Care Home: 25-27a Alexandra Road

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What the care home does well People who live at the home are given support to enjoy their leisure time and do things in the community. Staff are caring and want to work with people who live at the home. They want to improve things at the home. What has improved since the last inspection? Staff talked to peoples` Doctors and sorted out homely remedies. People can now do their own laundry with help from staff. What the care home could do better: It is important that information about the home is provided so people know it`s the right place for them. Care plans must include all the information about people and be kept up to date so that staff know what care and support people need. The manager and staff need to understand person centred planning better so that records reflect current good practice and are more meaningful for residents. People must see health workers every year to make sure that they stay well. If residents` needs change staff need to reassess them and consider if the home is still suitable for them. Risks need to be assessed and managed so staff know what to do so that they can keep people safe. People who use the service must be protected from abuse, neglect and harm. Staff need to be trained in how to care for and support all of the people who live at the home. The management of Alexandra Road needs to improve to make sure that people are safe and live and benefit from living in a well run home. Information about people must be kept private so that other people cannot see it. Key inspection report Care homes for adults (18-65 years) Name: Address: 25-27a Alexandra Road 25-27a Alexandra Road Weymouth Dorset DT4 7QQ     The quality rating for this care home is:   zero star poor 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: Susan Hale     Date: 2 7 0 4 2 0 1 0 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 43 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: 25-27a Alexandra Road 25-27a Alexandra Road Weymouth Dorset DT4 7QQ 01305760663 01305770236 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.dorsetforyou.com Dorset County Council Name of registered manager (if applicable) Daniel James Crone Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. To accommodate up to a maximum of 2 service users in the category of LD (E) at any one time. Date of last inspection Brief description of the care home 25/27a Alexandra Road is a care home providing a service to adults who have a learning disability. The home is located in Weymouth, a short distance from the town centre, and is owned and operated by Dorset Social Care and Health Directorate. Alexandra Road was built in the late 1970s and can accommodate up to 21 people. The Care Homes for Adults (18-65 years) Page 4 of 43 Over 65 0 0 0 23 3 2 Brief description of the care home home is split into units, accommodating between 3 and 8 people in each unit. Each unit has a lounge, dining room, kitchen and their own bathroom and toilet. Each person has a single bedroom. The home has special adaptations and equipment to meet residents various physical needs. These include ground floor bedrooms; walk in showers, and a Stannah chair lift, which ensures all residents can have access to the first floor. The property is surrounded by gardens and the front entrance is attractively decorated with container plants and to the rear there is a pergola, which is used seasonally. Staffing is provided 24 hours a day and as well as providing personal care and support, service users are encouraged to be part of the local community by taking part in leisure and social activities. The current fees payable are availble from the home. Care Homes for Adults (18-65 years) Page 5 of 43 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: zero star poor 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: Two inspectors spent the day at Alexandra Road. We spoke to people who use the service, we observed life in the home, and we spoke to staff and the manager. We also looked at the records and looked around the home. Care Homes for Adults (18-65 years) Page 6 of 43 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Adults (18-65 years) Page 7 of 43 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 43 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 9 of 43 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 home does not provide a statement of purpose or service user guide giving information about the services provided by the home. People do not have access to information about the service in a format they can understand. Peoples needs are assessed but they cannot be sure that the home can meet their complex needs whilst maintaining the safety and well being of others. Evidence: The AQAA ( both in 2009 and 2008 ) told us that the home intended to provide an easy to read, accessible service user guide. However, Mr Crone told us that the home does not have a service user guide or statement of purpose specific to Alexandra Road. We were told that there is a brochure about the home but this was not provided and is therefore not commented on in this report. Mr Crone told us that the brochure was not available in accessible formats that could be understood by people who live at the home. Care Homes for Adults (18-65 years) Page 10 of 43 Evidence: There have been no new admissions to the home since the last inspection. However, there was no evidence to support how the people who live at the home are consulted or considered when new people are admitted. There was no evidence that when peoples behaviours significantly impacted on other