Care Home: 59 & 61 Whipton Barton Road

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What the care home does well Systems are in place to ensure prospective residents` needs would be fully assessed, promoting the success of any admission to the home (although it is not intended to admit anyone else to the home). The wellbeing and views of those living at the home - or of their advocates underpin the review and development of the service, with action taken to 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 promote the health and welfare of everyone at the home. Limitations on facilities, their choices or human rights are documented, showing how individual choices have been made or why others have made decisions, to evidence these are in the person`s best interests. Systems are in place to ensure complaints are addressed, to improve the service people get. Staffing arrangements help to ensure that people`s needs are met consistently and safely, with recruitment practices protecting them from unsuitable staff. What has improved since the last inspection? Opportunities for personal development and fulfilment have improved, including that each person is supported to participate in the community around the home, which promotes the quality of their life. Staff receive training appropriate to the work they are to do, including training on safe working practices. At least half of the staff have achieved a recognised care qualification. The accommodation has been made more homely, pleasant and safe, with refurbishment of one lounge and new kitchen fittings, for example, and recommended routine servicing or maintenance carried out. What the care home could do better: Having care plans available with sufficient and up-to-date information about each individual`s needs, personal goals or risks to their welfare would help to ensure each person gets person-centred and safe support to meet all their needs and to make appropriate decisions. Although medication is managed carefully on behalf of those who live at the home, some additional action would make systems safer. Addressing hand hygiene more fully would reduce cross-infection risks within the home. This was raised at our last inspection. People would benefit from improvements to the staff induction programme and more formal support for staff. Various measures are in place to prevent people being harmed, although ensuring staff know local safeguarding procedures would increase the level of protection people have. Timely action on certain matters would help to ensure the home is run in people`s best interests, such as for the manager to complete a management course so that she is qualified for the role.59 & 61 Whipton Barton RoadDS0000064093.V377230.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 59 & 61 Whipton Barton Road 59 & 61 Whipton Barton Road Exeter Devon EX1 3NE Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 21 August 2009 10 am 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 1 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. 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 home adults 18-65 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. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 59 & 61 Whipton Barton Road Address 59 & 61 Whipton Barton Road Exeter Devon EX1 3NE 01392 462512 01392 873233 gillian.bond@nhs.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Premier Living (Devon Partnership NHS Trust) Mrs Gillian Ann Bond Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 4. Date of last inspection 29th August 2008 Brief Description of the Service: The home provides personal care for up to four younger adults who have a learning disability. It cannot offer nursing care other than that which local district nurses can provide for. It is intended that this registered service will close by 31 March 2009, with planning of more suitable support services for current residents underway. The home is two adjacent modern bungalows converted into one property, with nothing to distinguish it externally as a care home. The gardens to the rear and front of the property are still divided into two. It is in a residential area, with local shops, and roadside parking outside the home. There are four single bedrooms, with two lounge/dining rooms, a relaxation room, a piano room, two kitchens, two bathrooms, two laundry rooms and a staff office. Coded locks prevent free movement between the two sides of the home. Weekly fees at the time of the inspection were £1500 - 3500, depending on individuals’ needs. These are negotiated through Social Services, as part of a block contracting arrangement. Fees do not include toiletries, chiropody, hairdressing, personal clothing, holidays, entrance fees and the cost of some meals on outings. Nor do they include hire of the home’s transport, a lease car (which all people living at the home are expected to contribute to), and fuel. Our previous inspection reports on the home are available in the home’s office, or they can be viewed, downloaded or requested through our website. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place as part of our usual inspection programme. Prior to our visit to the home, the home had returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service they offered and any plans for the future. It included general information about the people living at the home and the staff, some assessment of what the home does well, and any plans for improving the service. We also sent surveys to the home for them to give to the four people living at the home and to three staff. There was a lack of certainty that these had been given out, and none were returned. Our unannounced visit to the home took place over seven hours on a weekday. Three people were living at the home at the time. We could not get their views in detail, because of communication difficulties, but two were able to answer some of our questions. We looked in some depth at the care and support all three received. We did this by reading their care records and related information (medication records, personal monies records, etc.), and looked at the accommodation in relation to their needs. We found out what it was like living at the home from them and by talking with staff (including two agency carers), observing care or interactions between staff and the people they supported, and reading records. We also checked staff recruitment and training files, and records relating to health and safety (such as accident and maintenance records). We ended the inspection by discussing our findings with Mrs Gill Bond, the registered manager. Information in this report is from all these sources, and from communication with or about the service since our last inspection. What the service does well: Systems are in place to ensure prospective residents’ needs would be fully assessed, promoting the success of any admission to the home (although it is not intended to admit anyone else to the home). The wellbeing and views of those living at the home - or of their advocates underpin the review and development of the service, with action taken to 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 6 promote the health and welfare of everyone at the home. Limitations on facilities, their choices or human rights are documented, showing how individual choices have been made or why others have made decisions, to evidence these are in the person’s best interests. Systems are in place to ensure complaints are addressed, to improve the service people get. Staffing arrangements help to ensure that people’s needs are met consistently and safely, with recruitment practices protecting them from unsuitable staff. What has improved since the last inspection? What they could do better: Having care plans available with sufficient and up-to-date information about each individual’s needs, personal goals or risks to their welfare would help to ensure each person gets person-centred and safe support to meet all their needs and to make appropriate decisions. Although medication is managed carefully on behalf of those who live at the home, some additional action would make systems safer. Addressing hand hygiene more fully would reduce cross-infection risks within the home. This was raised at our last inspection. People would benefit from improvements to the staff induction programme and more formal support for staff. Various measures are in place to prevent people being harmed, although ensuring staff know local safeguarding procedures would increase the level of protection people have. Timely action on certain matters would help to ensure the home is run in people’s best interests, such as for the manager to complete a management course so that she is qualified for the role. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure prospective residents’ needs would be fully assessed, promoting the success of any admission to the home. EVIDENCE: There have been no admissions to the home since our last inspection, with none intended, given the plans for the future of the home. The manager confirmed the home’s admissions procedure was, in theory, still as thorough as described in our previous reports. Information about prospective residents’ needs would be obtained from current carers and Care Managers. The manager would then meet the person to assess their needs more fully, before inviting them to visit the home. These visits could progress to staying for a meal or overnight, with existing carers if necessary. The individual and supporting professionals would be consulted again before a place at the home was offered. The needs and views of those already living at the home would be considered throughout the enquiry and assessment period. Because of this well thought-out approach, the home would not admit people in an emergency or at short notice. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have up-to-date information about individuals’ needs, personal goals or risks to their welfare, creating a risk that people living at the home may not get person-centred and safe support to meet their needs and to make appropriate decisions. EVIDENCE: We looked at care plans and associated records for the three people living at the home. We saw that the individual as a person was reflected in the care planned and the daily life or routine described for them. One person’s care notes included the person’s own names for members of his family, for example. Staff told us that they found the care plans for individuals were helpful. One found the ‘scripts’ for responding to individuals who repeated questions particularly helpful; these helped to ensure a consistent approach from the staff team. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 11 We saw a comprehensive personal profile for one person (including ‘emotional health’ and ‘sexuality’, for example). Where certain behaviours were noted here, guidelines for staff responses were given in risk assessments elsewhere. Cross-referencing the two sets of information would alert staff to relevant details elsewhere in the person’s care file. Some risk assessments were dated 2007; we noted some needed updating. The manager told us one person had been given an up-to-date version of their care plan, but we found there was no copy for staff to refer to. There was no health plan available to staff in one person’s care records file, although we were shown a copy on the office computer by the manager when we discussed this with her. Another person’s health plan in the office file was dated 2007, and did not reflect current input from certain community-based professionals which staff told us about. Someone’s records included health care information given after a hospital appointment, which had not been added to the person’s current care plan. Some information was undated, so it was