Care Home: 55 Daventry Road

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What the care home does well The staff are friendly and respectful and there are enough on duty to meet the needs of the current people at the home in a manner that respects their dignity. People are supported to get out and about to shops, local attractions, parks, and other places they enjoy so that they take part in the like of the local community. The people at the home are encouraged to make everyday choices such as what they do and what they eat. Good medicine management helps ensure people using the service are given their prescribed medicines correctly to promote their health and well being. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. People living in the home benefit from having a balanced and nutritious diet. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes. The home has a good system in place with regard to the appointment of staff. Accommodation is safe clean well maintained and comfortable. There are sufficient numbers of staff on duty to meet the needs of people living inthe home. What has improved since the last inspection? This is the first inspection of the care home under 55 Daventry Road since changes to their registration. What the care home could do better: The home should ensure that anyone wishing to move to the home has their needs assessed before they move in to ensure that their needs can be met properly. People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their ownperspective. The manager must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to use of restraint and people`s behavioural needs. The home needs to continue to offer training to all staff. This should include Safeguarding, Whistle Blowing and other mandatory training. This will ensure that staff take the appropriate action if there are any allegations or suspicion of abuse, and will equip staff to meet the needs of people living in the home whilst carrying out their work safely. The manager needs to ensure all staff have supervision and annual appraisals to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. The management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. This should make sure that the home is run in the best interests of people living in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 55 Daventry Road 55 Daventry Road Dunchurch Rugby Warwickshire CV22 6NS The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie McGarry Date: 2 0 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: 55 Daventry Road 55 Daventry Road Dunchurch Rugby Warwickshire CV22 6NS 01214306306 01788811427 redwood@cttm.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care Through The Millennium care home 16 Number of places (if applicable): Under 65 Over 65 16 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 16 The registered person may provide the following category of service only: Care Home Only To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disability (LD) 16 Date of last inspection 1 3 0 3 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home 55 Daventry Road is a situated in the village of Dunchurch, approximately four miles from Rugby. The home comprises of three separate two storey houses located in close proximity to each other. Each house has a lounge, dining area, kitchen, bathrooms and ensuite bedrooms. There is no lift access within each of the houses. The home is registered to provide care to up to 16 people with a learning disability. The fees charged are variable according to peoples needs, which range from £1250 to £2000 per week. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Care Homes for Adults (18-65 years) Page 5 of 36 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 Care Homes for Adults (18-65 years) Page 6 of 36 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is one star this means that people using the service receive adequate outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We carried out this unannounced key inspection over two days. As the inspection was unannounced the registered owner manager and staff did not know we were going. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. There were 11 people in residence on the day of our inspection. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. At the end of the visit we discussed our preliminary findings with the manager of 55 Daventry Road. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well The staff are friendly and respectful and there are enough on duty to meet the needs of the current people at the home in a manner that respects their dignity. People are supported to get out and about to shops, local attractions, parks, and other places they enjoy so that they take part in the like of the local community. The people at the home are encouraged to make everyday choices such as what they do and what they eat. Good medicine management helps ensure people using the service are given their prescribed medicines correctly to promote their health and well being. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. People living in the home benefit from having a balanced and nutritious diet. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes. The home has a good system in place with regard to the appointment of staff. Accommodation is safe clean well maintained and comfortable. There are sufficient numbers of staff on duty to meet the needs of people living in Care Homes for Adults (18-65 years) Page 8 of 36 the home. What has got better from the last inspection What the care home could do better The home should ensure that anyone wishing to move to the home has their needs assessed before they move in to ensure that their needs can be met properly. People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own Care Homes for Adults (18-65 years) Page 9 of 36 perspective. The manager must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to use of restraint and peoples behavioural needs. The home needs to continue to offer training to all staff. This should include Safeguarding, Whistle Blowing and other mandatory training. This will ensure that staff take the appropriate action if there are any allegations or suspicion of abuse, and will equip staff to meet the needs of people living in the home whilst carrying out their work safely. The manager needs to ensure all staff have supervision and annual appraisals to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. The management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. This should make sure that the home is run in the best interests of people living in the home. Care