people living in the home that any action was taken to identify that the home was not able to meet the persons and other peoples needs. The contracts provided by the organisation are not accessible and appropriate for the needs of people who live in the home. Care Homes for Adults (18-65 years) Page 11 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are not always detailed enough or completed for all areas identified in assessments to ensure that peoples specific needs are identified and met. People who live at the home are not involved in planning or agreeing to the care and support they receive. Evidence: We asked for the care files of the people we decided to case track but were not initially given all the information relating to these people. Each person has multiple folders containing information about them. Overall the records are complex and include assessments, some relevant information , some duplicated information and some that is out of date. There are also organisational care plans, health and social care professional assessments and numerous risk assessments. On one care plan looked at the person had sustained a fracture but there was no care Care Homes for Adults (18-65 years) Page 12 of 43 Evidence: plan put in place at the time of the fracture to tell staff what care the person needed. The organisational format for assessments, care plans and risk assessments are in small print and have blocks of print under the headings. It is not easy to access or follow all of the relevant information that staff would need to be able to support an individual. On one care plan looked at the person had a diagnosed medical condition but there was no information on file about this condition and no guidance or information to staff on what they need to do if the person became ill. Risk assessments dated 2008 were in place and it was recorded that these were all to be reviewed in 2009 but this had not been done. There was no risk assessment on file in relation to the persons medical condition. Some risk assessments were in place for specific events such as holidays but these have not been cross-referenced with the everyday risk assessments so were incomplete. On one file looked at there was a document entitled I have a bowel chart and I am diabetic and need to control my sugar intake. There was no other information or guidance on how these issues were managed or how the sugar intake was controlled. There was no information on file in relation to diabetes and no advice or information for staff on the possible side-effects and symptoms of becoming unwell. On one care file looked at the communication chart was blank. A person centred plan was in place that had been reviewed in October 2008. The document entitled what I like to do on my day off had been completed in March 2006 and reviewed in October 2007 but we could not verify that the persons choices that were recorded were still relevant. On one care plan looked at a body map was in place in relation to a bruise but the map had not been dated or signed so it was not possible to cross reference with the daily records. There was very little evidence in the care files we looked at that people are actively involved in care planning and reviews or are asked whether they agree with the care and support provided. There is very little personal life history information in peoples plans. Life history work should be developed where appropriate that includes details and photographs of their history such as family, friends, where they have lived, pets, work etc. Life history Care Homes for Adults (18-65 years) Page 13 of 43 Evidence: books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. Daily records are kept and personal care checklists. However the personal care checklists are inconsistently completed and do not reflect how the person spent their time or their ill or well-being. There are not any means to enable people to be involved or included in the records kept about them. Four relatives completed our survey, two of whom said that the home always met the needs of their relative and two said that the home usually did. Two people said that the home always kept them up to date about important issues and two people said that the home usually did. Three relatives told us that the home always gave the support and care needed and one person said that the home usually did. Care Homes for Adults (18-65 years) Page 14 of 43 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. Further work is needed to ensure that people are supported to participate in activities, attain personal goals and develop their life skills. Evidence: We looked at how people are supported to have and achieve goals. These had been identified in the files looked at but it was not clear if they were meaningful for individual residents. For some people the goals have not been reviewed and did not include specific details on how they were to be achieved. It was positive to note on one residents file that they have been supported in their choice to attend a local slimming club. We looked at peoples help /task list which detailed how they prefer to be supported and their preferred routines. Peoples preference of the gender of staff is not actively Care Homes for Adults (18-65 years) Page 15 of 43 Evidence: sought or recorded in their assessments or care plans. There was no evidence on any of the care plans looked at that people are supported on how to develop and maintain personal intimate relationships or how to express their sexuality other than by paying attention to their appearance. The AQAA recorded that none of the residents had any religion or faith. However, six of