Care Home: 20 Windlesham Road

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What the care home does well The following statement taken from the service`s own yearly quality assurance inspection is an accurate reflection of what this service does well: "the team work with great unfailing commitment and positivity towards service users, some of whom have extremely complex and challenging needs". This inspection report highlights the challenges currently faced at 20 Windlesham Road and yet the Manager and staff team have worked tirelessly to support and protect residents through this difficult time and for this, they should be acknowledged. Each resident has their own bedroom which they have been supported to personalise and make their own. Residents have regulalrly go out and undertake activities which give them opportunities to be involved in the local community. The care plan for one person is very detailed and comprehensive and provides a lot of useful information about their needs, expectations and choices and such will prove to be invaluable in supporting them to identify a better way of having their needs met. What has improved since the last inspection? The management of the home is now stable, with Sarah France successfully completing the registration process during the course of this inspection. This has provided consistency of approach and a sense of leadership in what has been a very difficult period for the service. The standard of some documentation has improved and in particular the service can now demonstrate that people are supported by a team of staff who have been appropriately recruited. The frequency of staff meetings and one to one supervision sessions has also improved which enables staff to discuss and share their ideas and concerns. A number of environmental improvements have been made to help create a safer environment, although it is highlighted below that further work in this area is still required. What the care home could do better: The incompatibility of needs of the people living at 20 Windlesham Road has created an unacceptable situation whereby the individual needs, choices and aspirations of all four people are not being met. This report highlights that this situation has had a negative impact across all of the outcome areas and as such it is now time for appropriate action to be taken. People need to be supported to lead their lives as they choose and the service needs to be honest about whose needs can and cannot be met at 20 Windlesham Road. In essence, it is now time for the service to act on the information it has gathered from its own quality monitoring systems and seek to resolve the current issues in order tosustain good outcomes for all four of the people it currently accommodates. Environmentally the communal areas need to be upgraded to provide residents with a safe, clean and homely place to live. Staffing levels and training records need to be reviewed to ensure that there are sufficient numbers of qualified, experienced and permanent staff on duty at all times to enable people to live their lives according to their own individual plans of support. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Windlesham Road 20 Windlesham Road Brighton East Sussex BN1 3AG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lucy Green     Date: 2 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 37 Information about the care home Name of care home: Address: 20 Windlesham Road 20 Windlesham Road Brighton East Sussex BN1 3AG 01273294320 01273294318 sarah.france@brighton-hove.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brighton & Hove City Council Name of registered manager (if applicable) Miss Sarah France Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 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 Brief description of the care home 20 Windlesham Road is a semi detached property in a quiet, residential road in Brighton. It is possible to walk to the shops, and public transport systems are within close proximity. The service is for up to four adults with learning disabilities. Single bedroom accommodation is provided on the ground and first floor, two of which have ensuite facilities. There is one bathroom upstairs and toilets are located on both floors of the home. The home is domestic in scale and communal areas provide a lounge, conservatory and kitchen with a dining area. There is a garden to the rear of the property. More detailed information about the services provided at 20 Windlesham Care Homes for Adults (18-65 years) Page 4 of 37 care home 4 Over 65 0 4 Brief description of the care home Road can be found in the homes Statement of Purpose and Service User Guide copies of these documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at 20 Windlesham Road are referred to as residents. This report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment and an unannounced site visit which took place over two days and lasted a total of seven hours and forty five minutes. The first visit was carried out unannounced on Tuesday 7 April 2009 between 10:15am and 3:15pm. Due to the complex needs and anxiety levels of one of the residents, it was not possible on that day to spend any time Care Homes for Adults (18-65 years) Page 6 of 37 in the communal parts of the home and to meet properly with the other people living in the home. As such, a follow up visit was arranged and carried out on Monday 20 April 2009 between 10:30am and 1:15pm when the resident affected was not at home. The site visit included a tour of the premises and an examination of some care, medication and staffing records. The Inspector observed the interaction between staff and residents. Throughout the inspection process, the Inspector met and spoke with three of the four people living at the home. Time was also spent individually with the Manager and two support workers were interviewed in private. The Inspector also viewed the questionnaires sent out by the home as part of their own quality monitoring systems. What the care home does well: What has improved since the last inspection? What they could do better: The incompatibility of needs of the people living at 20 Windlesham Road has created an unacceptable situation whereby the individual needs, choices and aspirations of all four people are not being met. This report highlights that this situation has had a negative impact across all of the outcome areas and as such it is now time for appropriate action to be taken. People need to be supported to lead their lives as they choose and the service needs to be honest about whose needs can and cannot be met at 20 Windlesham Road. In essence, it is now time for the service to act on the information it has gathered from its own quality monitoring systems and seek to resolve the current issues in order to Care Homes for Adults (18-65 years) Page 8 of 37 sustain good outcomes for all four of the people it currently accommodates. Environmentally the communal areas need to be upgraded to provide residents with a safe, clean and homely place to live. Staffing levels and training records need to be reviewed to ensure that there are sufficient numbers of qualified, experienced and permanent staff on duty at all times to enable people to live their lives according to their own individual plans of support. 