Care Home: 12-13 Exbury Place

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What the care home does well There is written information to tell any new person about the service before they move in. People are well settled and say they are happy living at the home. People live in an adapted house that is attractive, clean and homely. They have an accessible garden. People receive support from a committed staff team. They are helped to keep in touch with their families and friends. People like the food and have a choice over what they buy and eat. People like the staff who support them and they all have a keyworker. Proper checks are carried out on new staff to help protect people. New staff are helped to learn their job and half the staff team are qualified. What has improved since the last inspection? Staffing has been changed to offer people more regular outings. People are being supported more safely with their mobility needs. People`s care plans now better explain how their complex needs are met and how they are helped to stay safe and well. Training has been arranged to help staff better meet people`s health needs and ensure their safety. The fire safety arrangements have been reviewed and staff are clear what to do if there is a fire. Mr Deakin is visiting the house more often and the owners have said they will carry out better checks on the service standards. What the care home could do better: People could be better helped to plan towards personal goals and ambitions with their supporters. Information about people`s care plans and review meetings could be made more accessible to them. The disruption caused some evenings by staff leaving to work elsewhere should stop. Staff need training in some areas to help them to their job well.The house could be changed to give more dining space. Key inspection report Care homes for adults (18-65 years) Name: Address: 12-13 Exbury Place 12-13 Exbury Place St Peter The Great Worcester WR5 3TP     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: Jean Littler     Date: 1 0 0 7 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: 12-13 Exbury Place 12-13 Exbury Place St Peter The Great Worcester WR5 3TP 01905611147 01905612958 andrew.deakin@scope.org.uk www.scope.org.uk SCOPE care home 4 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 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 4 Date of last inspection Brief description of the care home The service provider is SCOPE, which is a national organisation and registered charity providing a range of services for people with cerebral palsy and other physical disabilities. Exbury Place was first opened as a care home in 1993 and is part of a local community project called First Key Worcestershire. The First Key office is at Unit 3, Lowesmoor Wharf, Lowesmoor, Worcester, WR1 2RS (tel no. 01905 611147) and the registered manager (Mr Andrew Deakin) is based there. Exbury Place provides accommodation with personal care for four adults who have cerebral palsy, or a similar physical disability, and may also have an associated learning disability. Information about the home is provided in a statement of purpose Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 4 2 7 0 1 2 0 0 9 Brief description of the care home and a service users guide that are available from the home and the SCOPE office. The current fee for the service ranges from fifty-two and sixty-three thousand pounds each year. People have to pay for their own personal costs such as hairdressing, chiropody, personal telephone or internet use, shopping, travel, newspapers or magazines. Funding for activities and holidays is as agreed with each persons funding authorities. 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: We, the Commission, carried out this Key inspection over 6 hours. The last Key inspection was on 27th January 2009. The service was rated as providing poor outcomes for people. Prior to this the service was rated as providing good outcomes, so it had not been inspected for two years. We looked around the house and spoke with some people who live there. Some records were looked at such as care plans, medication and money. We spoke with two staff and three relatives who were visiting. The manager, Mr Deakin, sent us information about the service before the last inspection in the Annual Quality Assurance Assessment (AQAA). Care Homes for Adults (18-65 years) Page 6 of 34 We received surveys at the last inspection with the residents and other peoples views about the service. 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 could be better helped to plan towards personal goals and ambitions with their supporters. Information about peoples care plans and review meetings could be made more accessible to them. The disruption caused some evenings by staff leaving to work elsewhere should stop. Staff need training in some areas to help them to their job well. Care Homes for Adults (18-65 years) Page 8 of 34 The house could be changed to give more dining space. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has information to help people decide if they might like to live there and if the service could meet their needs. Procedures indicate that people would have their needs assessed and be given the chance to try out the service. Evidence: SCOPE provides appropriate information documents for the home, including a statement of purpose and a service users guide. A copy of the guide is on display in the home and this has been kept under review. There has not been any changes in the resident group for some years. Should a vacancy occur there is written guidance on the assessment of a prospective new persons care needs, with a placement procedure flow chart and a care profile tool. People reported in the surveys received for the inspection in January 09 that they were given enough information about the home and had a trial period when they moved in. Care Homes for Adults (18-65 years) Page 11 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. People receive good daily support from staff they