the residents who completed our survey told us that they considered themselves Christian. The section in the AQAA relating to sexual orientation had been completed but did not identify the sexual orientation of any resident (There is a section for not known). However, two people who completed our survey described themselves as heterosexual while the rest of the respondents did not wish to say. 10 residents completed our survey, six people said that they always make decisions about what they did every day, three people said that they usually make their own decisions and two people said they sometimes do. On the care files looked at we could see that people are supported to attend health care appointments and see the GP and other health and medical professionals when necessary. People living at home do not have annual health checks or have access to their health action plans. The daily record contains some detail of how people had spent their time either in the house or in the community. People participate in some of the daily routines at the home. They are supported to undertake daily living tasks such as laundry. There was no evidence that people living home are involved in the planning or choosing of menus or involved in shopping for groceries. This should be reviewed and ways of people being involved developed. We can see from the records we looked at that people using the service are supported to be out in the community. Comments made by people who live at the home included that the food was good and that the person had a good bedroom. Another person commented that the staff look after me and that they take me out. Two other residents said that they were happy and that the home was lovely. All four relatives who completed our survey said that the home always helped their Care Homes for Adults (18-65 years) Page 16 of 43 Evidence: relative keep in touch with them. One relative commented in our survey that they were happy that their relative lived in Alexandra Road. Care Homes for Adults (18-65 years) Page 17 of 43 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. The health and personal care that people receive is usually based on their individual needs. Improvements need to be made to demonstrate that the principles of respect, dignity and privacy are put into practice. Medication is managed and administered in a way that keeps people safe. Evidence: There were positive relationships and interactions observed between staff and the people who live at the home. We saw that staff were caring and they told us they wanted to support people in the best way that they could. We looked at peoples help lists which detail how they prefer to be supported and their preferred routines depending on the time of day. Peoples preference of the gender of staff who support them is not actively sought or recorded in peoples assessments or plans. We could see from care files that people receive additional specialist support and advice when needed. Care Homes for Adults (18-65 years) Page 18 of 43 Evidence: We could see from records that residents are supported by staff to attend health and medical appointments whenever necessary. We saw some evidence that peoples right to access to quality health care was being promoted. However due to the number of different records and files kept about people it was difficult to cross-reference some information. There was no evidence on files looked at that people were supported with issues relating to emotional relationships and sexuality. On one care plan looked at the person had been diagnosed with epilepsy. There was no epilepsy care plan and other records on file such as how to support me and a record of what was important to the person made no reference to epilepsy. There was no information about epilepsy and no advice and guidance to staff on what they should do if the person became unwell. The home uses the key link worker system to give people continuity in their care and support. It was positive to see that one resident had chosen to attend the local slimming club and was being supported by staff to do this. We looked at medication practice in the home and found that it was well managed. As stated elsewhere in this report due to problems with the training matrix we were unable to verify if all staff have completed appropriate medication training. Two relatives who completed our survey said that they felt the home always responded to the different needs of individuals living there and two people said that the home usually did. Two relatives said that the home always supported people to live the life they chose and two people said that the home usually did. Care Homes for Adults (18-65 years) Page 19 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recording of complaints was chaotic and it could not be evidenced that complaints are robustly investigated. The serious shortfalls in the managers and staffs knowledge and understanding of adult safeguarding means that allegations were not reported to the relevant authorities and people were and continue to be at risk of harm or abuse. Evidence: The home has a corporate complaints procedure but this was not available to look at in the complaints record. The complaints procedure is not available in alternative formats suitabed to the needs of all of the people who live at Alexandra Road. 10 people who live in the home completed our survey and they all knew who to speak to if they were not happy and how to make a complaint. Four relatives completed our survey all of whom knew how to make a complaint and all of whom said that the home responded appropriately if any concerns had been raised. Complaints are