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 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 37 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 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The inability to fully meet the needs and aspirations of one person is having a negative impact on the quality of life for the other people living in the home. Evidence: Previous inspections have identified ongoing compatibility issues in respect of an individual who was admitted to 20 Windlesham in an emergency placement situation. The needs of this person are not compatible with the needs of the other three people living at the home. At previous inspections it has been required that the home undertake a formal review of the needs assessments of all the people living at 20 Windlesham Road. These reviews were completed and despite the outcome of the review for the person placed in an emergency stating the physical layout of the home is not suitable for [residents name] needs on 01 March 2006, this individual has continued to live at the home. In order to protect the dignity and confidentiality of the person concerned, this report will not provide specific details about the behaviours and challenges faced by the Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: service in their efforts to support this person safely. It is highlighted in documentation and through discussion with the Manager and staff and from observation of this person throughout the inspection, that this person is clearly indicating that that they do not want to live with other people. Furthermore, many of the issues that are presenting challenges to this group and which ultimately lead to restraint being used, are likely to be less of a problem, if this person were living in a one person service. As such under the principles of the Mental Capacity Act 2005, care is not being provided in the least restrictive way. A service user survey completed by this person in 2008 included the comment I would like to live on my own. Im happier when there are less people in the house. During the inspection, this individual was observed repeatedly saying they wind me up. The impact on the other three people living in the home with someone who doesnt wish to live with them, is distressing for them and as such the service is also failing to meet their needs and expectations. In a survey completed in April 2008, one of the other residents said that things that make them sad is stress and noise, they also went on to say that I am a person who likes a quiet and peaceful environment, unfortunately this is not something that 20 Windlesham Road can offer this person in the current situation. The Inspector was so concerned about the situation at the home and in particular, the length of time over which this has continued, that much of the inspection time was spent discussing how the service needs to support this person to live in a home that meets their needs and aspirations. As the first part of this process, the home has been required to make an urgent referral for a mental capacity assessment in respect of accommodation to be undertaken with this person. Depending on the outcome of this assessment, the service may also need to make a referral under the Deprivation of Liberty Safeguards. It is evident from this report that the effect of this ongoing situation cuts across all of the outcome areas. The Manager and staff team are working relentlessly to keep people safe and minimize the number of high level incidents, but other day to day things are being missed and as such this situation must now be resolved within the timescales provided in this report. Following the inspection, the Manager wrote to the Inspector and stated that she felt that the inspection report did not fully recognise all the work that has been undertaken to support the needs of the individual as highlighted at this inspection. As such, it was confirmed that a decision was made with the Care Manager and staff team in March 2009 for more suitable placement to be explored. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: It was noted that the licence agreements in care plans were not signed by either party. The Manager advised that a steering group for the Council were working on producing a standardised service user guide and licence agreement. In August 2008, the Inspector met with the Service Improvement Manager for the Council during an inspection of another one of the services run by the Council, she informed the Inspector at that time that the process of reviewing the terms and conditions and updating the resident information packs to ensure licence agreements, statement of purpose and service user guide are in accessible formats would be completed by December 2008. As it is now April 2009 and these documents are not yet in place at 20 Windlesham Road, the home is required to submit this information as part of its improvement plan. Care Homes for Adults (18-65 years) Page 13 of 37 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. Some people have detailed plans of care that include comprehensive guidelines about how to support them, others require greater collation of information. In all cases, outcomes would be improved if the documentation and knowledge about people were more strategically used to formulate life goals and develop person centred approaches. Evidence: Through discussion with the Manager, three members of staff and observation of their interaction with residents, it was highlighted that they have positive relationships with the people they support and a good level of understanding of