Homes for Adults (18-65 years) Page 10 of 36 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julie McGarry 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 11 of 36 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 12 of 36 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. People who are considering moving into the home do not benefit from timely or detailed assessments and can not be confident the home can meet their needs. Failure to issue people with contracts could lead to their rights being compromised. Evidence: Information is available to the relatives/advocates of people who are considering moving to the home. This information is provided in the statement of purpose and the service users guide. We saw that these documents provided a range of information about what a person can expect from the service. Both the service user guide and statement of propose need to be updated to reflect current fees and correct details about the Care Quality Commission. Information about the service is not provided in a format suitable for the people for whom the home is intended. Contracts for people who use the service were not available for inspection. It is necessary to issue contracts so that the people at the home and their representatives are clear about the service they can expect to receive for their money. Page 13 of 36 Care Homes for Adults (18-65 years) Evidence: Two residents have moved to live at this service since the last inspection. A preadmission assessment was completed for one individual six months prior to their move into the home. Pre-admission assessments should be carried out within a short timescale of people moving in, this to ensure the home has up to date information about peoples needs and ensure the home can meet their needs. Other pre-admission assessments seen were poorly recorded and not always legible. Care Homes for Adults (18-65 years) Page 14 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from choices to enable them to exercise day to day control over their lives and from having their personal care needs met in the way they preferred and with respect for their privacy and dignity. Evidence: The AQAA states We are offering more choices of activities both inside and outside the home. We have been trying to do different activities with the guys, swimming, horse riding etc. All our service users have individual care plans and are updated regularly. These ensure we offer equality and diversity. Each person living at the home has a care file. Care files include important background information about each person, however the plans do not always identify all care needs and support required to meet those needs. For example, a social services assessment states one individual can be dis-inhibited ... routine and structure may minimise anxiety levels. There are no care or risk assessment plans in place with guidelines for staff on how to support this individual when they demonstrate dis-inhibited behaviours or become anxious. Additionally, there have been further changes to this persons needs Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: that have required the support from a health professional. Charts are being maintained to monitor the change in needs, but there is no care plan in place to advise staff on this change and what is expected of them to support the individual. Staff spoken with had a very good understanding of peoples individual needs. Staff were observed communicating with people who use the service effectively and respectfully. Care plans however lack detail of information to guide staff how to communicate with individuals in their preferred style. This is important to people living in this home and reminds staff of individuals particular styles of communicating. For example, whether a person is able to communicate verbally and can understand what is being said or whether sometimes this may prove to be difficult and staff need to use gestures, nodding and pointing. The homes approach to care planning is not consistently person centered (PC), in that the plans do not focus on the preferences skills and goals of each person. Improvements should be made in ensuring people who live at this home are taking part in this process. This would mean care plans need to be in a reading style suited to people who live at 55 Daventry Road, such as, using pictures and symbols to aid individuals understanding. This would provide individuals with the chance to influence the way their needs are met, by whom and at times to suit them. Comments in surveys received from relatives of people who live at the home include start treating x as an individual person rather than part of the whole unit. X has the ability to know what they want.. x does not access the extended community, some months ago x would visit Coventry, Birmingham and many other places, this happens no more. Peoples risk assessments were looked at. There is evidence that people are supported to take manageable risks, and individuals are encouraged to have an independent lifestyle. The risk assessments cover areas such as behaviour, mobility, epilepsy, nutrition and medication. These assessments are for staff to follow so that individuals health and safety is maintained. Detailed behaviour management strategies were in place for one individual. This provides staff with guidance about possible triggers to behaviour, and guidance on how to prevent some behaviours occurring as well as what to do in the event of some behaviours occurring, this includes the possible use of restraint. We looked at another persons records who requires support to manage behavioural needs, it also refers to the use of restraint, however there is no guidance about possible triggers to behaviour, and guidance on how to prevent some behaviours occurring. This could lead to inconsistent and unsafe care being delivered. Comments from the relative of one person who lives at the service if X has one of their episodes and the right staff are on duty, they know how to manage X to de-escalate the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: situation, quite often without having to use PRN. Comments in a survey from a professional connected to the service on how the service could do better include : Care plan and risk assess and act on better; Managing behaviours and Meeting individual needs rather than that of the home. Daily records gave us some information about how people spend their days, any health appointments, how people are on that day together with concerns highlighted. These help staff to communicate with each other and for all communication to be smooth from one shift to