recorded in a bound book that includes personal information about all complainants in breach of the Data Protection Act 1998. The way that information was recorded was unstructured and chaotic and made it impossible to track which complaints had been investigated and what the outcome was. Complaints had not been acknowledged by Mr Crone in writing, there was no record of the investigation Care Homes for Adults (18-65 years) Page 20 of 43 Evidence: into the complaints and there was no evidence that complainants were formally informed of the outcome of their complaint. One complaint had been made to a senior manager outside the home and there was a record of the acknowledgment of this complaint and the outcome but no record of any investigation relating to the complainants concerns. The home has an adult protection policy and also a copy of the locally agreed multi agency policy and procedures. The AQAA states that staff have undertaken adult protection training upon induction, in-house adult protection training and the manager regularly updates in his role as an adult protection investigator. However,Dorset County Council commissioned a safeguarding audit of the home in January 2010 and found numerous issues of assault between residents which had not been properly reported to the local authority under safeguarding protocols and had not been reported to the Commission. There is an ongoing safeguarding investigation and until this has been concluded there will be no new admissions to the home. We therefore found that people are potentially at risk, safeguarding protocols have not been followed, and risk assessments have not been updated to reflect individuals current circumstances. People are not being supported to live safely in their own home. There were no clear plans in place to address issues of aggression between residents. On the day of the inspection we saw evidence of one resident who had assaulted another resident on two occasions despite one to one staffing being provided. The male resident concerned lived in a unit with two female residents and it was clearly recorded on their care file that there was a risk of them assaulting other people. The manager told us that there had not been any consideration as to whether this person was appropriately placed either within the unit with two vulnerable women or within the home in general. Information about safeguarding protocols should be made available to the people who live in the home in a format that is suited to each individual. This is so that they know who they can communicate with if they dont feel safe or they are worried about abuse. Following the recent safeguarding investigations it is strongly recommended that all staff and the manager undertake refresher training in adult protection. Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: People are supported to manage some aspects of their finances. We looked at the financial records of three residents. Monies were kept separately with receipts in individual wallets. Two of the three records checked with them to be correct. We were told that records were audited when staff have time. The recording system for residents finances refers to one staff and one resident signature. This is only appropriate where the individual is able to understand their finances and preferably can read the account record. Where the individual is not able to sign their own record two staff signatures should be obtained. The whistle blowing policy does not include information for staff on how to contact Public Concern at Work and did not include the Commissions contact details. Care Homes for Adults (18-65 years) Page 22 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home does not enable people use the service to live in a safe, well maintained environment which enhances and promotes independence. Evidence: The home is registered to accommodate 21 people but was not purpose built for people with a learning disability. Residents bedrooms were personalised to reflect the personalities of the individuals. The home was clean, tidy and free from any unpleasant odours. One person commented that I like to clean and hoover my room and help in the kitchen. Eight people completed this section of our survey. Five people said the home was always fresh and clean, three people said it usually was and one person said it sometimes was. Although the home was built many years ago before the recognition that best practice for people with a learning disability is to be supported whenever possible to live in the community, it was clear that staff worked hard to treat each unit as individuals Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: homes. Each unit has its own lounge, dining room and kitchen but it was unclear from records looked at how much the kitchen is used by residents in relation to them attaining independent living skills. The main meal is prepared in a central kitchen by staff. There were bins in communal bathrooms and toilets and these were lidded but not foot operated which may compromise infection control practices. There are domestic laundry systems in place that residents can use with staff support so that they can learn independent living skills. The AQAA told us that one improvement that had been made was a fitting of a new high rising bath. However, staff told us that this is positioned too high for residents to use independently without using a stool. Care Homes for Adults (18-65 years) Page 24 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the recruitment information kept in the home varies and needs significant improvement to make sure people who live in the home are