not clear how current it was. We were told that time had been given to gathering information for the design of future services for each person living at the home, rather than ensuring there were current plans of care for all of them. A ‘Best interest’ meeting had taken place to consider where one person should stay for a period of recovery after a change in their health, given the relationships within the home and the nature of the accommodation. We heard staff asking people when they wanted their lunch, and discussing what choices there were. Throughout the day, staff checked their understanding of people’s intentions, actions or conversations before acting themselves. People living at the home needed help to manage their finances. There was evidence that staff had contacted the Benefits Agency on behalf of someone when they were sent a letter which the individual would not have been able to respond to. We saw a letter from a medical practitioner stating that they felt one person lacked the ability to manage their own affairs, and that therefore it was appropriate to seek support from other agencies. The manager told us that the process of establishing appointees other than the home’s staff was ongoing (as found at our last inspection). 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12 – 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for individuals’ personal development and fulfilment, promoting people’s wellbeing and quality of life. EVIDENCE: We noted an improvement since our last visit, when we found one person had had relatively few outings, compared to his peers. Care records showed that all three people had been enabled to regularly enjoy leisure activities, go on outings, etc., accompanied by staff. This had been both with other people who lived at the home, and also for people to go out without their peers. People had enjoyed their own interests within the home and in the wider community around the home. One person had been to an air show with others from the home, enjoyed their musical interests, visited the theatre or gone to church 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 13 without their peers, played board games, and been for walks or a drive, for example. Two people had been away on holiday since our last visit. One person was encouraged to do their own laundry, which we saw was part of their care plan. They also helped with some aspects of daily life at the home, such as returning cups, etc. to the kitchen. Care records showed some people helped staff at mealtimes in various ways. One person’s care plan indicated they might be reluctant to participate in household chores, and staff told us they enabled the person to occupy themselves in other ways – usually with a preferred leisure activity such as drawing or going out in the garden. Staff were compiling a list of ‘Ideas for Christmas’ for one person without close family. Daily care notes showed some people were enabled to keep in touch with their relatives regularly. Availability of a cordless phone meant people could talk in private, if they wished. The menu for the week of our visit included a variety of main meals, as the evening meal, such as poached fish, vegetable lasagne, mixed grill, and a roast. The lunchtime menu was of lighter meals such as hot dogs, with a brunch on Saturday. People enjoyed home-grown tomatoes in their salads at lunchtime, during our visit. Staff told us one person often declined what they were initially offered from the menu, but would then indicate what they wanted, which the staff would prepare for them. We later heard staff checking with people what they wanted for lunch. One person went out with staff during our visit to buy ingredients for the meal they chose. We saw fresh produce, a range of condiments and sauces, etc. in the two kitchens. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18 – 20. People using the 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 generally receive healthcare and personal support they need and want, through multidisciplinary input from various professionals as well as the staff. Their medication is managed carefully on their behalf, although some additional action would make systems safer. EVIDENCE: During our visit, staff were calm, patient, attentive and responsive to the people they were supporting. We heard supportive conversations, with staff encouraging people and responding in ways that would promote the person’s self-esteem. They prompted people discretely, through the day, to visit the toilet. Housekeeping duties were carried out around people’s needs and wishes - staff stopping cleaning, for example, to spend time with people who chose to interact with them. And we saw people responding positively to the staff. Staff recognised potential triggers that could change the behaviour of people they were supporting, and responded in a consistent way. As indicated in one 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 15 person’s care plan, they told us that reading to stories to one individual could be calming, and one sat with this person during our visit for this purpose. They added that the stories should be of a particular nature if this was to be an effective strategy, something that was not detailed in the care plan we saw. We were told that staff group handovers and writing of care records had been modified because they were stressful to the people living at the home. When we looked at incident forms that staff had completed, they showed that staff had followed written protocols, trying to use distraction to diffuse situations, for example, and with good records of events leading up to the incident, which was useful for future learning. We noted slightly different, more familiar language was used in one person’s care records as compared to others, which we discussed with the manager. There was evidence that people saw medical staff regularly, with regular