another. All the staff spoken with were enthusiastic and had a positive attitude on promoting peoples independence. Throughout the day we saw that staff spoke appropriately to each person and addressed him or her, as they would wish. All care was undertaken in private and the member of staff who was showing us around the home knocked on each door before entering to demonstrate respect that this was a persons home. We also observed people moving around each of the houses unrestricted and using the office area as they wished to chat to staff or just pass the time of day. Care Homes for Adults (18-65 years) Page 17 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a nutritious and varied diet and have access to a range of activities that take into account their needs and preferences. Evidence: In the AQAA, the manager stated that We are encouraging all our service users to lead a healthy lifestyle. We offer them a health and well balanced diet with some treats. We encourage them to spend time with family friends, and encourage their family to spend time with them in their home. We are trying to give them the opportunity to access activities they would not normally choose. To find out whether this was the case, we looked at two peoples care files. Activity planners were seen in individual care plans and showed that people do different things each day either in small groups or on a one to one basis with staff. We saw records which are used to monitor when people take part in a variety of activities based on their individual needs and capabilities, for example, swimming, horse riding, Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: college courses and playing pool. The home supports one person to keep a rabbit. We observed this person spending time with the rabbit and they told us that they enjoyed having the rabbit as a pet. Other residents were also seen to enjoy this new addition to the home. We saw evidence to demonstrate that a number of outings had taken place in 2009 includes visits to Draycote Water, Blooms Garden Centre, the local pub, and Leamington Park. Regular key worker meetings between staff and people who live at the home ensure they are part of any planning of activities within or outside of the home. We also observed staff offering choices during the inspection in less formal ways. Due to the learning needs of the people who live there they require staff support to make any meals / snacks. It was seen that staff understood when residents were indicating that they wanted something and staff responded in a timely and respectful way. Staff were observed offering choices to the people who live there. The home does not employ catering staff, the care staff team prepare all meals and snacks. The AQAA shows that none of twenty three staff have completed training in food hygiene. Menus and records of food consumed by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples needs and preferences. A range of food had been offered including a cooked breakfast, jacket potatoes with fillings, beef stew and dumplings, fish and chips, and chicken and white wine sauce. The kitchens were viewed and shows that they are well stocked with good quality food products. Each house has a separate dining room and there is space for everyone to be seated. The main meal of the day was seen in one house, it appeared well cooked and portions were ample. People are able to eat at their own speed, staff ate their meals with residents creating a sociable occasion. People asked said that they enjoyed the food at the home. In relation to household tasks there are limitations to the extent that residents are able to be involved. However staff encourage them to do so as much as possible even if this is just being with them and observing. The cultural and religious needs of people living at the home are respected and suitable arrangements have been made to meet these. The manager told us that the staff support people to maintain contact with families and friends. We saw examples of visits made by peoples families and some are involved in and consulted about most aspects of the care. Changes to the visit arrangements for one family have been introduced by the organisation. Clear records should be maintained to ensure all decisions made by the on peoples behalf are made in peoples best interest. Page 19 of 36 Care Homes for Adults (18-65 years) 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. Not all people benefit from up to date care files with information about their needs, this could lead to inconsistent care being delivered to people living in the home. Medicine management is considered safe and protects the people who use the service. Evidence: The AQAA tell us All our service users are registered with a doctor and dentist. Those that require chiropody appointments have access to one. All health care needs are met as and when they are needed. A majority of the staff are medication trained and all are aware of medical needs of the service user they are looking after. Staff adhere to the care plans to ensure continuity. To check if this was the case we looked at three peoples care files, audited the medication records of four people, spoke to staff about peoples needs and observed staff interactions with people living at the home. During the inspection staff were seen to be responsive to requests for help and to enjoy a good rapport with the people living at the home. All personal care support was carried out behind closed doors indicating a regard for peoples dignity. We saw and heard staff seeking permission to enter residents bedrooms before entering talking to individuals in a friendly and respectful manner and offering assistance with personal care discreetly. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: Three peoples care plans were looked at. The care files covered all the main areas of care including medical history, personal care, nutrition, continence and mobility. There was information absent from two care files. As previously mentioned, there is no care plan or risk assessment plan in place for one person who has behavioural and emotional needs. Additionally, information seen in body map records maintained at the home and notifications received at the Care Quality Commission show that one person is experiencing a high level of unexplained bruises. There were no care plans or risk plans in place to tell staff how to manage this concern, additionally there was no records to demonstrate if it had been investigated and what the outcome was. Staff have a walkie talkie in place to monitor an individual during the night. There is no risk assessment plan in place to support the use of a device that could impact upon this individuals privacy. The manager discussed the need for the walkie talkie explaining the benefit of this individuals safety. Records show that annual health appointments undertaken as needed. Some weight records showed that the checking of peoples weight has not always been consistent to ensure they are not losing or gaining a significant amount of weight that could be an indicator of an underlying health need. One persons plans told us they had a history of epileptic seizures. On discussion with the manager and staff we were informed that this person has not had any seizures in the past year, however there are current concerns that they maybe having seizures during the night. The care plan does not provide clear guidelines regarding the different seizures that this person can experience, nor does not tell staff about possible signs, symptoms and what staff should do. Staff spoken with were knowledgeable about the people in their care but the lack of documented information describing their care needs means that there is a risk of inconsistent care being delivered to people living in the home. Entries in peoples health records show that they are being supported to attend health care appointments to monitor and treat diagnosed health needs. Peoples records show that they are being supported to attend routine health appointments such as annual health checks, dental check ups, psychologist appointments, and eye tests. The manager explained that due to peoples high support needs no one currently manages their own medication. A sample of Medication Administration Record sheets (MARs) were checked and indicate that staff are recording medication correctly. A member of staff was able to demonstrate a good understanding of safe medication procedures. The home currently carries no controlled drugs that would necessitate any special storage and recording arrangements. The names of staff who are able to Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: administer medication are listed in the front of the administration records. Staff in all parts of the home confirmed that only staff that have received medication training and have been properly observed and assessed. A sample of medication records were examined these were satisfactory. Medications recorded as dispensed tallied with those remaining. The majority of medicines are dispensed from pre-packed blister folders. These were seen to be accurate. Entries on the medication sheets show that the amount of medication received for people is being recorded so that it can be accounted for properly. Staff confirmed that medication is checked daily to make sure that it has been given out and signed for properly so that any errors can be promptly picked up and addressed. The medication was kept in separate medication cabinets in each house. The home does not regularly check and record the temperatures of the rooms where the cabinets are stored. All medicines should be stored below 25C to maintain their stability. The home needs to ensure all medicines are stored in compliance with their product licences. Medication protocols are in place explaining the circumstances under which people should be given PRN (as required) medication. Care Homes for Adults (18-65 years) Page 22 of 36 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. People would be better protected by staff who have received up to date training in the protection of vulnerable adults. Shortfalls in physical intervention training have compromised safe care practices. Evidence: The AQAA states We have regular meetings that professional, staff, service users can raise any concerns. We have an open door policy that any one can come and speak to myself or staff. Our staff have all had safeguarding for vulnerable adults training. We encourage service users to speak to someone they have trust in, and have got a pictorial complaints procedure in their file. Any concerns are dealt with quickly and professionally. To find out if this is the case, we requested the concerns, complaints and compliments folder, looked at staff records and talked to staff about complaints and safeguarding the people who live there. The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. However the complaints policy is not displayed in the home for the benefit of the people who use the service or visitors. The safeguarding policy in place does not include the multi agency approach to safeguarding. The Annual Quality Assurance Assessment (AQAA) states that the home has received four complaints in the past twelve months. Three of which were upheld. Complaints are not Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: always addressed within the timescales stipulated in the homes complaints policy. The manager acknowledges this and tell us in the AQAA that the home needs to improve on this. Comments in a survey from a professional connected to the service on how the service could do better include : we have had to deal with a number of family complaints..and have liaised with the local authority with regards to safeguarding issues. Comments in surveys from two relatives include : We have made several complaints. Some have been answered, but some have been completely ignored. I am totally dissatisfied with the service. I have complained to staff, management and regional management on numerous occasions with involvement from community health nurse to no avail. Four staff spoken with demonstrated a satisfactory understanding of the types of abuse they might encounter and to whom they should report any concerns, however not all staff have received training in the Protection of Vulnerable Adults and whistle blowing. The local authority has supplied the home with safeguarding vulnerable adult work books, which the managers are currently marking. Staff spoken to confirmed that they have completed the work books. Staff were seen to be attentive to the needs of the individuals, using knowledge gained from other professionals, the homes care plans, and their own experience of working with each person. We observed staff taking time to listen and observe signs and cues to ensure they understood peoples views. Individuals who live at the home appeared relaxed with staff which may indicate that they feel safe. There has been one safeguarding incident at the home. This incident has been investigated with the involvement of Social Services and the organisation. As previously noted, to ensure people are protected from inappropriate use of restraint, any actions by staff that could restrain an individual should be clearly documented with information