protected from the risk of harm. Staff do not receive formal supervision in line with the frequency recommended in the national minimum standards. The recording of supervision breaches Data Protection requirements. Significant efforts are needed to increase the numbers of staff that are qualified to a least NVQ level II or above to make sure they have the skills and knowledge necessary. We were unable to evidence that staff are supported to undertake relevant training to be able to meet residents needs. Evidence: We looked at the staff rotas which showed that the units were staffed according to the need of the residents with some staff working between different units. The rota did not include the designation of the staff or indicate which member of staff was the qualified first aider on each shift. Care Homes for Adults (18-65 years) Page 25 of 43 Evidence: 10 people who live at the home completed our survey. Five people said that the staff always treated them well, three people said they usually did and two people said that they sometimes did. Five people said that staff always listened and acted on what they said, one person said that staff usually did and three people said that staff sometimes did. One relative who completed a survey said that their relative was receiving the right care providing the staffing levels are correct and of the right calibre . Another relative commented that regular staff do very well but went on to say that the home could possibly do with more regular staff instead of having to rely on an agency. We looked at the staff files of three people who started working at the home since the last inspection. All files contained an application form. On two files there was no photograph of the person to prove they were who they said they were. None of the files contained a Rehabilitation of Offenders declaration completed at the time of application. On one member of staffs supervision file there was a supervision agreement and evidence that the person had received formal supervision twice during 2010. However, the person had started working at the home in 2009 and there was no record of any supervision until 13th January 2010. On the second supervision file checked a supervision agreement was in place dated 21st January 2010 and the person had received formal supervision twice during 2010. However, the person had been employed at the home since 2009 but there was no evidence of supervision during this period. The information in the AQAA relating to staffing was contradictory and this information was requested again after the inspection and supplied by a member of staff. However, some of the information was still incomplete and incorrect. The amended AQAA stated that the home employed forty four care staff, sixteen of whom have completed training to at least NVQ level II or above (36 ). The AQAA told us that 40 care staff have completed induction training. The home employs forty one female care staff and three male care staff. Supervision records included personal information about individual residents in a way that breached the requirements of the Data Protection Act 1998. We also saw that individual staff supervision records were kept on individual residents personal files. Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: There was no training matrix available in the home on the day of the visit. We requested that this information was sent to us but it was received in a format that could not be cross-referenced and each member of staffs training record verified. It was therefore not possible to evidence that staff were given the opportunity for foundation training or statutory training. The home later sent us a record of enhanced training undertaken by seven senior staff. The record did not include evidence of the training undertaken by the registered manager. Although effective personal development and breakaway techniques was on the list of topics none of the staff had completed training this and this was the same in relation to learning disability and sexual health. One member of staff had completed training in communication and listening skills in 2001. Four members of staff had not completed training in person centred planning , one had completed it in 2004 and two have completed it in 2007. Two members of staff had not completed training in total communication. One senior member of staff had completed training in four of the 17 topics. However, three of those courses had been in 2007 and one in 2009. The member of staff concerned had not completed training in the administration of medicines. Four relatives who completed our survey, said that the care staff always have the right skills and experience and two people said that staff usually did. Care Homes for Adults (18-65 years) Page 27 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home do not benefit from or live in a home that is consistently well managed or that has effective monitoring systems. There are no organisational systems to update policies and procedures to make sure that they reflect current good practice and give up to date information and guidance to staff. Information is not kept in a way that respects peoples right to confidentiality or in a way that meets the legal requirements of the Data Protection Act. The system in place does not clearly show that staff are up to date with mandatory training in fire safety, movement handling and first aid. Evidence: There were clear lines of accountability in the home, the staffing of the home consists of the manager, senior staff, care and housekeeping staff. During a visit staff appeared confident that in their roles, the home was relaxed