Care Home: 12 Dormy Way

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What the care home does well People are supported to take part in a range of activities they enjoy and to keep in contact with family and friends.The home is well maintained and provides a clean and comfortable environment for people.Staff have received additional training in administering medications. They now ensure people are supported to take their medication at the right time.There are good systems to deal with complaints. This helps to ensure any concerns people have about what is happening in the home are addressed. What has improved since the last inspection? We did not ask the home to make any improvements following the last inspection. What the care home could do better: People`s care plans do not contain all the information staff need to be able to meet people`s needs.Better records of the checks on staff before they start work in the home need to be kept.Staff need to receive better training in the specific needs of people who live in the home. This will help to ensure staff know how to meet people`s needs.The manager and senior managers in Community Integrated Care need to ensure any problems in the home are put right quickly. Key inspection report Care homes for adults (18-65 years) Name: Address: 12 Dormy Way 12 Dormy Way Gosport Hampshire PO13 9RF one star adequate service The quality rating for this care home is: 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: Craig Willis Date: 2 0 1 1 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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 Information about the care home Name of care home: Address: 12 Dormy Way 12 Dormy Way Gosport Hampshire PO13 9RF 01329231737 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) : dormyw@c-i-c.co.uk www.c-i-c.co.uk Community Integrated Care care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection A bit about the care home 12 Dormy Way is registered to provide care and accommodation for up to four adults who have a learning disability. Community Integrated Care manages the service and is the registered person in respect of the home. 12 Dormy Way is located on the outskirts of Gosport. It is a detached property in keeping with others in the area. All of the bedrooms are single. Residents share the use of kitchen dining and lounge areas. There are two bathrooms, one upstairs and one on the ground floor. The property has a large enclosed rear garden. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 20 November 2009. During the visit we observed how staff were listening to people and responding to them. We spoke with the person managing the home, two staff on duty and two senior managers from the provider organisation. We viewed the communal areas of the home and viewed documents relating to the running of the service. At the time of the visit the home had an acting manager as the manager was not available. What the care home does well People are supported to take part in a range of activities they enjoy and to keep in contact with family and friends. The home is well maintained and provides a clean and comfortable environment for people. Staff have received additional training in administering medications. They now ensure people are supported to take their medication at the right time. There are good systems to deal with complaints. This helps to ensure any concerns people have about what is happening in the home are addressed. What has got better from the last inspection We did not ask the home to make any improvements following the last inspection. What the care home could do better Peoples care plans do not contain all the information staff need to be able to meet peoples needs. Better records of the checks on staff before they start work in the home need to be kept. Staff need to receive better training in the specific needs of people who live in the home. This will help to ensure staff know how to meet peoples needs. The manager and senior managers in Community Integrated Care need to ensure any problems in the home are put right quickly. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Craig Willis CQC – South East Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. There are good systems to assess peoples needs before they move into the home. This helps to assure people that the home will be able to meet their needs. Evidence: The manager reported in the annual quality assurance assessment that no one has moved into the home in the last year. Community Integrated Care has procedures in place for the referral and admission of new people into the home, although these were not inspected during the visit. The home has provided information about the service in pictorial and audio format to make it more accessible for people. The person managing the home at the time of the visit reported that this information was currently being reviewed and updated. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes systems to develop and review support plans and risk assessments are not always followed and some plans are out of date. This means staff do not get accurate, up to date information about peoples needs. Evidence: We looked at the records of two people who live in the home. Both people had a care and support plan that set out how their needs should be met. The plan included support required in relation to communication, personal care, mobility and health. The plans we looked at had been reviewed in February 2009. Both of the people whose records we looked at had a person centred plan that set out their wants and aspirations and covered how people should be supported to make decisions. The plan for one person had not been reviewed since September 2007. The care management assessment for one person stated that there was a risk of pressure sores due to their immobility. This person did have a risk assessment about pressure sores but there was no care plan in place setting out the support the person needed to manage pressure areas. Both people had a set of risk assessments, which identified the hazards people face and contained actions necessary to manage the risk of harm. One assessment we looked at concerned bed rails and the risk of the person becoming trapped in them. The assessment stated that the rails must be checked weekly. There was no record of these checks being completed and the person managing the home at the time of the visit reported that these checks did not happen. The moving and handling assessment for one person stated that it should be reviewed every six months. The assessment had not been reviewed since November 2008. The person managing the home at the time of the visit reported that she was aware of Evidence: the need to update all the care plans and risk assessments. Staff spoken with during the visit said there was some good information in the care plans and risk assessments, but some information was out of date and they needed to be reviewed. 