Care Home: 8-10 Richmond Road

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What the care home does well The acting manager makes sure she gets really good information about people and their needs before they come to live at the service so the staff can support them. People can come for day and overnight stays before admission so they get to meet the other people living at the home and staff. People who live at the service told us the staff are kind, helpful and supportive, that they are able to make their own decisions and that they are encouraged to keep their life skills and be independent. The staff are very good at supporting people who have moved out into the community and provide an invaluable support structure. People who live at the service go out regularly and attend day services, college and have jobs. They tell us they can come and go as they please. They are encouraged to develop and maintain relationships with family, friends and partners. People choose the menu and can always make their own drinks and snacks. Routines are very flexible. The home is comfortable, homely and homely. People live in a pleasant and warm environment and they told us this helps to keep them calm and relaxed. People know they can complain, they know how to do this and they are encouraged to raise concerns with staff. They tell us they would feel confident in raising any concerns. The service already has over 50% of its staff trained to National Vocational Qualification level 2. Health and safety testing is done as required to make sure people living at the service and staff are using safe equipment. What has improved since the last inspection? Only one requirement was set following our last inspection of the service, about making sure that record keeping is up to date and accurate, this remains outstanding. The new acting manager has implemented lots of changes and the policies and procedures are better organised. There have been many improvements to the decor of the home and the service has a warm and homely feel. The acting manager has improved relationships with outside agencies to build a good support network for people living at the service. What the care home could do better: Care plans could be much better, they need to have a consistent format so that staff can access the information and guidance they need easily. These plans could be better particularly in terms of assessing physical health care needs and any safeguarding concerns. The assessment of risk and plans to minimise these could be much better so the staff are clear about how to support people appropriately. The staff need to have a better understanding of the Mental Capacity Act and how this affects their work so they can make sure that people make decisions for themselves unless they lack capacity. The medication could be better organised, recording and administration could be safer and there could be better checks in place to make sure people receive their medication as prescribed by their Doctor. The recruitment of staff could be much safer and the acting manager could be better at making sure she has obtained all of the information and documents needed to check people are suitable to work with vulnerable people before they start work. There could be better access to induction, training and supervision so that staff are competent and understand their roles and responsibilities. The management of the service could be much better, and hopefully the extra days allocated now for management tasks will help to move this along. The acting manager could progress her application to become registered with greater speed to make sure the service has a person who is accountable. Equally the owner could make sure she is checking on the way the home is being run more regularly so she is happy with the progress being made. The acting manager and the owner could be better at auditing the service, and getting feedback from people who live there to help them decide how to develop and improve the service being provided. Key inspection report Care homes for adults (18-65 years) Name: Address: 8-10 Richmond Road 8-10 Richmond Road Lincoln Lincolnshire LN1 1LQ     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: Linda Hirst     Date: 0 2 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: 8-10 Richmond Road 8-10 Richmond Road Lincoln Lincolnshire LN1 1LQ 01522887123 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Hayley Stephens,Mrs Jill Ross care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The home is registered to provide care for service users of both sexes whose primary needs fall within the following categories:- Mental Disorder, excluding learning disability or dementia (MD) - 12 Date of last inspection Brief description of the care home 8-10 Richmond Road is a care home providing personal care and accommodation for 12 younger adults with Mental Health needs. The home was opened in 1993 and is located in a residential area of Lincoln city centre and is within easy walking distance to the city centre and all the amenities the city has to offer. The building consists of a pair of two-storey Victorian terraced houses connected via an internal corridor. An extension has been added to number 10 to afford more communal space on the ground floor. Accommodation is in 10 single bedrooms and one double room; number 8 accommodating five people and number ten accommodating seven. Each house has its own kitchen and laundry, but facilities are shared freely between the people living there. The home has small frontage gardens and small, steep interconnected rear gardens, which are maintained by the people living at the service. There is no Care Homes for Adults (18-65 years) Page 4 of 39 Over 65 0 12 1 9 1 2 2 0 0 8 Brief description of the care home designated car parking area but the home has six residents parking permits for visitors. The home has a single rate, which is currently £365 per week. Care Homes for Adults (18-65 years) Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We did not receive this back, (in spite of sending a reminder letter) until after we did our visit. The acting manager and provider have been warned that this must be returned on time in Care Homes for Adults (18-65 years) Page 6 of 39 future so we can use it to plan our visit and to decide what areas to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out surveys to people living at the home and to staff to get their views on the service being provided. We received 4 surveys from people who live at the home and 4 from staff. Comments included, the home is very friendly and has a warm and welcoming environment helping long term residents relax and new ones feel more settled, and (it is) clean and tidy, they do well with hygiene. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. All of the people who live at the home are White, British at the moment, the staff team come from a wide variety of backgrounds and experiences. We spoke with two members of staff to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Adults (18-65 years) Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: Care plans could be much better, they need to have a consistent format so that staff can access the information and guidance they need easily. These plans could be better particularly in terms of assessing physical health care needs and any safeguarding concerns. The assessment of risk and plans to minimise these could be much better so the staff are clear about how to support people appropriately. The staff need to have a better understanding of the Mental Capacity Act and how this Care Homes for Adults (18-65 years) Page 8 of 39 affects their work so they can make sure that people make decisions for themselves unless they lack capacity. The medication could be better organised, recording and administration could be safer and there could be better checks in place to make sure people receive their medication as prescribed by their Doctor. The recruitment of staff could be much safer and the acting manager could be better at making sure she has obtained all of the information and documents needed to check people are suitable to work with vulnerable people before they start work. There could be better access to induction, training and supervision so that staff are competent and understand their roles and responsibilities. The management of the service could be much better, and hopefully the extra days allocated now for management tasks will help to move this along. The acting manager could progress her application to become registered with greater speed to make sure the service has a person who is accountable. Equally the owner could make sure she is checking on the way the home is being run more regularly so she is happy with the progress being made. The acting manager and the owner could be better at auditing the service, and getting feedback from people who live there to help them decide how to develop and improve the service being provided. 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. Care Homes for Adults (18-65 years) Page 9 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the home can be assured that they will receive a full assessment, ensuring their needs can be met at the service. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they receive comprehensive assessment information on people who want to live at the home. They set up trial periods involving regular visits to the home, overnight stays, and they tell us they work closely with the referring agencies and all those involved in the transition. Their plans for improvement include referring people on to independent advocates. We looked at the care plans of three people who live at the service, including the person most recently admitted. We found that each person has very comprehensive information on their files demonstrating a full assessment has been done on them before admission. This includes information on their needs, their risk history and their background. This information is updated regularly through the Care Programme Approach reviews. Care Homes for Adults (18-65 years) Page 11 of 39 Evidence: The people we spoke with told us, I was in (Hospital) for some time following the closure of my rehabilitation placement and I chose to come here as one or two clients and my nurse said it was fantastic, the best place of its kind in Lincoln. I came in for a couple of visits before I moved in and I can honestly say its brilliant, I love it here. The staff we spoke with told us, I dont have anything to do with initial assessments, but I meet people on their initial visits. Community Nurses, social workers, the manager and the doctor are usually involved in making the decision for people to come in. They let us know when they will admit people. We usually get a care plan, sometimes on the day they come in. I feel that most of the time we get enough information but we often discover other things they havent written. We then assess habits and so on. Other staff told us in surveys, the home makes service users very welcome. It is a very relaxed and friendly environment, another agreed, the home is very friendly and has a warm and welcoming environment helping long term residents relax and new ones feel more settled. Care Homes for Adults (18-65 years) Page 12 of 39 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. Individuals are involved in decisions about their lives, but the systems for planning their care and making sure staff can manage risks effectively are not robust enough to ensure a consistent and safe service is provided. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they develop and agree an individual plan with each person, which includes rehabilitation. They say they have successfully supported 4 people to move into supported living in 2009 and they work closely with the agencies involved to ensure the adequate support package is in place before they move, and take an active part in the transmission. They acknowledge care plans need to be better. We looked at the care plans of four people and found that there is no consistent care planning format and no effective care plan written for any of the people whose files we saw. There was some good information held in the daily records which shows us that staff are monitoring behaviour and mental health, but without these being translated Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: into a plan of care there is insufficient guidance to staff on how to provide a consistent approach to the complex needs of people living at the service. We also found that the plans have not been reviewed and updated to reflect the current needs of people who live in the home. The staff told us, the support plans are written by the managers, and documents have been passed to us about their needs when they first come to live here and we follow that for a while. I believe we have to update our care plans; ours are not as good as those from Health, we need to know about peoples illness, risks, medication and a bit about them, their history and background. We need the guidance about the care they will need from us. At present the care plans dont give us what we need. The people living at the service told us, I have two support plans, my Care Programme Approach one and my one here which they talk to me about. Im pretty independent, I know whats in my plan, they have talked to me about it. Another said, they talk to me about what I need help with. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they promote independence and decision making. When we looked at the care plans we saw clear evidence that the acting manager understands when an assessment under the Deprivation of Liberty Safeguards (DOLS) is needed and takes steps to make a referral. There is a copy of the Code of Practice at the service. However, decision making other than this is not effectively care planned. We did not see evidence that the Mental Capacity Act is being actively considered by staff, although the acting manager tells us that the staff have had a talk on this subject. We did not see any certificates to prove this has taken place. The staff we spoke with told us, The DOLS thing is still a bit of a mystery for me. We have not had any training on the Mental Capacity Act and Deprivation Of Liberty Safeguards. That said, the staff did tell us in surveys that they support people and accept their decisions, residents have freedom and choice, and another person told us, we promote independence, choice and freedom. People who live at the service tell us they make their own decisions about their lives, I make my own decisions, another told us, I make my own decisions all the time, like about going to stay with (family.) If I want to stay longer, or go earlier, the staff support me and I run things past them. The psychiatrist wanted to reduce my tablets at my last review, but I thought about it and decided I would rather not take the risk. Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they monitor the progress of each residents risks, assessments and daily living needs, they feel however that risk assessments need to be more comprehensive and updated regularly. When we looked at the care plans we found there is good information from the Care Programme Approach documents in terms of risk history and profiling, but this is not then translated into an effective care plan by the staff at the service. We saw some good risk assessments but there is no consistent approach to risk assessment and we also saw some generic risk assessments (aimed at staff rather than concerning people living at the service) in individuals files. The staff we spoke with told us, we have a meeting about a person if they have challenging behaviour, we have had guidance from the manager and we record everything, most of the time this has worked. We are concerned about the risk some people pose, one person shouts out a lot and this has unsettled the group, a few became frightened. One person decided to move rooms. Others are affected when there are issues in the house, they can get agitated, we try and calm (people) down. I would like more detail in risk assessments and new staff need more information about how to manage this. In terms of relapse I would feel most confident about recognising signs and triggers of the people who have lived here the longest. People who live at the service told us about the risks their mental ill health cause for them and others, I have been to Hell and back. I have been told though that I have plateaued. The psychiatrist wanted to reduce my tablets at my last review, but I thought about it and decided I would rather not take the risk. Care Homes for Adults (18-65 years) Page 15 of 39 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 who use services are able to make choices about their life style, and they are supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they encourage people to pursue chosen daily activities, work and training. They tell us that 8 people attend day services, some attend the gym and Information Technology training. The staff support residents with these activities where necessary. We saw daily activity plans in some files and these were signed by the person themselves to show they agree with them. In other cases we could not find any records. That said, during our visit we saw people coming and going from the service, Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: to their day services, to work and going out shopping. It is clear that people come and go as they please. People we spoke with told us, I have a job and in the past I have done lots of courses and I am interested in doing a language course which Im looking into.I go to the gym and I go home every weekend. In the