their needs. For the reasons highlighted under the Choice of Home section, the home is not currently fully meeting the needs nor is it providing good outcomes for any of the people living at 20 Windlesham Road. That being said however, if it were not for the sheer dedication and patience of the staff team, outcomes would be poor. The care plan for the individual who presents challenges to the service is Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: comprehensive and evidences how consistent and robust support by staff has made their placement as safe as possible. Guidelines, particularly around daily support needs are detailed and clear. It was however, identified that many of the guidelines and the majority of staff time is spent managing and containing behaviours. Whilst incident records evidence a decline in high level incidents where serious injury is caused to others, the regularity of other incidents where staff intervention is necessary is happening many, many times each day. It was also highlighted both in the care plan, through discussion with staff and observation during the first day of inspection that often the way care is being delivered to this person is restrictive due to the needs and safety of all parties. As such, the guideline for mealtimes necessitates that the individual must eat in their bedroom unless staff can absolutely guarantee that no one else will interrupt [residents name] where and when they are eating. In a group living environment, such a guarantee can never be made (unless all the other residents are out of the home) and as such the reality, as confirmed by staff, is that this individual eats virtually all of their meals in their bedroom. Similarly, the strategies for managing so many of this persons needs and behaviours is recorded as re directed to bedroom. As short term crisis measures these documents are understandable, but given that the home has a raft of documentation spanning more than three years, however comprehensive this type of care plan is it cannot be viewed as meeting the individual and diverse needs of this person. Likewise, there is little value in continuing to record and review the same thing without actually doing something with the information. Similarly the person showed the Inspector their person centred plan and whilst this was seen to be a highly personalised and meaningful document it is not ultimately serving its primary purpose; which is to put the person at the heart of the process and support them to identify the goals and aspirations for their life. The Manager advised that less time had been available for the updating of other care plans, although they were in the process of being updated to a more detailed format. The Inspector viewed one of the other persons care plans and agreed that more detail was required. Again there was a body of evidence that indicated that keyworkers have worked hard with their key residents to develop person centred plans that are meaningful and accessible to them. The documentation in place however does not sufficiently demonstrate how the home supports residents to strategically formulate life goals and develop their skills and independence. In light of the above information, a requirement has been made for the service to move the care planning system forward and ensure that each person has a plan of care that contains up to date information in a format that is easily accessible to the Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: reader. The care plan must also identify both short and long term goals which are linked to skill building and developing independence. In order for this important piece of work to be completed in a meaningful way a requirement has been made with a compliance timescale of six months. Care Homes for Adults (18-65 years) Page 16 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents benefit from the opportunities to access the local community and to participate in educational, social and meaningful activities, the service needs to resolve the incompatibility issues to ensure that the all lifestyle choices reflect the needs and interests of people as individuals and not the needs of the home as a collective group. Evidence: As with other outcome areas, lifestyles are also affected by the current compatibility issues at 20 Windlesham Road and there is a difference between the experiences for one person in comparison to those of the other three. One resident is allocated two staff members to work with them throughout the day and as such the type of activities they engage in are largely dependent on their own personal choice. That being said, the potential for this person to fully engage with Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: activities is affected by their dislike for sharing the communal spaces with other people. As such it was reported by staff that an activity, for example, cooking, which this person might like as an activity in itself, is problematic if other residents are present in the kitchen. For this person there is a structured weekly schedule of activities which enables the person to choose from a list of options each day. The staff team at the home have worked hard to support this individual to access external activities and they are currently working on a model of two community based activities each week. The success of these activities, however is totally dependent on the expressed needs and choices of the person on any given day. On the second inspection day, the Inspector was able to visit the home at a time when this person had been supported to go out for a drive and drink out. On their return it was reported that this trip had been very successful. Staff however commented that the success of such activities are dependent on so many variables, including weather, the residents mood and which staff are on duty. The other three residents have their own activity schedules, although it was evident throughout the inspection that whilst access to structured day services do occur, many house arranged activities are affected by factors other than the personal choice of these three people. The needs of the individual discussed above affects the type of activity these people can participate in, as does the number of staff on duty. As reflected in the staffing section of this report, 20 Windlesham Road has a high level of staff sickness and it was evident from discussion with staff and a review of documentation that the effect