health checks on their weight, blood pressure, etc. thus carried out, as well as specialist support given for mental health needs, etc. Some additional detail would have been helpful – such as what blood tests were for, where these were noted. People had had sight tests in the last year. We saw from care records that staff had contacted the Learning Disability link nurse at a local hospital when someone who lived at the home was to have treatment there. Staff recorded medication received into the home from the supplying pharmacy. Topical preparations (such as those for use when bathing) had been signed for, on administration sheets. Daily administration of medication was generally recorded well. However, we noted that whilst staff had recorded what dose had been given in one case, as is required where a variable dose had been prescribed, they had not done this for another medication. Staff confirmed there were no controlled drugs prescribed currently, nor any medication requiring cool storage in a fridge. Where someone was prescribed an antipsychotic for use ‘when required’, records indicated it was not given often. When staff gave any medication that was for use ‘when required’, they had recorded the circumstances in which it was administered. We also saw that senior staff had been consulted first, which was in line with individual written protocols in people’s care records. Medication for one person was taken with them when they went on outings, for use if required. We saw the container used to take the medication out of the home, but the quantity of medication in it was different from that which staff told us was usually taken out. There was no protocol for this procedure, or record of what was taken out of the home and returned. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure complaints are addressed, to improve the service people get. Various measures are in place to prevent people being harmed, although staff lack knowledge of local safeguarding procedures, which reduces the level of protection people could have. EVIDENCE: The AQAA said the home had not received any complaints since our last inspection. We have not received any complaints in that time either. The manager said she would update the home’s written complaints procedure with our new contact details. Everyone living at the home would need support to ensure any complaint was heard and addressed. Staff said that they would report any signs of unhappiness to senior staff, who they felt would listen and act on what they were told. The people living at the home approached staff freely during our visit, appearing at ease with them. People’s expressed choices were noted in daily care records, and were respected by staff during our visit. Staff we spoke with could define abusive practices and were clear about their responsibility to report any concerns, but were unclear about the local authority’s safeguarding procedures or to who they could report any concerns (if necessary) outside of the home. Contact details for the local learning 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 17 disability safeguarding team were displayed in the office which staff used, and the manager said all staff had been told. Staff updating on safeguarding was overdue, however, which the manager explained was due to a lack of suitable online training. A learning package used by the home did not include the local authority’s safeguarding procedures, or other local agencies to who safeguarding concerns could be reported if necessary. The manager told us the provider was trying to find other training on safeguarding. Risk assessments in people’s care records included potential issues around individuals’ ability or inability to give informed consent. Thus there was guidance for staff relating to their medication, and hospital treatment (if required), for example. Staff were also reminded here to be mindful of the implications of the Deprivation of Liberty Safeguards. We checked the personal monies accounts kept by the home for the three people living there. Two staff had signed transactions to verify them, relevant receipts were available, and cash held matched the totals shown on each account. Statements were also available for individuals’ bank accounts; these could be cross-referenced with records kept when staff took and returned people’s debit cards, when withdrawing money on their behalf. Property lists had been written for individuals. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. People using the 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 accommodation that is generally clean, more homely and safe, although an unaddressed cross-infection risk could affect people’s wellbeing. EVIDENCE: Bedrooms had been personalised, reflecting individuals’ interests; some had direct access to the gardens. Throughout our visit, doors elsewhere were open to the gardens, with garden furniture provided and colourful flowers. One lounge had been tastefully redecorated since our last visit, with a new carpet fitted. A relaxation room was available in one half of the home, with special lighting, etc. Care needed to be taken that a piano room remained a pleasant room and did not return to being used for storage; the easy chairs had been removed since our last visit. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 19 New kitchen units had been fitted since our last visit, and a new cooker. A bathroom had been made more welcoming and less institutionalised since our last visit. There are showerheads over the baths, and some grab rails to help people when getting in/out of the bath. Bedrooms, toilets and bathrooms had privacy locks. Staff felt they had a safe work place, and told us that repairs were addressed in a timely way – usually 2-3 days, according to the maintenance log we were shown. Staff had reported a lounge door, designated as a fire door, that wasn’t shutting properly. However, we found a laundry door (also a ‘fire door’) held open by inappropriate means, which we brought to the manager’s attention. The fire safety log included records of weekly testing of fire alarms and emergency lighting, as well as checks on fire escape routes and fire extinguishers. The fire risk assessment had been reviewed in May 2009. Fire drills were carried out 6-monthly when an external trainer gave staff training. The home generally looked clean, and was free of malodours. We saw staff using disposable gloves and aprons when they were to provide personal care. We heard a staff member encourage someone who lived at the home to wash their hands before helping with some cooking. There were two laundry rooms, separate from food preparation areas, where washing machines have recommended programmes for proper cleaning of laundry. We had raised the issue on two previous inspections that there was no soap or hand-drying facilities in these laundry rooms. This was still the case on this visit. We were told this was because quotes were being sought for replacing the sinks, to provide appropriate facilities for handwashing – without providing soap and paper towels or making alternative provision, as a basic infection control measure, in the two years since we first raised the matter. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32 - 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements help to ensure that people’s needs are met consistently and safely, although people would benefit from improvements to aspects of training and support for staff. Recruitment practices protect people living at the home from unsuitable staff. EVIDENCE: When we arrived, there were 3 people living at the home, with 3 care staff on duty who had known the people living at the home for at least several months. An agency carer was also on duty, who had worked at the home before. In the afternoon, 3 of the 4 staff on duty were agency staff, 2 of who had known the people living at the home for some time. The manager was the fourth member of the care team. Two awake staff worked overnight. We were told these were the usual staffing levels. This is relatively better staffing levels during the day than at our last visit, when 4 people lived at the home supported by the same number of staff. Care staff also carried out 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 21 housekeeping duties – cooking, cleaning, gardening, decorating, etc. – with people living at the home sometimes helping. A protocol for covering staff shortfalls was displayed in the office, as well as for summoning help from the other staff member at night, when there was a staff member on duty in each half of the home. Staff were supporting people at the home in unsettled times, yet appeared committed to providing person-centred care and an appropriate home life for the people they supported. Only one staff member had been recruited since our last inspection (though some staff had been transferred from the provider’s other registered services). They had previous care work experience. Their recruitment file contained required information, including timely police checks and two references, which had been obtained before they were employed. Gaps in their employment history had been explored, as a now standard part of the interview process. All this helps to ensure they were fit to work in this care setting. They had also been given a contract of employment. We saw job offer letters to new staff included that they must undergo a compulsory induction. There was a record showing a new staff member had undergone such an induction. We were told that work was still being done to bring the home’s induction programme in line with nationally recognised standards for social care staff, however. An agency staff member we spoke with told us they had had a good induction on their first shift at the home, and confirmed they had always worked with the home’s own staff on their shifts there. Of 21 permanent staff, 12 have a recognised care qualification. Fire, manual handling and infection control updates are provided by a trainer, and staff are sent a letter if they do not attend this annually. The provider has chosen to train or update staff on other topics by ‘e-learning’ (i.e. computerbased modules that staff complete online). The manager explained that when staff attempt an online questionnaire, a notification is sent to her, and she then checks their responses. Senior managers are also sent information from which they can identify if further action is needed – such as for staff who have not undertaken e-learning as expected. A computer-held overview of training identified when staff had last attended training and highlighted anyone overdue for an update – information monitored by external managers, the manager told us. It appeared from the overview that the majority of staff had had annual updates in safe working practices and some topics related to caring for people living at the home. The newest staff member had undertaken learning on safe working practices, equality and diversity, and breakaway techniques. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 22 New staff told us they had had one-to-one supervision sessions with senior staff two weeks’ after starting to work at the home, and could request such meetings at any time. They said they had been told to ask rather than assume anything. We were also told that senior staff were always on call if not at the home, and we observed that staff contacted them during our visit, in line with certain of the home’s written procedures. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People using the 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’s views and welfare underpin the review and development of the service, although more timely action on certain matters would further ensure it is run in their best interests. EVIDENCE: The home’s manager, Gill Bond, was registered by us in April 2007, having previously been the registered manager of a similar care home owned by the same provider. She qualified originally as a nurse for people with Learning Disabilities. She is undertaking a recognised course for managers of care services, which she had hoped to achieve this year but now hopes to complete by next summer. Staff told us that senior staff were very supportive. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 24 Although we noted there were positive developments since our last inspection, we also noted some delays in action. Appointeeship and certain hand-washing facilities remained unresolved after 2 years, for example. Staff had had appraisals but still did not receive more regular formal supervision. And it was not clear that our surveys, sent earlier, had been given out. When we asked who was in charge of the home at the time of our arrival, we were told no one person was. One staff told us that whoever was present when an incident or accident occurred would deem themselves in charge of that situation. Certain staff were allocated key-holders for the shift. We discussed ‘in charge’ arrangements with the manager later, citing a situation such as a fire when one person usually takes charge, and whether there should be clearer indication of who was in charge of the home on each shift. No-one living at the home was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. There was some local information in the office relating to the deprivation of liberty safeguards. The home had noted that a medical decision had been made without full consultation, contacting the person’s care manager to raise the matter of ‘best interests’ discussions. Improving individuals’ care in the longer-term had been given a priority since our last inspection, with multidisciplinary input and discussions to ascertain what individuals might want for themselves in the future, in terms of support, care and where to live. In the shorter term, care or health reviews, staff meetings and observations were used to improve the quality of people’s lives. The AQAA indicated that servicing of equipment and facilities was up-to-date. The home’s contract of employment included health and safety responsibilities. An agency staff we spoke with was able to describe fire procedures appropriately. We saw duty rotas identified a first aider on each shift. Records we read indicated that someone had attended the local Casualty department after sustaining an injury in an accident at the home, but we had not been notified of this. Senior staff said they were unaware they had to tell us, thinking this was only necessary for very serious injuries such as fractures. There is guidance for care services on our website, on notifiable occurrences. Radiator covers were in place. Where we checked, bath water temperature was at a safe level, and staff told us this was always the case. Systems had been put in place, since our last inspection, to monitor hot water temperatures to ensure people were not put at risk of scalding. We found staff had not recorded water temperatures regularly in recent days, which the manager said she would follow up. Fridge and freezer temperatures had been recorded, and showed food had been stored at appropriate temperatures for safety. There were lists of cleaning duties in the kitchens, and equipment looked clean. 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Version 5.2 Page 26 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(1) & (2) Requirement You must review each person’s care plan if their needs change (particularly their health needs), or at a recommended minimum interval of 6 months, in consultation with the individual or their representative wherever possible, notifying the person of any changes, and making the current care plan available to them and to staff – To ensure that people’s health & welfare needs will be met, in a person centred way. You must ensure the home has safe, effective arrangements for the receipt, recording, handling & administration of medicines, especially with regard to a) Medication that is taken out of the home for administration if required, ensuring there is clear guidance for staff about its use; b) Records of what dose has been given, where a variable dose had been prescribed – 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 27 Timescale for action 30/11/09 2 YA20 13(2) 31/10/09 3. YA23 13(6) So that people’s medication is managed safely on their behalf. You must make arrangements, through training staff or other measures, including ensuring that all staff know the local authority’s safeguarding procedures for reporting allegations of abuse – To fully safeguard people living at the home from abuse or harm. Original timescale of 31/12/08 not met. 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA9 YA35 YA36 Good Practice Recommendations You should ensure that each person’s personal risk assessments are regularly reviewed, including as part of their care plan reviews. The staff induction training programme should be to Skills for Care specifications. Staff should have regular recorded supervision meetings (at least 6 times a year) with their senior/manager in addition to regular contact on day-to-day practice, to receive the support and supervision they need to carry out their jobs. The registered manager should obtain the Registered Managers Award or an equivalent qualification, to help ensure she is qualified and competent to run the home and to meet its stated purpose, so people living at the home benefit from a well run home. There should be proper hand washing facilities in laundry areas to reduce cross-infection risks, since staff may be handling soiled/infected items for washing. 4 YA37 5 YA30 59 & 61 Whipton Barton Road DS0000064093.V377230.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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