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 take part in a range of activities they enjoy, to keep in contact with family and friends and to maintain a healthy diet based on their likes and dislikes. Evidence: The manager reported in the annual quality assurance assessment that people are supported to experience new activities and that they gather information from people about their likes and dislikes. People are supported to attend a local day service and the files seen contained details of meetings with day service staff to assess the activities provided and whether any changes were necessary. Staff spoken with reported that there were no longer individual activity plans for people as they had been removed by the manager. Staff said activities were planned with people based on their likes and dislikes. One staff member said it was sometimes difficult to support people to get out because of a lack of drivers, although people were always supported to get out each day if they wanted to. The person managing the home at the time of the visit said she was in the process of reintroducing the activity plans to ensure support for people to take part in activities is planned more effectively. People are supported to keep in contact with family and friends and visitors are made welcome in the home. Staff keep a record of regular contact with family members to keep them informed of what is happening. The home has a menu that is planned each week and takes into account peoples likes and dislikes. The menu is not currently displayed in a format that is accessible for people who live at the home. The person managing the home at the time of the visit said she Evidence: planned to produce the menu in a pictorial format. 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. The home has taken action to ensure errors in the system for recording and administering medication are addressed. The systems for meeting peoples personal care and health care needs are now working effectively, although controlled drugs are not being safely stored. Evidence: The care and support plans we inspected contained details of the support people need to meet their personal care needs. The plans contained information about how people communicate their needs and preferences regarding personal care. Staff spoken with said they had a good understanding of how to meet peoples personal care needs. As reported in the individual needs and choices section of this report, work is required to ensure all the plans are up to date. The personal records we inspected contained details of the health appointments people have been supported to attend. These record the reason for the appointment and any advice from the practitioner. The person managing the home at the time of the visit discovered an error in the levels of medication one person was taking due to a mix up in communication between the home, the psychiatrist and the GP. Action was taken for an out of hours GP to assess the person and decide on the levels of the medication that should be taken. This was followed up with an appointment with the psychiatrist. Details of how the error occurred are currently being investigated by the home after being reported to adult services under the safeguarding procedures. We received two notification reports from the home in August 2009 reporting incidents in which staff failed to administer medication that people had been prescribed. Following these incidents staff have received additional training and the person managing the home at the time of the visit has introduced a daily check of medication by the home staff. In addition to this check, senior staff from the organisation are coming into the home each Evidence: day to check the medication. The medication administration records for the current month were inspected during the visit. Most had been fully completed, with staff signing to say what medication they had supported people to take. One of the records had a gap where a staff member had not signed to say they had administered the medication. This incident has been addressed with the staff member concerned and it was reported by the person managing the home at the time of the visit that the person did receive the medication they had been prescribed. Medication is stored in a locked cabinet and records are kept of medication received into the home and disposed of. One person is currently prescribed a controlled drug. This was recorded in a controlled drug register and the balance recorded matched the medication held in the home. The medication was not stored in an approved controlled drug cabinet as is required but in a lockable money tin stored in the main medication cabinet. One of the senior managers visiting the home during the visit acknowledged that a controlled drugs cabinet was required. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems to deal with complaints and respond to allegations of abuse. This helps to ensure people who live in the home are protected. Evidence: The home has a complaints procedure that is provided to people who live in the home in pictorial and audio form to help their understanding of it. The manager reported in the annual quality assurance assessment that no complaints had been received in the last year. This was confirmed by the person managing the home at the time of the visit. The procedures set out who will respond to a complaint and the time-scales for responses. An electronic log is maintained of complaints, which can be accessed by senior managers within CIC. CIC has procedures for keeping people safe from abuse and copies were available in the office at the time of the visit. Two staff members were spoken with during the visit. Both demonstrated a good understanding of abuse issues and action to take if abuse is witnessed, reported or suspected. 