that demonstrates a multi-disciplinary approach. Only staff with up to date training in restraint should use restraint techniques. Peoples money is held in safekeeping by the home. Three peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Receipts are being kept as further evidence of money spent. Care Homes for Adults (18-65 years) Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with clean, comfortable, homely accommodation that is equipped to meet their needs. Evidence: The AQAA states We offer a warm and safe environment. We have constant hot water and warm rooms when needed. Our outer doors have digit locks on to maintain the safety of our service users. All medication and cosh items are in lockable cupboard. Staff request that everyone who enters the building sign in the visitors book. Fire testing and checking the alarms are done on a weekly basis. Every bathroom is cleaned daily and each service users has their bedroom cleaned thoroughly weekly. Washing is done individually and put away by an allocated person. We looked at the environment in which people live, this included peoples personal rooms and communal areas. We sampled relevant health and safety records. Since the last inspection the home has changed their registration with us from two separate homes to one home comprising three separate houses. The three houses are managed by one manager who is registered with us and further supported by a manager or acting manager based at each house. The home was tidy and clean with no unpleasant odours. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: The kitchens were clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. To help maintain good infection control procedures, staff are supplied with paper towels and soap dispenser in the bathroom and kitchen areas. Laundry facilities are domestic in nature but are suitable to the needs of the people who live there, staff support people in undertaking some laundry and cleaning duties. From talking to staff and observations, cupboards containing potentially hazardous materials is being kept locked at all times when not in use. We noted a cupboard that contains hot pipes was not locked. The home took immediate action to lock the cupboard when we raised our concerns that people would be able to access the hot pipes and this may present as a risk. One relative in the surveys received comments the entrance gates and intercom facility to the property are unreliable...the entrance walking and parking areas also need urgent attention. We discussed the external environment with the manager at the inspection who assures us that action has been taken by the home to address these matters. Care Homes for Adults (18-65 years) Page 26 of 36 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. People would benefit from a better trained staff team who have the knowledge and skills needed to carry out their job. People who use this service are protected by robust recruitment procedures that have been consistently followed to ensure staff are suitable to work with vulnerable adults. Evidence: The AQAA states We ensure all our homes are staff according to the needs of our service users. We have a high staff level two service users to one staff member and some on a one to one. We have five waking night staff throughout 55 Daventry Road plus a sleep in and someone on call. Our senior staff have got NVQ3 / 4 or working towards it. We offer a good skill mix and welcome people who have never worked in care prior to this. Our team is enthusiastic and appear to enjoy working within 55 Daventry Road. To check that this is the case, we looked at three staff files, spoke with staff and the manager. During our visit we saw staff talking with and supporting the people who live at 55 Daventry Road with personal care. People were comfortable in the company of the staff and were seen communicating effectively with staff. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: From discussion with the manager and staff, and from looking at staff rotas, we found that the home is supported by a registered manager; two home managers and one acting manager for each of the separate houses; two senior team leaders; three team leader; and care workers. There are typically three care workers available on each day shift to support the needs of the people who live there. The number of staff can vary depending on peoples needs. For example, there are occasions when supporting people in the community two members of staff to support one individual is needed, rotas show that this additional support is being provided. Additionally, funding has been secured for some people to receive one to one support, the rotas show that this being provided. There has been a turnover of staff at the home in the past year. The home has employed new managers for two of the three houses and new care staff. The files of two staff were checked and found to contain records to confirm that appropriate recruitment and vetting procedures are followed, including taking up references and Criminal Record Bureau checks / POVA first (check the list of banned workers) before staff start work at the home. Two recently employed staff confirmed that they had received induction training. The training matrix was seen and shows that not all staff have completed or had refresher courses in areas of mandatory training. The manager informs that this is currently being addressed and training courses have been planned. Comments in a survey from a professionals connected to the service on how the service could do better include :Develop and nurture a positive/ motivated staff culture, Ensure staff are skilled and competent; Staff retention and training 38 of care staff have achieved a minimum of level two in the National Vocational Qualification in care. This is below the minimum level of 50 of staff required. The AQAA states that the home needs to improve on regular supervisions and keep up to date with mandatory training. The files seen show that supervision of staff is not taking place on a regular basis. Supervision can be an essential tool in staff development and to help protect residents by giving staff the opportunity to speak in private about their work. It would be positive if the frequency of sessions were set at six per year as detailed in the National Minimum Standards. Staff spoken to told us that they felt supported and that the home had improved with clearer lines of accountability in place. Comments in one survey include I find that the home employ nice staff of different ages, male and female, and respond to any concerns I have. There is not much room for improvement. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of an effective quality monitoring system in the home means that people are not listened to or consulted about how the home runs or develops. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the service manager was completed to a poor standard. When asked what the home could do better the manager informs we are going to improve our communication with families of our service users, and we will do this by arranging a coffee morning and introducing the new home managers as well introducing the new staff. The AQAA was completed in November 2009, however we have found no evidence that this objective has been planned for or achieved. We looked at how the home monitors the quality of the service it provides. We found that there were a number of aspects of the running of the home that needed more careful attention such as the care plans, risk assessments and the quality monitoring process. Quality assurance systems in place are limited to an annual satisfaction survey of people who live in one house of the home. The manager had not surveyed other stakeholders, for example, GP, District Nurse or Chiropodist. There are no residents or relatives Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: meetings. We were told that peoples views are sought at reviews, however there was limited documentation of this. Further work is required to improve quality assurance systems to ensure that the people who live at 55 Daventry Road are happy with service provided. Comments in a survey from a professional connected to the service on how the service could do better include : Manage relationships with family better; communicate better with all - including commissioners There was evidence from a random check of records that equipment is regularly serviced and maintained health and safety checks are carried out. A number of checks are made by staff to make sure that peoples health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. Staff meetings are periodically held in each house. It was evident that the manager had discussed with staff the management of medication, supervision and care plans to ensure the quality of care and services provided is improved. As previously noted, peoples money is held in safekeeping by the home. Three peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Care Homes for Adults (18-65 years) Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 2 14 Prospective residents must have a detailed assessment of their needs completed prior to their admission. 08/03/2010 This is necessary so that everyone is clear that the home is able to meet their needs and so that any essential training identified can be arranged in advance of the person moving in. 2 34 18 Staff must receive all the necessary mandatory training, including food hygiene, first aid, moving and handling. 10/04/2010 This will ensure that residents health and safety is protected when staff are providing care and supporting them. 3 35 18 Sufficient numbers of staff 10/04/2010 Page 32 of 36 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 Description Timescale for action must have undertaken specialist training. This should include:challenging behaviour, epilepsy, and communication for example Makaton. This will ensure residents individual needs are met. 4 39 24 The quality auditing system that is robust must be improved. A report must be produced that summarises the findings of the auditing and sets actions and targets for improvement. 30/04/2010 This will ensure that the service is acting in the best interest of those using the service and demonstrate planned improvements. 5 42 13 The manager must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to supporting people with behavioural and emotional needs. 08/03/2010 This will ensure that appropriate and consistent care practices are used. 6 42 13 All areas of risk are identified, and 08/03/2010 Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action appropriate plans in place to minimise any risks. This relates specifically to use of restraint. This will ensure the appropriate actions in the use of restraint are in place. 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 The home needs to ensure that the information provided to prospective residents details up to date information and includes the weekly fees and any other costs. People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Care plans should be updated to show the changing needs of people living in the home. This will make sure that people have their current care needs met. Clear records should be maintained to demonstrate how the home is making decisions in peoples best interests in relation to maintaining relationships that are important to them. The purchase of a refrigerator thermometer to monitor the maximum, minimum temperatures to ensure that all medicines are stored in compliance with their product licences is advised to be purchased. Page 34 of 36 2 5 3 4 6 6 5 15 6 20 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 7 22 A copy of the complaints procedure should be made available in the home at all times and should be clearly displayed throughout the service. This will help to ensure that people who use the service, staff and visitors have a clear understanding of how to make a complaint. Proceed with plans to provide staff with restraint training updates where they have not recently received this training. This is necessary to ensure that staff deliver care in a safe way to protect people from harm. Proceed with plans to provide staff with safeguarding training where they have not received this training. This is necessary to ensure that staff are equipped to protect people from harm. All staff should complete the required training to provide safe care and services to the people at the home. The training schedule should be kept updated and show the dates when refresher training should be undertaken by. This will ensure that staff get their skills and knowledge updated regularly. 50 of staff should be qualified to NVQ level two to ensure people are supported by staff who have the competencies and qualities required to meet their needs. Staff should receive formal supervision at least six times per year. This is to ensure that individual training and performance needs are being addressed and met. Proceed with plans to survey the views of the people at the home, their relatives and other interested parties so that they can contribute to the development of the service. 8 23 9 23 10 32 11 32 12 36 13 37 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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