of this on activities is usually borne by the three people who present less challenges to the service. It was reported by staff and the Manager that in order to create a quieter environment in the home, these three residents are often supported to go out. Whilst it is true to say that they therefore have a lot of opportunities to access the community, it is not always on their terms and as such destination and timing are not person led in this respect. In order to improve outcomes in this area, the home needs to demonstrate how the activities and goal planning are linked to person centred plans of care which support individuals to achieve live goals and achieve maximum independence. The home has a positive approach to enabling residents to maintain contact and relationships with families and friends. There was evidence in the care plans that the home supports residents to meet with and receive visits from their relatives and Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: friends. Discussion with the Manager and three staff confirmed that the home understands the importance of good relationships with other stakeholders. Resident reviews include the opportunity for residents relatives or representatives to attend if the resident wishes. Mealtimes and menu planning at 20 Windlesham Road also present a number of issues that are not acceptable. As previously highlighted, one resident has to eat their meals in their bedroom as a long term physical condition means there is a safety risk if they are disturbed by other people whilst eating. For other people, there is limited opportunity for them to be involved in either the planning, shopping or preparation of meals. Staff reported that menus are drawn up by staff based on their knowledge of individual likes and dislikes. It was reported that due to how busy the home is, staff usually do the food shopping on their own. The menu displayed showed that it had been recently updated and included a range of varied and well balanced meals, but there is little evidence of resident involvement in this area. Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the sensitive and dignified way in which they are supported with their personal care. Further protection would be afforded if improvements are made to the way their healthcare needs are managed. Evidence: Care plans provide documentary evidence about personal and health care needs and in respect of the former, these guidelines are comprehensive. Personal support was observed to be being provided in a sensitive and respectful way at the time of both inspections. It was also evident that referrals are made to external professionals, including doctors, dentists and opticians and the home has introduced health action plans in line with Valuing People. At previous inspections, discussions have been had with regard to the ongoing difficulties with a regular medical intervention that one person has. This situation has been highlighted to the home on several occasions as one which causes the Commission concern in particular in relation to issues of restraint and consent. Since the last inspection, the Mental Capacity Act (MCA) has come fully into force and the Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: way this treatment is provided falls within this legislative remit. As the consent and best interests documentation in place for this procedure was completed prior to October 2007, it is not currently MCA compliant. In particular, the behavioural support team cannot be classified as the decision maker responsible for signing off this intervention. The home is therefore required to ensure that swift action is taken to remedy this situation and ensure that the appropriate referrals are made and that any such medical intervention from this point onwards is carried out in accordance with the principles of the Mental Capacity Act 2005. Medication systems were assessed by way of a review of records, storage and discussion with a member of staff. The medication policy was not inspected on this occasion. Given the size of the home, there is a large amount of medication to manage and the staff member spoken with demonstrated a good understanding of the importance of ensuring the right person receives the right medication, at the right time. The Inspector was confident that the administration of medication is being dealt with in a person centred way. That being said, a number of signature gaps were identified on the Medication Administration Record (MAR sheet), where it was identified that the corresponding tablet had been taken from the blister pack. Similarly, at 12:10pm on the second day of the inspection, a staff member approached another member of staff and requested that they administer a residents breakfast medication. It was evident that the reason this medication had been delayed was due to them having their breakfast very late. As the next dose of this persons medication was due at lunchtime, the staff member advised that she would need to seek appropriate advice. A staff member also highlighted difficulties with administering evening medication at 9pm, as this was identified as a particularly busy time. The Inspector advised that such issues should be discussed at the medication review with the doctor, as there may be some flexibility with times that they can be given. Discussion about all of these issues with staff highlighted that staff often have to handle medication under difficult circumstances. As such, it is not always easy for staff to concentrate solely on the task in hand. Staff stated that it is not uncommon that when they dispense medication and administer to residents, their attention is then interrupted by an incident within the home which leads to them forgetting to go back and sign the MAR sheet. Similarly, the location of medication cupboards in the home mean that staff are prone to interruptions. The home is required to review the medication systems within the home to see how these mistakes can be prevented. Care Homes for Adults (18-65 years) Page 21 of 37 Care Homes for Adults (18-65 years) Page 22 of 37 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. Residents benefit from the internal systems in place to listen to their views and safeguard them from harm, but there are no positive conclusions in response to the information being shared. Evidence: The home has a complaints procedure in place, which provides a pictorial version for residents, although the due to