and has the qualifications, skills and experience to do so. A deputy manager is employed as the nurse manager and manages the day to day care of the people who live there. The ex by ex said, It was obvious that the people living there loved the managers. One person told the ex by ex, The managers are so good to us. Our records showed that we had not received the Annual Quality Assurance Assessment (AQAA) when we asked for it. The manager said that he would deliver a copy of it to our office the day after the inspection as he could not find a copy on the day. We did not receive this. Following our visit a Statutory Requirement Notice was sent to the home requiring the AQAA to be returned. The manager said that one of the other directors visits every month to do an audit and Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: writes a report of their visit. The reports of these visits since October last year were not available. The manager said they were on the directors computer and they would forward them to us. We have not yet received these. Previous reports showed that they included meeting with the people living there and asking their views about the home. The manager said that they have signed up to a Healthcare Acquired Infection Programme and are one of ten homes involved in this. It includes attending four workshops in a year and is a very extensive audit. It will involve staff and hopefully a person who lives there. The manager feels this will be a useful exercise as part of the homes improvement programme. The handyman tests the water temperatures to ensure they are not too hot, which could put people at risk of being scalded. Records showed that they were not tested regularly. They were not on duty and staff did not have access to the thermometers they use to test these. Records showed that in May the temperature of one of the baths was eight degrees higher than the recommended safe temperature of 43C. There was no record of anything being done to reduce this. We felt the water in this bath, it felt hot but not scalding. The scald warning triangle in the bath did change colour slightly indicating that people could be at risk of being scalded. There was no evidence from looking at accident reports that anyone had been scalded. The manager said that there had been a problem with the hot water and a plumber had ordered some new thermostatic valves to regulate the temperatures, which were to be fitted the following week. The manager said they would turn the water temperature on the boiler down until these were fitted to reduce the risks of people being scalded. Fire records showed that staff had training in fire safety. Staff test the fire equipment weekly to make sure it is working. An engineer regularly services the fire equipment so it is well maintained and works well. The last record of there being a fire drill was in June last year. The manager said there was one in November last year but the records of this could not be found. There should be a fire drill at least very six months so that staff and the people living can practice what to do if there was a fire. In the smoking room there was a hole in the fire door where the lock had been removed. The manager reported this in the maintenance book immediately and said it would be repaired urgently. The local fire officer visited in June last year and stated that they observed nothing of concern and a risk assessment was completed to ensure the risks of there being a fire were minimised. Records showed that the gas equipment and electrical wiring were tested when required and that they were safe to use. Care Homes for Adults (18-65 years) Page 28 of 34 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 29 of 34 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 9 13 Risk assessments must be in 31/10/2009 place for all the people living there and include all the risks to their safety. So that people can take risks in their lives but be as safe as possible. 2 20 13 For each person who is 30/08/2009 prescribed PRN (as required) medication there must be a protocol in place stating when, why and how much of the medication should be given. This will ensure that people get the medication they need to be well. 3 23 13 All staff must have regular updated training in safeguarding the people living there from abuse. 30/11/2009 Care Homes for Adults (18-65 years) Page 30 of 34 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 To ensure they know how to protect the people living there and ensure their safety. 4 34 19 The required recruitment records must be available in the home. This will ensure that staff are suitable to work with the people living there so ensuring their safety and well being. 5 42 13 The water temperatures must be within the recommended safe temperatures. So that people are not at risk of being scalded. 6 42 13 The fire door to the smoking 05/07/2009 room must be repaired. So that the risk of smoke escaping through it if there were a fire are reduced. 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 31/08/2009 05/07/2009 1 1 The statement of purpose should be updated so that people have the information they need to make a choice as to whether or not they want to live there. The information for the people living there about the home Page 31 of 34 2 1 Care Homes for Adults (18-65 years) 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 should be updated so they have the information they need. 3 4 6 6 Care plans should be reviewed more thoroughly to ensure they are still effective in meeting individuals needs. Care plans should include more detail about how staff are to support individuals to meet their needs and achieve their goals. All the people living there should be offered regular opportunities to go out and do the things they enjoy. Records about peoples health checks and tests should be organised to ensure that staff can be clear when checks are due and the outcome of any tests people have are recorded to ensure their health needs are met. The temperature of the medication room should be monitored to ensure that the effectiveness of the medication is not reduced, which could affect peoples health. There should be regular audits of the medication systems to ensure that people are getting their medication as prescribed so ensuring their well being. The complaints log should include a record of all complaints made to ensure that people know their views are listened to and acted on. The complaints policy should be updated to ensure that people have the information they need so they know their views will be listened to and acted on. All staff should have training in the Mental Capacity Act and the Deprivation of Liberty Safeguards. This will ensure they know how this legislation may affect the people living there Some redecoration should take place so it is a homely and comfortable place for people to live in. Consideration should be given to replacing the beds with a type that is more homely and comfortable for people. Lampshades should be provided in bedrooms where people want these so their bedroom is comfortable to spend time in. People should be provided with a standard price flooring type of their choice in their bedroom so it is homely and 5 6 12 19 7 20 8 20 9 22 10 22 11 23 12 13 14 24 26 26 15 26 Care Homes for Adults (18-65 years) Page 32 of 34 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 comfortable for them. 16 33 Staff meeting minutes should be available in the home so that staff who are not able to attend can read them and be updated with any changes to the needs of the people living there. An analysis or risk assessment as to how many qualified staff are needed on each shift should be done. This will ensure that sufficient staff are available to meet individuals needs. Staff should receive the training they need so they know how to support the people living there to meet their needs. Reports of monthly visits by a representative of the owner should be available in the home. This will ensure that the home is regularly audited to ensure the needs of the people living there are met. There should be records of regular fire drills to ensure that staff and the people living there can practice what to do if there was a fire. 17 33 18 19 35 39 20 42 Care Homes for Adults (18-65 years) Page 33 of 34 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. 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