and the people appeared Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: at ease and comfortable. The AQAA was completed by Mr Crone and returned within the required time scale. However, the information given in the AQAA was very brief and some sections most notably the section asking for the dates of equipment servicing were blank. The information about equipment was requested verbally on 1st April 2010 but this was not supplied by Mr Crone and this information was requested for the third time on the day of the inspection. The organisation has an equal opportunities policy to protect both residents and staff. However, there is no consideration within the home that residents may choose to have a personal care from a person of the same gender . There is also no consideration of gender issues in relation to where people live within the home and it is assumed that female and male residents would choose to live in the same unit. There are a number of serious shortfalls in the assessment of risks, care plans, access to health care, the recognition and reporting of allegations of abuse, staff training and reporting to the Commission. There have also been failures in reporting incidents that affect the well-being of people to the Commission. There is a quality assurance system in place. Mr Crone told us that he had some completed surveys (date unknown) but that these have not been collated so the results were not available. The policies and procedures are provided by the organisation but the majority were written some years ago and have not been updated to make sure that they include current, up-to-date guidance on good practice for staff. There is no evidence of staff and people who use the service being involved in the development of policies and procedures. Individual records are not in good order and are maintained in a way which is not always in accordance with the Data Protection Act 1998. There is no demonstration of year-on-year development for each person using the service which is linked to implementation of their individual plan. We looked at fire safety. Records and found that the fire system was serviced and checked regularly to make sure it was in good working order. Fire drills have been carried out monthly in 2010 but there was a period from September to November 2009 inclusive where no drills were undertaken. Record show that the fire alarm Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: system should be tested weekly but this has not happened during February 2010, January 2010, and March 2010. The manager, Mr Crone told us that there were no personal evacuation plans in place for residents in relation to providing information and guidance to staff and the fire service should a fire occur. It is a serious concern that the organisation has conducted monthly visits under regulation 26 as required but that issues such as poor record-keeping, poor complaints recording and safeguarding issues were not picked up. We looked at the accident book which showed that although accidents such as trips and falls were recorded there was no record of any treatment given. The incident reports relating to 2 residents did not record if referrals have been made to the safeguarding triage team or if a regulation 37 form had been completed and sent to the Commission . On some records looked at it was not recorded if any treatment had been given after people had had an accident. A training matrix was not available on the day of the inspection but was forwarded following the visit. Unfortunately as stated in the previous outcome group , the information was not in a format that could be followed or understood. The home was therefore unable to evidence that all staff have undertaken mandatory training or show that systems were in place to update this on a regular basis. The home later provided evidence of the enhanced training records of senior staff ( this did not include the manager). This showed that three people had not undertaken any training in infection control and the four that had done this training had completed it in 2007. Care Homes for Adults (18-65 years) Page 30 of 43 Are there any outstanding requirements from the last inspection? Yes R 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 1 42 23(4)(d) All staff must receive mandatory fire training within the specified time limits e.g. night staff quarterly. 31/01/2008 Care Homes for Adults (18-65 years) Page 31 of 43 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 1 5 The registered person shall produce a service user guide. To ensure that service users and their representatives are given clear information about the home. 30/06/2010 2 1 4 The registered person shall compile a statement of purpose giving details of the facilities and services to be provided for service users. To ensure that service users and their representatives are given clear information about the home. 30/06/2010 3 2 14 People must only be 30/06/2010 admitted to the home following an accurate assessment that demonstrates that staff have the skills and knowledge to meet their needs. Peoples needs must be reassessed as their needs change. Page 32 of 43 Care Homes for Adults (18-65 years) 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 This is to ensure that people are placed at the right home and their needs can be met. 4 6 13 Any areas of risk identified from individual must be assessed in this assessments must include individual behaviours, harm to other people, nutrition and pressure area care. They must include descriptions of how staff are to support them. This is to minimise any risks and staff to be provided with guidance on what action to take to keep people safe. 5 6 15 Peoples care plans must be reviewed, kept up-to-date, and include all the individuals needs identified in their assessments. It must also include their wishes and aspirations. This is to ensure that staff know what care and support people need so their needs can be met. 6 6 15 The registered person shall 02/08/2010 consult with the service user and make the service uses plan available to the service user unless it is impracticable. 