like. Details of how their complex needs will be met are now better reflected in their care plans, although some gaps remain. People are being enabled to make some decisions in their daily lives, however, this can be improved. A more proactive Person Centred Planning would help further develop peoples opportunities. Evidence: Three peoples care records were seen. These included a pen picture that describes the person and information such as their preferred daily routine. These had been reviewed recently. The information is worded respectfully and is person centred in terms of showing that each individual has specific needs and wishes. The care plan format has been changed since the last inspection. The information recorded describes more clearly how peoples specific needs will be met. Complex areas of care were covered in more detail. People have been consulted about their support and their wishes included. People may be better enabled to understand their Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: care plan if a more accessible format were used. Mr Deakin reported that senior staff will look into what is available and consult residents about this. Staff said they had attended This is Your Life training, about person centred planning, and they are helping people develop Life Books. These are a visual record of peoples achievements and special memories that they can take with them if they leave. Staff record a daily diary for each person and significant events, such as health care checks, family contact and activities participated in. These provide helpful information about their life and wellbeing. Mr Deakin reported that Keyworkers will be expected to use their allocated Keyworker time to complete monthly summaries of this information that will then inform the review process. Consideration should be given to developing separate incident forms that can be signed off by Mr Deakin on his weekly visits, to demonstrate that he is aware of significant incidents for residents. Currently incidents such as people becoming angry and being given additional medication are recorded along with other information such as health reports. The files showed that some people have had a review meeting since the last inspection. Until recently reports were only completed for annual review meetings. Mr Deakin said six monthly reviews were held but that no record was made of these. He has committed to formalising these meetings. This is positive, as person centred planning should be active and meeting minutes should demonstrate that peoples wishes are being listened to and actioned in agreed timeframes. Consideration should also be given to providing review information in a more accessible format to better involve the resident concerned. Health Action Plans, HAP, have been developed in the last year. Not all have been dated to show when there were originally completed. The risk assessments in care plans have been reviewed. Hazards covered included going out, road skills, being left alone in the home and holding keys. Details of peoples moving and handling needs are now clearer and staff confirmed they had been retrained in line with the new guidance. The care plans now contain more information on pressure care, although some referred to a pressure care risk assessment that was not found. Bedrail risk assessments were included that covered the suitability of the rails for the type of bed. The assessments would be improved if they showed that the person concerned and their chosen representatives have been made aware of the risks associated with entrapment in bed rails and other options have been discussed. This part of the risk assessment had been left blank. More information about risk assessments is covered under the Health section of this report. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Mr Deakin reported that people would be supported to review personal goals with the team coordinator and the staff. In line with Person Centred Planning principles this should be done regularly with representatives of the persons choice. People said they are being supported to make choices in their lives. Staff were observed to ask people for their choices during lunch and conversations about the days activities. Two people are able to express themselves articulately. It was clear staff have the skills to understand people when they communicated through methods such as body language. Discussions confirmed that peoples views are respected in regards to the activities they wish to take part in. People are being consulted about some decisions in the home, such as food purchasing. Mr Deakin is still requiring one of the two workers on weekday evenings to go and support a person living in the community with their care needs. For the majority of 2008 this has been happening against the wishes of people at Exbury Place. The after tea visits have been reduced from five to three times a week but the 9.30pm visits continue five nights a week. One resident said he does not like it happening particularly the early evening visit. Staff were not aware that Mr Deakin had consulted people about this recently or given any timeframe for the arrangements to change. When this was raised at the last inspection Mr Deakins line manager confirmed that the practice had started without consulting the residents, senior staff in the organisation or relevant external professionals and that it could have been managed in a more open way. 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. People are supported to pursue individualised activities of their choice and to mix within the community. Activity opportunities have been increased by changes made to the staffing arrangements. Personal development goals are being reviewed. People are supported to maintain contact with their families and they enjoy their meals. Evidence: There was a relaxed atmosphere in the home. Two people were enjoying the sun and taking a nap on the patio, one was in bed with a headache, the other was having a late breakfast after a lay in. She said she had been tired after being out the previous day. During the day people were seen to choose where to spend their time. One man put the television on and watched the test match with another resident. People have their bedrooms set up with their preferred pastimes and hobbies. A jigsaw puzzle was in the process of being completed in the lounge. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Most people need a high level of assistance with their personal care, so this takes up a significant part of their daily routines. The care plans seen contained activities plans. People have at least one regular activity they take part in such as music sessions at the Snoozelan, aromatherapy and hydrotherapy. As well as the planned sessions people also go shopping for personal items and food and have monthly one to one time with their Keyworker and choose what to do. Staff said that the hours the community enabler works to provide support with outings have been changed and the new arrangement is better for the residents. Three staff are also now being provided on an extra day to facilitate more outings. One person said he prefers to spend most of his time at home. Staff told us he has been offered new activities but may start them and then decline to go again. They hope after a pending operation he will have more energy and enthusiasm for activities. Another persons review meeting showed the funding authority felt the service should aim to further develop his social life. Staff told us that two people have been on holidays of their choice in the last year. People have contact with their families if they wish, and can telephone them. Keyworkers support them to visit their relatives if needed. One person said she likes to call her mother in the evenings. Another goes out with his family each week. There is a limit to how far people can take responsibility for the day-to-day running of the household, due to their disabilities. Staff cook and carry out most tasks, but try to involve people when they can. Mr Deakin reported that peoples goals are being reviewed with them and consideration will be given to how people are supported to develop. One person can communicate verbally and another uses a communication aid very effectively. The staff on duty for the next 24 hours is displayed to inform people in the home, but no other forms of accessible information were seen around the home to promote communication, understanding and involvement. People do reportedly join the first part of the team meetings. Mr Deakin told us that consideration is being given to the development of communication aids and that the involvement of a Speech and Language therapist would be requested. Regarding food provision each person has their own housekeeping money for food and household products. They choose to put this together and have joint meals. Staff support people to shop locally and then prepare the meals. People confirmed they liked the food and can choose what they want. They choose their own breakfast and snack meals and main meals are decided by all each day. Nobody requires a special Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: diet but some people have to monitor their weight and some are at risk of choking so food needs to be prepared in a certain way. At the last inspection a worker was assisting two people to eat at the same time, which is poor practice. Mr Deakin reported that this is being reviewed and people are being consulted about how they prefer to have their meals. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are having their personal and health care needs met appropriately. Some areas of care planning and staff training could be further improved. Evidence: People looked well presented and staff interacted with them in a friendly and appropriate manner. The care plans outline the assistance people need with their personal care and health needs. The plans do guide staff to promote independence where possible. There is a privacy policy in place to guide staff about good practice in this area. Two people confirmed that staff always come to assist when asked. A call bell system is in place and adaptations have been made so everyone can use this regardless of their physical abilities. Feedback from the district nurse team at the last inspection indicated that staff always respect peoples privacy, dignity and diversity. The nurse manager said, People always look cared for and appear happy. The service usually seeks and acts upon advice given to meet peoples health needs. Following the concerns raised at the last inspection about the moving and handling arrangements being unsafe a review was carried out. The owners reported that staff had been manually lifting two people, contrary to the guidance in their care plans. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: They confirmed in writing that systems had been changed and were now satisfactory. Staff confirmed that arrangements had now been improved and that they were working in line with the guidance. Some feedback indicated that one person may not be very comfortable when using the mobile hoist. As there has been mixed views across the staff team about the best arrangements for transferring people it would be a positive step if Mr Deakin were to arrange for an Occupational Therapist (OT) to independently assess peoples needs. An OT has recently been to reassess the shower chairs used by some people as those provided were not suitable. One person has also had adjustments to his wheelchair following a health condition developing from poor positioning. Records continue to show that people are being supported to have routine health checks such as the dentist, optician and chiropodist. Each person now has a health action plan and is having annual health checks. Mr Deakin has agreed to ensure that people are offered the same preventative health checks that can be requested by any member of the public, such as cholesterol checks. Records are being made after appointments and specialists are involved to meet specific health