Inspection on 06/06/09 for Yorkminster Drive

This inspection was carried out on 6th 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Yorkminster Drive 04/09/08

Yorkminster Drive 19/03/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

Key inspection report CARE HOME ADULTS 18-65 Yorkminster Drive 1-5 Yorkminster Drive Chelmsley Wood Birmingham West Midlands B37 7UG Lead Inspector Julie Preston Key Unannounced Inspection 6th June 2009 10:00 Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yorkminster Drive Address 1-5 Yorkminster Drive Chelmsley Wood Birmingham West Midlands B37 7UG 0121 788 2763 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caretech-uk.com CareTech Community Services Ltd Manager post vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only To service users of the following gender: Either Whose primary care needs on admission the home are within the following categories: 2. Learning Disability (LD) 12 The maximum number of service users to be accommodated is 12. Date of last inspection 4th September 2008 Brief Description of the Service: Yorkminster Drive is situated in Solihull close to shopping facilities, the town centre of Chelmsley Wood, places of worship and public transport. The home provides care and accommodation to up to twelve people with a learning disability, some of whom have a physical disability. There are three bungalows housing four people in each bungalow. Facilities available include bathrooms, individual bedrooms, and lounge and kitchen space and laundry facilities. Equipment is provided for people who have difficulties with moving around, including ramps, hoists and adapted bathing facilities. Each bungalow has its own front door and back door entrance and staff are designated to work in each bungalow. The fees charged each week are varied according to people’s needs. More details can be obtained from the home. People pay a contribution according to their individual welfare benefit. The inspection report from the CQC is made available in the home for people and/or their representatives to look at. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) 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 which included, • • • notifications received from the home that tell us about events that have affected the well being of people information about complaints information about safeguarding This visit took place over one day at the weekend. People who live in the home and the staff team did not know that we were coming. Three people were “case tracked” and this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, quality assurance systems and health and safety records were reviewed. We looked around the building to make sure that it was warm, clean and comfortable. We spoke or spent time with all of the people who live at the home and five staff as well as the manager. Relatives present during our visit also contributed their opinions of the service provided. What the service does well: Information about the home is made available to people before they move in so that they can make an informed choice about whether to live there. There is a procedure for assessing people’s needs prior to admission so they can be confident the home is suitable for them. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 6 People enjoy their meals and mealtimes. We were told that (the food) is “very good”. People are supported to keep in touch with friends and relatives so that they do not lose relationships that are important to them. People live in a clean and comfortable home, which is fitted with equipment that meets their needs and helps them maintain their independence. The home operates a robust system of recruitment for the protection of the people who live there. What has improved since the last inspection? What they could do better: 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. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 7 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is made available to people before they move in so that they can make an informed choice about whether to live there. There is a procedure for assessing people’s needs prior to admission so they can be confident the home is suitable for them. EVIDENCE: There have been no new people admitted to the home since we last visited in September 2008. All of the people who live at Yorkminster Drive have lived there for a considerable period of time and there are currently no vacancies. At our last visit, we saw that there was a procedure for assessing the needs of people before they move in to the home. We were told that no changes had been made to the procedure so we did not look at it again. The manager sent us a copy of the statement of purpose and service user guide as they were being updated when we visited and were not available. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 10 These documents provide information about the services and facilities provided in the home. The service user guide contained pictures and plain language so that the content would be more accessible to people who have difficulty reading. We were told that the documents are made available to people and their families before they move in. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the information they need and a good understanding of how to offer care and support to each person. This should make sure that people are supported according to their individual needs and preferences. EVIDENCE: We looked at three care plans, for one person in each of the three bungalows. Care plans explain what people’s needs are and describe the care and support they require to make sure these needs are met. Some of the care plans we looked at had been reviewed and the files reorganised so that all the relevant information about the person was in the same place. Other care plans (which had not been reviewed) were difficult to read as information was spread over several different files. The acting manager confirmed that all care plans would be reviewed within the next few weeks. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 12 The files we looked at gave detailed information about how staff should support the people in order to meet their individual needs in relation to health, personal care, communication, culture and social and leisure preferences. Care plans had been linked to a risk assessment so that the person could take responsible risks according to their individual needs. The majority of risk assessments we looked had been reviewed and clearly stated how to reduce hazards to protect people from potential harm. One exception was a moving and handling assessment which contained vague information about supporting a person when transferring from a wheelchair to a car. There was no specific detail to describe how to support the person, whose records identified they were at risk of falls. We did, however speak to two members of staff who work closely with this person. They were able to describe how to assist the person to safely make transfers, despite the lack of guidance in the risk assessment. We spoke to staff on duty in each of the three bungalows. They answered our questions about the people whose records we looked at and clearly know them well. People who live at Yorkminster Drive need assistance to manage their money. There are systems in place to record individuals’ income and expenditure, which are audited each week for their ongoing protection. We have not been advised of any financial errors and the records we looked at during this visit showed no anomalies. This indicates that financial systems are working for the ongoing protection of people who live at the home. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, 17 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited opportunities for people to go out and do things they enjoy as there are not enough staff on duty to support people to do so. People enjoy their meals, however people’s food intake is not recorded consistently so that it is evident they are receiving a nutritious and balanced diet. EVIDENCE: We were advised that people’s attendance at local authority day centres had been reduced and would cease as CareTech were taking over the arrangements to offer activities to people during the day. We were told that Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 14 this had been planned for by senior staff from CareTech in conjunction with staff from the day centre. Previously people had spent up to five days a week at their day centre. Some people had attended for many years and had formed friendships with other people that use it and work there. We were told that there would be opportunities for people to meet their friends as part of their regular routines. We looked at staff rotas and activity records to make sure that people had opportunities to do things they enjoy with the support of staff on a regular basis. On the day that we visited (a Saturday) only two people out of the twelve who live at the home were able to go out. This was because there were not enough staff on duty to give everyone the chance to do so. We were told that each bungalow is allocated a set number of staff each day, which had been agreed some years ago in accordance with the total of contracted care hours identified as sufficient at the time. Eleven of the twelve people at Yorkminster Drive use wheelchairs either at home or out in the community and some people require the support of more than one member of staff when they go out. At our visit there were two staff on duty in bungalows 1 and 3, with three staff in bungalow 5. This clearly did not meet the needs of people who live in the home. Staff did try hard to provide an activity but this meant everyone had to go to bungalow 1 to take part in it. One person made it very clear they did not wish to join in so the manager had to intervene to find staff to take them back to their own bungalow. For the rest of our visit we saw people sitting in the lounge with the television on, although some did receive visitors. One person told us that they were bored and another said there was nothing to do. We looked at three people’s daily records to see how activities had been planned for as a result of CareTech taking responsibility for providing a day service to people. A two week period was looked at. One person’s records showed that he had been out twice in fourteen days and there was no other information to describe whether activities had been offered within the home. Another person’s records had not been fully completed so it was difficult to establish what they had been doing during the day. It was evident that the withdrawal of the day centre service has impacted on people’s quality of life with regard to their social and leisure opportunities. We Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 15 wrote to CareTech’s Operations Manager to tell her about our concerns and promptly received a response to confirm that additional staffing would be provided with immediate effect. This should make a difference to peoples’ lifestyles, however it remains of concern that action had not been taken to address this situation prior to our visit. We spoke to several relatives who all commented on the lack of staff as an area of concern and worry to them. They did tell us that there were no problems with them visiting and could do so when they wanted to. The care plans we looked at clearly described how people should be supported to keep in touch with their relatives such as making and receiving telephone calls and sending cards and presents on special occasions. Menus and records of food eaten by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples’ needs and preferences. In two of the food records, people’s meals had not been consistently recorded. There were many gaps where it appeared that they had not eaten on several occasions each day. This was of particular concern for one person who was felt to be losing weight. The manager did say that she felt this may be due to omissions in recording; however without consistent record keeping it is difficult to establish that someone is eating regular meals and is well. Otherwise, menus showed that people have a choice of meal each day which they help to choose. People told us that they liked the food, one person said, “It’s very good”. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to meet individual’s personal care needs and manage medicines safely for people’s ongoing well being and protection. The home is not providing sufficient staff training or keeping accurate records to ensure that people’s health care needs are consistently met. EVIDENCE: We looked at personal and health care plans for three people. There was some comprehensive information to describe how people should be supported in these areas so that their needs would be met. We met all of the people who live in the home, who had clearly been assisted with personal care during our visit. Everyone was well dressed and wearing clothes suitable for the time of year. Women were wearing nail varnish and make up, which they said they liked. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 17 The home has adapted bathing facilities so that people can bathe and shower safely. We saw that care plans described how people should be helped to bathe and shower and that morning and evening routines had been recorded. The staff we spoke to showed awareness of people’s needs and preferences. The home has implemented a system of health action planning. A health action plan describes what a person needs to do to stay healthy and the services they should access to do so. The information in the health action plans sampled varied depending on whether the person’s records had been reviewed. Those that had contained accurate and up to date information about people’s health, those that had not were incomplete and vague. For example, one plan stated the need for a person to have chiropody every six to eight weeks and to be weighed on a regular basis. There was no record of any chiropody for 2009 and an entry in the plan stated that weight could not be measured as the home does not have the correct equipment to do so. Another plan had been left blank and contained no information about how to manage the person’s health care needs. People have a range of health care needs. We saw that some, but not all staff had received training in epilepsy awareness, moving and handling and dementia care. Staff have not had training in tissue viability despite their being incidents of pressure wounds in the home. This could lead to people’s needs not being met and place them at risk of poor health. We looked at the management of medicines to make sure that a robust system was in place for people’s ongoing protection. Each bungalow has a secure cabinet so that medicines can be stored safely. Medication is received into the home using the monitored dosage system in blister packs. The Medication Administration records (MAR) cross-referenced with the blister packs sampled indicating that medication had been given as prescribed. There were protocols in place which described the circumstances under which people should be offered medication they take on an “as required” basis. The staff that we spoke to were able to explain the content which suggests that protocols had been read and understood. MARs contained information about the way people prefer to take their medicines and we saw this being respected when staff gave out medication. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 18 The home has reported two errors in dispensing medicines since our last visit. Both had been investigated and action taken to reduce the risk of this happening again. From looking at records and talking to staff it was evident that accredited training had been provided in the safe handling of medicines. Two staff members confirmed that only trained workers administer medicines, which should contribute toward a safer system of management for people’s ongoing protection. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to listen to and respond to complaints made about the service and to safeguard vulnerable people from harm. EVIDENCE: The home has received eleven complaints since our last visit, of which nine were upheld and two continue to be investigated. We were told that the majority of complaints related to concerns about staffing and the effect that inadequate staffing levels have upon people’s quality of life. The Annual Quality Assurance Assessment identified that 95 of complaints had been resolved within 28 days of receipt. This means that people receive a prompt response to their concerns. After discussion with the manager it was evident that she is taking the investigation of complaints seriously and has made a number of changes in response to complaints received. One area of change is that the manager and deputy manager now work over the weekend so that they have a better overview of the difficulties that inadequate staffing levels create. The manager told us that she and CareTech managers were due to meet with Solihull Care Trust commissioners to discuss how to move forward with planning staffing levels that meet the needs of people who live in the home. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 20 Some people who live at Yorkminster Drive have complex communication needs and are dependent on their families to raise concerns and complaints on their behalf. It was evident from looking at records that families are aware of the procedure for making complaints and are confident in doing so. There have been two safeguarding referrals made to the Care Trust since our last visit. At the time of writing this report both were being investigated by the lead agency for safeguarding vulnerable people (Solihull Care Trust). The home has kept us fully informed of the action taken to protect people whilst these investigations take place and have clearly followed their own safeguarding procedures. Some people demonstrate behaviour that means staff must work with them in a particular way to help them stay safe and well. We were shown guidelines, which had been recently reviewed by psychology services to explain how staff should support people with these needs. We observed staff following the guidelines several times during this visit, which indicated that the team had read and understood the importance of their role in helping people to stay safe and well. Staff training records showed that the majority had received training in safeguarding vulnerable people. The staff we spoke to recognised the importance of this training to help them respond effectively to suspicion or allegations of abuse. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home, which is fitted with equipment that meets their needs and helps them maintain their independence. EVIDENCE: Yorkminster Drive consists of three bungalows that have separate entrances and rear doors, linked by the gardens at the back of each property. The home is located near to Chelmsley Wood shopping centre, places of worship and public transport routes. The location is important to people who live there as the majority have lived in Chelmsley Wood for many years and have friends and family close by. We looked around the bungalows and were invited to see the bedrooms of the people whose records we had looked at. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 22 All bedrooms were clean, warm, well furnished and decorated. People had clearly been supported to personalise their rooms to reflect their individual tastes. Each bungalow has a lounge which leads on to the kitchen, shared bathrooms and a separate toilet. Dining space is provided in the kitchens. There are adapted bathing facilities, ceiling hoists and ramps which, at present enable people to bathe and move around safely. The group of people currently living at the home have done so for many years and it was evident from our visit that their needs are changing. It is likely that further aids and adaptations may be required to ensure people live in an environment that meets their needs and promotes their independence. There are separate laundry rooms, which were clean and tidy. There was no evidence of a build up of laundry, which indicates that washing is done promptly. We saw that substances, such as cleaning products that could cause harm to people had been locked safely away. We did tell the manager about two issues that need to be addressed. The sofa in bungalow 5 was uncomfortable; the seating cushions appeared to have shrunk which meant there were gaps between the cushions and sofa frame. The television in this bungalow was not working properly. The screen was blurred which made it difficult to watch. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always sufficient numbers of staff on duty to make sure that people’s needs are met and to promote meaningful lifestyles. The home operates a robust system of recruitment for the protection of the people who live there. EVIDENCE: This report has identified our concerns about the number of staff that are available on each shift as being insufficient to meet people’s needs. We looked at rotas for each of the bungalows which showed that a number of agency staff are used to cover shifts, although the manager has attempted to ensure those staff are regular to promote continuity of care. We spoke to five members of staff, some of whom had a shift pattern of twelve to fourteen hours on duty, with a break in the middle. The staff members said Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 24 that this was very tiring and compounded by being unable to take people out as there were too few staff on duty at each shift. The impact of insufficient staffing levels on people’s lifestyles was evident during our visit. People were not able to go out, there were few “in house” activities provided other than television, records had not been fully completed to demonstrate that people’s needs had been met and people told us they were bored. The staff we did speak to demonstrated good understanding of people’s individual needs and have formed positive relationships with them. One person said (of the staff team), “they are really, really nice”. Some people were not able to tell us what they thought, due to their complex communication needs, so we watched how they related to those on duty at various times during the day. People sought out staff and sat next to them, held their hands; people smiled when staff members spoke to them. This indicates that people were comfortable with the staff on duty. The Annual Quality Assurance Assessment stated that seven of the thirty staff employed have completed training at National Vocational Level (NVQ) 2. This is below the national minimum standard of 50 . NVQ training provides staff with essential core knowledge of social care which should contribute toward the deployment of a competent team of staff. Staff training records showed that there were some gaps in training opportunities. This report has identified that training specific to meeting people’s health care needs has not been provided to all staff. We were told that all staff recruitment records have been checked by head office and the main information is held centrally. Each staff member has an individual proforma, which states what is available in their records. The Performance Relationship Manager who is employed by us, checks these records every six months to ensure that the process of employment remains good. The most recent audit took place on 1st September 2008 and was found to be satisfactory. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home is improving however there are some elements of health and safety practice that do not fully protect the people who live there. Quality assurance systems are in place but not sufficiently developed to address issues that may have an impact on the lifestyles of people who live in the home. EVIDENCE: The home has an acting manager who is yet to register with the commission. The manager has been in post for nine months and was initially employed as a Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 26 deputy. This person has worked in social care services for a number of years and is working towards qualifications appropriate to her role. Yorkminster Drive has not had a registered manager for many years and it is strongly recommended that an application is submitted to the commission so that there are adequate arrangements in place for the day to day running of the home. Staff and visitors told us that the manager was doing a good job to try and improve outcomes for people who live in the home. We were told that the manager was a good leader, friendly and knowledgeable. Quality assurance systems are in place. A representative of the registered provider visits the home on a regular basis to report on the standard of care provided of which reports are made available to the home. The reports that we looked at had failed to identify some areas of service provision that had a negative impact on people living at Yorkminster Drive, such as staffing levels and the frequency of opportunity people have to go out and do things they enjoy. A number of checks are made by staff to make sure that peoples’ health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. Fire drills had been conducted on a regular basis to enable staff and people who live in the home to practice evacuation in the event of an emergency; each drill had been recorded. One issue was raised with regard to fire safety. Risk assessments were seen for some people with regard to moving them safely in the event that evacuation took place during the night, but not for all. In light of people’s changing mobility needs, this could lead to individual’s being placed at risk of potential harm and should to be addressed. This report has identified (in standards 31-36) that there are gaps in staff training. We saw that some staff had not received training in fire safety, health and safety and moving and handling. We have made requirements about this. There were certificates available to show that adapted bathing and moving and handling equipment had been serviced on a regular basis to make sure it remained safe to use. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 27 Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X 2 3 2 X X 2 X Version 5.2 Page 29 Yorkminster Drive DS0000070424.V375491.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA12 YA13 YA33 Regulation 18 Requirement Staffing levels must continue to be reviewed so that people receive the support they need to take part in social and leisure activities as part of their regular routines. People must be offered opportunities to take part in activities they enjoy as part of a meaningful lifestyle. Records of food eaten by people must be maintained to make sure that they are receiving a nutritious and balanced diet. People must have access to health care services which meet their assessed needs. Records of appointments and outcomes with health care professionals must be maintained to make sure that there is an up to date record of each person’s health. Staff must be provided with training to assist them to meet people’s health care needs. This will be dependent on the changing needs of people who live in the home. The television in bungalow 5 DS0000070424.V375491.R01.S.doc Timescale for action 07/07/09 2 YA14 16(2) 07/07/09 3 YA17 17(2) 07/07/09 4 5 YA19 YA19 13(1) 12(1) 07/07/09 07/07/09 6 YA19 18(1) 30/07/09 7 YA24 23(2) 07/07/09 Page 30 Yorkminster Drive Version 5.2 8 YA24 23(2) 9 YA35 18(1) must be repaired so that people have access to facilities that work properly. The sofa in bungalow 5 must be repaired or replaced to make sure that people have access to comfortable furniture that is not damaged. A review of staff training must take place so that staff are provided with the skills and knowledge they need to meet people’s needs effectively. 30/07/09 30/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA9 YA29 YA32 Good Practice Recommendations Moving and handling risk assessments should be reviewed to make sure they clearly state how to support each person according to their individual needs. Consideration should be given to reviewing the provision of aids and adaptations in each bungalow to make sure that they are suitable to meet people’s needs. The arrangements to provide NVQ training in care should be reviewed so that more staff have the opportunity to undertake it, for the ongoing benefit of people who live in the home. An application for the registration of a manager should be submitted to the commission so that there are adequate arrangements in place for the day to day running of the home. Quality assurance systems should be reviewed so that prompt action can be taken to address issues which have an impact on the lifestyles of people who live in the home. Individual fire safety risk assessments should be reviewed so that clear instruction is provided to ensure that people are not placed at risk of harm in the event that an evacuation takes place at night. 4 YA37 5 6 YA39 YA42 Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 31 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Yorkminster Drive DS0000070424.V375491.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!