the complex needs of the residents they would require support to make a complaint. A complaints book is in place and it was noted that the home have received two complaints in the last twelve months which have been handled satisfactorily. The home seeks to operate an open culture where issues are openly discussed and opinions shared. Positive interaction was observed between residents and staff during the inspection. Residents and their representatives are encouraged to express their views about the service. That being said, the service has received lots of information from various sources which indicate that the current compatibility issues are not acceptable to a whole range of stakeholders. Each of the people currently living within the service, if able, would be within their rights to formally complain about the current situation at the home. As they require support to do so, the home should consider how it enables residents to ensure their wishes are truly listened to and acted upon. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: The home has a number of systems in place to protect residents from abuse. New staff are employed subject to the necessary checks being undertaken. There are systems for supporting residents with their finances which include monies being checked and signed for every day. Staff have demonstrated that they are aware of their responsibilities in respect of protecting vulnerable adults and know how to physically safeguard the people they support. Again, the service needs to consider how the impact of the current living arrangements fully protects people and ensures that they are kept safe from harm. Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work and consideration is needed to upgrade the internal environment in order provide a clean and homely property which fully meets the needs of all of the residents living there. Evidence: The home is three storey property which is situated in a quiet residential area of Hove. There is one bedroom located on the ground floor which has ensuite toilet and bathing facilities. The other three bedrooms are located on the first floor and residents must be independently mobile to access these areas. A tour of the internal environment highlighted that whilst bedrooms are personalised and nicely furnished and decorated, the majority the communal parts of the home look tired. It is recognised that staff have worked hard to improve the decoration and homeliness of parts of the home and the downstairs lounge is an example of this. The other ongoing issues within the service however have meant that parts of the home are either damaged or excessively worn and is also the cited reason for the absence of soft furnishings and other decorative items. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: The kitchen needs upgrading as cupboards and drawers are broken and paintwork and floor stained and damaged. Concerns were also expressed about the risks associated with the electric hob which takes a long time to cool after use. In an environment where behaviour that challenges is frequent, this risk needs to properly assessed. The laundry is also in need of total refurbishment with paint peeling from the walls, rust under the washing machines and broken bins used for storing soiled laundry. Similarly, the tiles are broken in the first floor bathroom. Greater attention must also be paid to the overall cleanliness of the home, as it is evident that staff are spending so much time managing behaviours that there is limited time to get anything more than the basic domestic work completed. It was also identified that the first floor toilet provided no paper towels, hand soap or gloves. Care Homes for Adults (18-65 years) Page 26 of 37 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. Residents benefit from the support of a dedicated team of staff who have been properly recruited and who are committed to working with them. Greater protection would however be afforded if appropriate staffing levels were maintained and staff had the time to undertake other aspects of their role, such as training and developing the keyworker function. Evidence: The Manager confirmed in the Annual Quality Assurance Assessment (AQAA) that three staff is the minimum level of staff during the core waking hours (8am to 9:30am) at night, the home is staffed by one waking and one sleeping carer. A review of the rota reflected this. As one resident requires the support of two staff, staff spoken with confirmed that on a typical day staffing levels needed to be provided with four staff in the morning and three in the afternoon. It was described that staffing levels below this meant they could just maintain care. Whilst there was evidence on the rota that these levels are strived for, ongoing staff sickness posed a constant challenge. As such there is still a need to use bank and agency staff to cover core shifts. Discussion with staff and the Manager identified that the compatibility issues at the home have affected staff morale and some staff expressed a view that the stress of Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: the job was a major factor in sickness levels. Evidence gathered from the homes own quality monitoring reports highlighted these issues and also the need to ensure the home is consistently staffed to minimise risk and manage behaviours. A review of the training records identified that the information held in the home was not fully up to date. It was however identified that not all staff hold current training certificates in all core areas and it was possible to track that not all staff had received training in infection control. It is therefore a requirement that the Manager undertake a full training audit for the staff team and ensure that update their skills accordingly. Three staff files were examined and these provided evidence of a robust system of recruitment being in place, with the correct documentation and checks being in situ. The Inspector saw evidence of regular staff meetings being conducted with minutes recorded. Staff also receive supervision every four to six weeks with either the Manager or one of the deputy managers. Care Homes for Adults (18-65 years) Page 28 of 37 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. Residents benefit from living in a home that is run by people who care about and understand their needs. At an organisational level however, the home is not reacting to its quality monitoring systems by making the changes needed to take the service forward. Evidence: The home is being managed by a skilled and experienced practitioner who successfully completed the registration process during the period in which this inspection was conducted. It was evident throughout the inspection, that the Manager has a good understanding of the needs of the service and an excellent relationship with the people who live at the home. The home has a system of quality monitoring in place with line management conducting regular visits in accordance with Regulation 26. There is also evidence that annual satisfaction surveys are sent out to stakeholders, although at the current time the results of these have not been formally collated and published. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: The issue for the Commission however, is what outcome is currently being achieved by the auditing and monitoring systems in place? For example, the Manager reports in the quarterly summary for January to March 2009 ongoing compatibility issues with one service user and high levels of staff sickness reducing consistency in practice. Similarly a relatives survey completed on 17 February 2009 included the comment that staff morale is not good. Furthermore the Regulation 26 report completed for the month of February 2009 stated that the effect of one resident was observed to be having an unacceptable impact on other residents. As such, the Inspector concludes that all of the issues raised in this report are already known to the Council as a Provider and as such, it is unacceptable that no appropriate remedial action has been taken. There are various systems in place to maintain health and safety within the home. It was identified in the Regulation 26 reports that certain issues require closer monitoring, including ensuring that regular fire drills are conducted. The Manager must ensure that such issues identified in the audits are swiftly resolved. As previously mentioned in the Environment section of this report, the home is required to action in respect of improving infection control and ensuring cleanliness. Care Homes for Adults (18-65 years) Page 30 of 37 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 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The Registered Person must 15/05/2009 make an urgent referral for a mental capacity assessment in respect of accommodation to be made in respect of the service user discussed at the inspection. To determine whether this individual has the mental capacity to make their own decisions about where to they wish to live. 2 3 14 Following completion of the assessment required above. The Registered Person must not provide accommodation to someone whose needs and wishes they cannot meet. The home must only provide accommodation to people whose assessed needs can be met. 01/07/2009 3 5 5 The Registered Person must ensure that the terms and conditions of residency are 01/07/2009 Care Homes for Adults (18-65 years) Page 32 of 37 available to each service user in a way they can uderstand. To ensure that service users have information about their rights available to them in a way they can comprehend. 4 6 15 Regulation 15(1)&(2): The Registered Person must ensure that care plans are developed in consultation with service users in a person centred way. These plans must be in a format that are easily accessible and formally reviewed at least every six months. To ensure that each service users knows their assessed and changing needs and personal goals are reflected in their individual plan. 5 13 16 Regulation 16(2)(n): The Registered Person must ensure that each service user has a programme of activities that meets their needs, choices and expectations. To ensure that each person has the opportunity to enjoy a fulfilling life that is led by their own needs and choices. 6 17 16 Regulation 16(2)(h): The Registered Person must ensure that service users are provided with opportunities to plan and prepare their own meals. 01/07/2009 01/07/2009 01/08/2009 Care Homes for Adults (18-65 years) Page 33 of 37 To ensure that service users are able to be safely included in the preparation of meals if they wish. 7 19 13 Regulation 13(5)&(6): The 15/05/2009 Registered Person must ensure that any intervention used in respect of health care treatment has been properly assessed and agreed in accordance with the Mental Capacity Act 2005. To ensure that people are not handled in unapproved ways that may be against their will. 8 20 13 Regulation 13(2): The Registered Person must ensure that there are systems in place to ensure that medication is managed safely and appropriately at all times. To ensure that service users receive the correct medication and the correct time. 9 33 18 Regulation 18(1)(a): The Registered person must ensure that staffing levels are kept under review to ensure that their are sufficient numbers of competent and qualified staff to meet the needs of service users. 01/06/2009 15/05/2009 Care Homes for Adults (18-65 years) Page 34 of 37 To ensure that service users are safely supported to lead their lives as identified in their individual plans. 10 35 18 Regulation 18(1)(c): The Registered person must ensure that an audit of staff training is conducted to ensure that staff undertake the necessary mandatory and specialist training to undertake their role. To ensure that service users are supported by appropriately trained staff at all times. 11 39 24 Regulation 24(1): the Registered Person must ensure that the system of reviewing and monitoring quality of care is effectively used to secure improvements to the way the service is provided. To ensure that identified areas of improvements are acted upon to improve outcomes for the people living at the home. 12 39 24A The Registered Person must 01/07/2009 supply an improvement plan to the Commission which details how the service intends to make the necessary improvements within the timescales set down in this report. 01/06/2009 01/06/2009 Care Homes for Adults (18-65 years) Page 35 of 37 To ensure that outcomes for the people living at the home are improved in a timely way. 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 22 The Registered person should consider the outcome of the complaints policy and procedure to ensure that service users receive the necessary support to express their views and concerns. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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