needs. Following the last inspection Mr Deakin reported that peoples needs will be a standing item on the staff meeting agenda to help ensure that all staff are well informed of peoples needs and are working consistently. Staff training has been arranged for epilepsy and the management of a gastric feed. Staff should also be provided with pressure care awareness and accredited medication training. Information about the risk posed to people from choking was seen in the care plans. Staff reported that choking was covered in their First Aid training but that the difficulties in assisting a person who is a wheelchair user were not covered in depth. They felt there was more focus on trying to stop it happening in the first place with careful food preparation. It would be beneficial if a risk assessment gave clear guidance to staff if an emergency happened. Once the staff team have attended the epilepsy training this should enable them to develop the care plans with up to date information. Plans should describe how the individual is affected and how risks associated with the condition are being managed. Regarding medication SCOPE provides general policies and procedures for the management of medicines in all their care services and there are also specific procedures for Exbury Place. The medicines are safely stored in locked drawers in peoples bedrooms and records are being maintained appropriately. A new company is now supplying the medicines and they have made an agreement to provide storage Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: cabinets in the bedrooms. They have provided training to staff on their Monitored Dose System. Each person has a written medication profile with a list of their prescribed medicines and information about their use and possible side effects. Guidance is now included in the care plans about when staff should administer medication prescribed on an as needed basis. This should be expanded to reflect the doctors instructions about when any subsequent doses can be given and at what point the GP should be contacted. Records indicated that in the past senior staff on call have advised carers that doses be given over several days without the GP being contacted. The team co-ordinator had made the assumption that four doses a day could be given, as there were four time slots marked on the administration chart, but there was no doctors letter or protocol to support this. 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. There are systems in place to support people and their representatives to raise concerns, but people cannot be confident that these will be effective. Staff are not attending regular refresher training about safeguarding vulnerable people. Evidence: SCOPE provides a formal complaints procedure and employs a Complaints Resolution Manager to investigate complaints about its care services. There is a complaints procedure for people in the home and a DVD explaining the procedure. Since the last inspection no complaints or vulnerable adults concerns have been raised with the Commission. People said in the surveys received for the last inspection that they know who to raise concerns to and would feel able to talk to staff or their family. Staff said in their surveys they would report any concerns or complaints and record them. A worker reported that people are offered access to advocacy services but only one man uses this. SCOPE provide staff training on responding to complaints. At the last inspection it was noted that no record had been made of the residents unhappiness about staff going to work at another service during their evening shifts. The providers reported that Mr Deakin will ensure all concerns are recorded in the homes complaints log. As reported staff are still working at the other service despite residents not liking this and they have not been given a timeframe for things to change. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: Mr Deakin reported in the AQAA in January 09 that there is a new adult protection policy and a whistleblowing policy. All new staff are trained in both safeguarding and whistle blowing as part of the induction programme. The team coordinator said he has not attended a refresher course on safeguarding since 2003. We were not able to establish how many other staff needed a refresher course due to the way the records were kept. The team co-ordinator agreed to collate this information after the inspection but it was not received by us. People have their own cash tins to keep their personal allowance in and savings accounts. One persons records were seen and these showed that systems are in place to help protect them from financial abuse. Balances are checked at handovers and audited monthly. Receipts are also kept when anything is bought for them. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an ordinary, clean and comfortable home within the community that has been suitably adapted. Evidence: The property is owned by a social landlord who leases it to SCOPE. It is an ordinary bungalow, which therefore is compatible with other housing around it. The home is a bungalow on a large modern housing estate, which is a couple of miles from Worcester city centre and close to Junction 7 of the M5 motorway. There are local shops, public houses, a superstore with a cafe and other amenities nearby. The home provides two suitably adapted vehicles to facilitate access in the wider community. One man has his own car which his family keep and use with him. The bungalow was especially adapted for people with physical disabilities so all internal areas are accessible to wheelchair users. People have single bedrooms that have been nicely personalised and set up for hobbies with equipment such as televisions, music and internet connections. None of the bedrooms have ensuite facilities. The size of some bedrooms helps with accessibility and independence. There is a reasonably sized sitting room, kitchen-dining area, shower room and assisted bathroom for all to use. There is also a utility room and staff sleep-in room Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: that doubles as the office. The kitchen has low level surfaces to make it easier for people in wheelchairs to use. The layout means the dining table has to be against a wall and there is not enough room for all four people to fit comfortably around it with the staff who support them during meals. Staff reported at the last inspection that they were hoping a conservatory will be added to improve this arrangement. The general impression of the home is homely, clean and comfortable. The garden can be accessed through patio doors off the lounge. Mr Deakin reported in the AQAA In January 09 that the garden has been made more accessible and the new patio doors also help access. The lounge and kitchen have been redecorated and new kitchen worktops, a cooker, hob and extractor fan have been provided. The team coordinator said the landlords are responsible for major repairs. One mans parents, who visit regularly, have redecorated most of the home and carry out minor repairs on an as needed basis. His grandparents come to tend the garden regularly, which they said they enjoy. Care staff receive training and there are policies and procedures relating to infection control within the home. They are responsible for all domestic duties. A nurse, spoken with at the last inspection, said the house is always clean and smells fresh when she visits. The service was rated as 4 Star at the last Environmental Health inspection. The Safer Food Better Business kitchen audits are used to help maintain standards and these were up to date. A generic food risk assessment was seen at the last inspection and it had been kept under review. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported by a small staff team who they like and who know them well. They are not happy that staff are still leaving their shifts to work at another service. Staffing arrangements have been improved to better enable outings. Staff are provided with relevant training but some gaps need to be addressed. The homes recruitment procedures help to protect people from abuse. Evidence: A team co-ordinator was appointed from another SCOPE service early in 2008 after a national management restructure. He is responsible for the day to day running of the home and is accountable to Mr Deakin, who is office based. The AQAA showed in January 09 that as well as the previous senior, two other staff have left in the last year. At this time there was a full staff team of eight. The team co-ordinator reported that there have not been any new staff start since the last inspection. Of the team of eight only two staff are men. The team could be better balanced as three people in the home are men. People living in the home all said they liked the staff and they treat them well. The relatives spoken with were also positive. One mans father said he was confident that whoever he passed information to would share it appropriately with others so he never felt the need to speak specifically to Mr Deakin or the team co-ordinator. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: The homes rota for the month was seen. A separate one is now being kept in-house to show which staff are supporting the other local care service. These would be more useful records if they indicated the actual hours staff are working in both settings rather than just their shift pattern. The hours the community enabler works should also be included on the homes rota. There are usually two workers on duty and one sleeps in at night. Because of peoples needs the staffing arrangements mean that spontaneous outings are difficult. However, since the last inspection the number of day shifts when a third carer or the activities worker is on duty has been increased to help enable more outings. In respect of staff recruitment Mr Deakin reported in the AQAA that SCOPE policies are implemented robustly and that people in the home are invited to be on the interview panel. A worker spoken with confirmed that one of the residents had interviewed him. Files are stored at the office and have not been seen, however, staff feedback indicated that appropriate checks were carried out before they started work and that they had an appropriate induction. SCOPE requires staff to complete mandatory health and safety training. Other relevant courses are provided such as disability awareness, complaints, equality and diversity and person centred planning. Staff feedback indicated that a good level of training is provided and requests to attend additional courses or briefings are supported. Mr Deakin reported in the AQAA that he plans to provide all staff with infection control and pressure care training this year. As mentioned under the health section, courses on epilepsy and the management of a feeding tube have now been arranged. Along with the pressure care, an update on safeguarding vulnerable adults and an accredited medication course now need to be arranged. In the AQAA Mr Deakin reported that four staff hold an NVQ qualification and one is working towards this award. An NVQ assessor is working on the team and so is able to help people gain an award more quickly. Staff said Mr Deakin does not meet with them individually but they get support from the team co-ordinator who holds supervision sessions with them at least six times a year and carries out annual appraisals. A worker explained that training is touched upon in these meetings but that there is no career pathway to follow in the current staffing structure. Staff said there is good communication in the team, through daily reports, shift handovers and team meetings. The team co-ordinator and staff were not aware of Mr Deakins plans about their continued support of the other local service. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: This is an indicator that communication could be improved between staff in the home and the manager. Care Homes for Adults (18-65 years) Page 27 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 involvement and overview of the service have been increased and people are safer as a result. The level of involvement and monitoring needs to be maintained to demonstrate that the arrangements are effective in maintaining standards over time. Evidence: Mr Deakin, the registered manager, is suitably experienced and holds a NVQ level 4 in Care and the Registered Managers Award. The management arrangements for this service are unusual as he is based at the First Key office, not the home, and oversees the running of four services. After a restructure he is now supported by three team coordinators, one of whom is based in Exbury Place. The team coordinator is expected to now gain an NVQ 3. The senior team provide 24 hour on call support for the four services. Following the concerns raised at the last inspection that indicated a lack of management overview the providers reported that Mr Deakin will visit at least weekly and will attend monthly staff meetings. The visitors book showed that he had been Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: doing this and when there was a gap of two weeks the health and safety lead, who is based in another local home, had visited each week. Evidence in this report confirms that positive steps have been taken to address the shortfalls identified in care planning and staff training, although some gaps still need to be addressed. As mentioned, the staffing situation is yet to be resolved to the satisfaction of the residents and staff team. The providers should consider how their quality assurance systems can be further improved to ensure they pick up areas such as gaps in care plans and risk management and cross reference peoples care and health needs against staff training. Mr Deakin submitted the AQAA for the January inspection when requested and it contained relevant information. The providers took the concerns raised at the last inspection seriously and were open with the findings of their enquiries. They acknowledged that the way the service is monitored needs to be improved to ensure standards do not fall again. They reported that they plan to increase the amount of time given to discussions with residents and staff during the monthly visit carried out by other service managers. It was not possible to see if this had been actioned as the reports were not available in the home. The providers reported that new feedback surveys are being developed to help in the monitoring process. Mr Deakin reported in the AQAA that equipment has been appropriately serviced. Following the last inspection we wrote to the Fire Authority and an officer visited and made some recommendations. Staff confirmed that they had had refresher training about evacuation procedures and they are clear what to do if lone working during the day or at night. Care Homes for Adults (18-65 years) Page 29 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 30 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Develop a system for recording significant incidents that demonstrates that the registered manager is aware of and monitors these. Consider how peoples care plans and review reports can be made more accessible to them. Hold person centred planning review meetings at least six monthly and use these to make the planning process more active. The manager should demonstrate that residents are being fully engaged in discussions about staff working elsewhere during their shifts at the home and any plans to end this practice. Request that the district nurses to completed baseline pressure care risk assessments called, Waterlow assessments. Further develop the bedrail risk assessments to better demonstrate why the person needs rails and that they and their chosen representatives are fully aware of the risks associated with the use of rails and what other options Page 31 of 34 2 3 6 6 4 8 5 9 6 9 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 there are. 7 19 Following the training on epilepsy information about peoples specific type of seizures and potential triggers should be included in their care plans. Ensure staff are clear about how best to respond if a resident chokes whilst being seated in their wheelchair. This guidance should be included in the risk assessment. Arrange for peoples moving and handling needs to be assessed by an Occutational Therapist. Staff who administer medication should completed an accreditied safe handling of medication course. Guidance for staff about when to administer additional As Needed doses of medication should include clear time frames about when any secondary doses can be given in line with the doctors instructions so on call senior staff are not making these decisions. For people on presecribed medication the GP should be asked to provide written approval about the use of homely medications such as paracetamol. In line with the homes procedure, demonstrate in the complaints record how peoples views about staff working in another service have been listened and responded to. Provide staff with a refresher course in Safeguarding Vulnerable Adults. (This training is provided free by Worcester Council). Consider if addtional dining space can be provided. The rota should show the actual hours staff work and include all staff should be included e.g. the community enabler. End the practice of staff working at another care service during their shifts. Provide all staff with training on pressure care and adult protection. The Responsible Individual should ensure that systems to monitor the quality of services are robust and do not just rely on self or peer monitoring. 8 19 9 10 11 19 20 20 12 20 13 22 14 23 15 16 28 33 17 18 19 33 35 39 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 20 21 41 42 Copies of the providers monthly monitoring visit reports should be in the home and available for inspection. Implement the recommendations made by the fire officer following his recent inspection of the premises and service. 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. 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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