02/08/2010 02/08/2010 Care Homes for Adults (18-65 years) Page 33 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To make sure that people are involved and consulted in care planning to make sure they agree with the care provided 7 9 15 The registered person must ensure that the service users plan is kept under review. This refers to risk assessments. To ensure that risk assessments are current and relevant. 8 19 12 The registered person shall 30/06/2010 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. This refers to a lack of information and guidance to staff in relation to epilepsy on one residents file. To make sure that residents assessed needs are met. 9 22 22 The registered person shall 30/06/2010 ensure that any complaint is fully investigated. The registered person shall within 28 days inform the person who made the 30/06/2010 Care Homes for Adults (18-65 years) Page 34 of 43 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 complaint of the action if any that is to be taken. To ensure that complainants are confident that complaints are taken seriously and investigated. 10 22 22 The registered person must ensure that the complaints procedure shall be appropriate to the needs of service users. To ensure that all residents are provided with information to raise concerns and complaints if they wish to. 11 23 13 The registered person must 01/06/2010 ensure that action is taken to safeguard the people who live at the home. To ensure that people are kept safe from institutional, emotional, physical, financial and sexual abuse. 12 32 18 The registered person shall 30/08/2010 in regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are 30/06/2010 Care Homes for Adults (18-65 years) Page 35 of 43 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 appropriate for the health and welfare of service users. To ensure staff working in the home receive the training they need to meet residents assessed needs. 13 34 19 The registered person shall 30/06/2010 not employ a person to work at the care home unless he has obtained the information and documents specified in the regulations. This refers to a rehabilitation of offenders declaration that must be made at the time of application. To ensure that recruitment processes are robust. 14 34 19 The registered person must ensure that proof of identity including a recent photograph is kept on staff files. To ensure that peoples identity is verified. 15 35 18 The registered person must ensure that all staff employed at the home receive training appropriate to the work they are to perform including statutory and specialist training. 30/08/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 36 of 43 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 This is to make sure that staff have the skills and knowledge to be able to meet peoples needs. 16 39 24 The overall management of the home must improve, and effective ways of assessing and monitoring the quality of the service must be developed. This is to ensure that the quality of the service is kept under constant review so that any shortfalls can be immediately identified. 17 39 26 Where the registered provider is an organisation the care home should be visited in accordance with this regulation The regulation 26 visits must be meaningful and ensure that people using the service are kept safe from harm. 18 42 13 The registered person shall 01/08/2010 make suitable arrangements for the training of staff in first aid, moving and handling, infection control, food hygiene and fire safety This is to ensure that all staff receive training and 30/06/2010 01/09/2010 Care Homes for Adults (18-65 years) Page 37 of 43 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 updates to ensure people use the service are safe and well cared for. 19 42 37 The registered person shall 30/06/2010 give notice to the commission without delay of the occurrence of any areas detailed in the regulation. This refers to safeguarding issues. To ensure that people in the home are safe and the home can meet its responsibilities under the regulation. 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 1 Urgent consideration should be given to providing a service user guide in accessible formats that meets the needs of people living at home. The service user guide and statement of purpose should be kept under review and the Commission notified of any revision within 28 days. Assessments should include and explore peoples culture and faith, preference and gender of staff, sexuality and important personal relationships. It should also include their finances and their communication needs. People who already live in the home should be consulted about any new people who may wish to move in. The contract should be in a format that is accessible to people living at home. 2 1 3 2 4 5 4 5 Care Homes for Adults (18-65 years) Page 38 of 43 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 6 7 6 6 Serious consideration should be given to undertaking a monthly review of all the care plans. Life history work should be developed that includes details and photographs of peoples history such as family, friends and where they have lived. This information should be used to develop person centred planning and will assist staff to have a greater understanding of people as individuals. Serious consideration should be given to providing care plans (known as help lists) in a language and format that individual residents can understand. Their plan should be held by them unless clear reasons not to do so are recorded. Urgent consideration should be given to reviewing risk assessments whenever individuals needs change, and if there should be no change on a regular basis. Risk assessments for special events should be crossreferenced with day-to-day risk assessments to make sure they are consistent. 