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. The home is well maintained and provides a clean and comfortable environment for people. Evidence: All the shared areas of the home were seen during the visit. Each person has their own bedroom and shares the lounge, dining room, kitchen, bathroom and garden. There is a separate laundry room. All areas seen during the visit were clean. Staff reported that urgent maintenance issues are dealt with quickly, although there has been a problem with more routine maintenance issues due to staff absence. The person managing the service at the time of the visit reported that she was arranging for maintenance staff from another area to complete the outstanding work. Communal areas of the home have been re-decorated in the last year and there are plans to re-decorate bedrooms. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for managing staff recruitment are not effective and staff do not receive all of the training that they need to do their job. This increases the risk that peoples needs will not be met. Evidence: The manager reported in the annual quality assurance assessment some staff have achieved the NVQ level 2 or 3 and some are working towards it, with the intention of having 80 of staff with the qualification over the next year. The person managing the home at the time of the visit reported that she had arranged a meeting with their training department to assess what training was necessary. It was reported that this was necessary as the training records had not been kept up to date so it was difficult to work out which staff had completed which courses. Through the initial work of the person managing the home at the time of the visit it appeared that all staff had completed training in crisis prevention and intervention, fire training, moving and handling and first aid, although two staff were identified as needing refresher first aid training. All staff administering medication have completed training. Despite identified need amongst people who live in the home it appeared that only two staff had completed the autism and epilepsy training and only one staff member had done the communication training. The manager reported in the annual quality assurance assessment that everyone who has worked in the home over the last year has had satisfactory pre-employment checks. During the visit we inspected the records of two staff recruited in the last year. One of the records contained details of all of the checks required, including two written references and a Criminal Records Bureau disclosure. The other staff file inspected did not contain details of any references obtained in respect of them. The person managing the home at the time of the visit contacted their head office during the visit, who confirmed that references had been obtained for the staff member and sent them through for the homes files. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements of the home have not ensured the service has been effectively managed. This has resulted in shortfalls in the service being identified but not improved. Evidence: The home does not currently have a registered manager. The person who was managing the home left in May 2009 and was replaced by a manager from a different CIC service. The person who came in completed the annual quality assurance assessment, but is currently on a period of extended absence from the home. An acting manager has been appointed from within the team to cover the period of absence. Staff spoken with said they felt well supported by the acting manager. CIC have kept us informed of the changes in management arrangements for the service. The provider has a quality assurance system in place, with visits to the home by senior managers and audits of the service. The most recent reports of visits to the home by the senior manager highlighted the shortfalls that are also identified in this report. We inspected a sample of servicing and maintenance records. These demonstrated that equipment in the home had been serviced within the required time-scales. Other health and safety records had not been completed or reviewed as often as they should have been. A hazard risk assessment for the home was last completed in October 2008. The assessment states it should be reviewed annually, although this has not yet happened. The fire risk assessment for the home was last completed in August 2008. The plan was not updated to state whether the listed actions have been completed and has not been formally reviewed. These shortfalls were also identified on the report of visits to the home by senior managers. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description Timescale for action 1 6 15 The registered person must 31/01/2010 ensure peoples care plans set out how all their assessed needs should be met. This will help to ensure staff have accurate information about how to meet peoples needs. 2 9 13 The registered person must ensure action is taken to manage any identified risks that people face. 31/01/2010 This will help to ensure people receive support to stay safe. 3 20 13 The registered person must ensure that controlled drugs are stored in an approved controlled drugs cabinet. 31/01/2010 This will help to ensure that controlled drugs are safely 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 Description Timescale for action stored. 4 34 17 The registered person must ensure that details of the references obtained in respect of staff are held in the home. 31/01/2010 This will helps to ensure that staff are thoroughly checked before they start working in the home. 5 35 18 The registered person must 28/02/2010 ensure staff receive training relevant to the needs of people who live in the home. This will help to ensure that staff have the skills and knowledge to meet peoples assessed needs. 6 39 24 The registered person must ensure action is taken to rectify deficiencies in the service identified as part of the quality assurance system. 31/01/2010 This will help to ensure that the quality of the service provided is improved. 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 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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