8 6 9 9 10 10 All information about people who use the service should be handled in accordance with the homes written policies and procedures and the Data Protection Act 1998. Serious consideration should be given to taking a more proactive and positive risk-taking approach to people being involved in day-to-day living at the home. People should be supported and encouraged to develop life skills. The home should ensure that group trips are planned and chosen by people who share the same interests. Residents should be supported in how to develop and maintain personal and intimate relationships and expressing their sexuality. People should be involved in the menu planning at the home. A collection of photographs of food should be developed so that people who communicate differently and participate in the menu planning. Peoples preference of the gender of staff should be actively sought and recorded in their assessment and care plans. Staff should be provided with training on how to safely support and guide people with personal and intimate Page 39 of 43 11 11 12 13 14 15 14 17 15 16 18 18 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 relationships and expressing their sexuality. 17 18 Effort should be made to ensure that people using the service have some choice about the staff who work with them including those from the same ethnic, religious or cultural backgrounds. Individuals should be facilitated to have health action plans. People who use the service should be offered annual health checks. 19 22 For residents for whom complaints information is not accessible there should be descriptions in peoples plans as to how they let people know when they were unhappy and unsettled. The complaints record should be audited regularly by the registered manager. Urgent consideration should be given to recording complaints in a manner that meets the requirements of the Data Protection Act 1998. Urgent consideration should be given that the manager and all staff should have refresher training in adult protection. Information about safeguarding should be available to the people of the home in a format that is accessible to each individual. Urgent consideration should be given to revising the whistleblowing policy to make sure it includes the contact details of the Commission and Public Concern at Work. All service users financial transactions on their record sheet should have two staff signatures. Urgent consideration should be given to recording referrals made to the safeguarding team. The organisation should consider and make plans for how the home can be managed so that people live in smaller living groups. Serious consideration should be given to how the new bathing facilities can be made more accessible to the people living in the home. All waste bins should be foot operated to reduce the risk of 18 19 20 21 22 22 22 23 23 23 24 23 25 26 27 23 23 24 28 27 29 30 Care Homes for Adults (18-65 years) Page 40 of 43 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 cross infection. 30 32 Urgent consideration should be given as to how the numbers of staff qualified to at least NVQ level II can be increased. Consideration should be given to how to make sure that the staff team reflects a cultural and gender composition of service users. The staff rota should clearly indicate each member of staffs designation. The staff rota should clearly indicate who is a qualified first aider on each shift. 33 34 Urgent consideration should be given to ensuring that staff recruitment files are kept in the home from the data that people stop working there. This recommendation was first made on 27th November 2007. 34 36 All staff should receive formal supervision at least six times a year. Staff supervision notes should not include personal information about individual residents. 35 37 The registered manager should undertake periodic training to maintain and update their knowledge, skills and competence while managing the home particularly in relation to safeguarding practice. Urgent consideration should be given to putting in place systems to review and update the homes policies and procedures to make sure they reflect current good practice. Urgent consideration should be given to the way that information is recorded in kept in the homes about individual service users. Urgent consideration should be given to testing the hot water temperature at least weekly and that testing should include all outlets on a random but regular basis. The accident book should clearly detail any treatment given to residents following an accident. 31 33 32 33 36 40 37 41 38 42 39 42 Care Homes for Adults (18-65 years) Page 41 of 43 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 40 42 Urgent consideration should be given to testing the fire alarm system at least weekly. Care Homes for Adults (18-65 years) Page 42 of 43 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 43 of 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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