evening though, I just like to relax and watch TV in my bedroom. Another person said, I go out when I want, but I havent wanted to for a while, we go on holiday to caravans at the seaside. Its a good laugh usually. The staff we spoke with told us, 5 people attend (the local day service), 1 person goes to work. No one attends college at the moment but they are looking at this again, 2 people are possibly joining college courses. In terms of activities, we have not been very good, the holiday went ahead, but the residents back out when we arrange things. We had arranged the pictures and the pantomime, but they didnt want to go when it came to it. People go to their groups, sometimes they tell us they dont have the finances for it. There is no budget for activities which makes it difficult. In the past we used to save for special events, but the new residents dont want to go. We bring it up at each residents meeting for discussion and new ideas. Other staff told us in their surveys, (we could improve by) giving residents more say about activities and more money for residents. Another said, (there should be) more social choices and outings . A pool table. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they encourage peoples family and friends to be involved, to visit and come to social occasions. Family members are also invited to formal reviews. We did not see any family or friends visiting during our inspection but people who live at the service told us, I go home every weekend and I go out with my friends, I have four or five really close friends. They are good here, they encourage us to go out, to make friends to see our family. We get on well together, some people need more help than others but we offer support, we understand what people go through. Another told us, I dont go out much because I prefer to stay in, I get on with most of the people who live here, one or two get on my nerves, but I stay out of the way. Staff we spoke with said, no one has a partner that I am aware of. No-one is sexually active as far as I am aware, the day service has done talks about sexuality and contraception. People who live at the service told us that the routines at the service are flexible, and Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: they said they learn key Independence skills, I get up when I want, and I go to bed when I want. If Im going out I dont say where I am going but I will tell them what time I will be back so they dont worry. I do jobs here, I do the hoovering, I sweep the gardens and I do the washing up. Another person told us, I used to live here, and now I have my own place, they helped me learn how to look after myself, how to look after my money and cook. I still come in and do the garden for them and see my friends. I think its a brilliant home. The staff we spoke with told us, we call people to us for their medication between half eight and nine, some go back to their beds after they have taken it. There are some domestic routines with laundry and bedrooms, they all have a job to do to help. Mealtimes are flexible apart from the main tea time, but if people choose to have it at a different time we will accommodate this. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that menus are chosen by people living at the service at their meetings and requested changes implemented. We looked at the menus and these looked varied and nutritious, throughout the day we observed people making their own drinks and snacks, including former residents who pop in for a drink and a snack. Meal times are flexible and relaxed, some eat in the dining room, others eat in their room. Good stocks of food are available at the home. People who live at the service told us, I like the food, I make myself snacks and drinks if I want but the staff make the main meal. Another person told us, the food is good, we have whatever we want and the menu is displayed on the board. We can always ask for something else if we dont like whats on offer. If I had any comment to make it would be to have a few less meals with boiled potatoes, but other than this I cant complain, we get plenty. I did the big shop with staff last night to help out. The staff commented to us, they choose the meals, the odd time they may say they are fed up of something. It is a balanced menu, in summer they will have more salads, BBQs, different puddings and so on. People can make their own snacks and drinks. Staff go out with a resident to do the main shop, the residents bring it in and help put away. Its good training for if they want to go into supported living. Id like to see residents cooking a bit, choosing what they want to cook, managing money and so on. Care Homes for Adults (18-65 years) Page 18 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The arrangements for medication are not safe and do not ensure that people are given their tablets as prescribed by their Doctor. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they encourage and promote sensitive and flexible support by staff to all residents. We looked at care plans and found that issues around personal care are not covered well, although there is a statement in some about gender preferences in terms of staff support. The acting manager has told us in her AQAA that she recognises this as an area for improvement. The people we spoke with told us they do not need any help with personal care and no one made any comments on this aspect of care in their surveys. Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: Staff we spoke with told us, most people need prompts with personal care, some need help with bathing and to make sure they change their clothes. No one needs special adaptations or equipment to help them move safely, they are all pretty mobile. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they have regular health reviews and will also request a review where there are issues of concern. They told us they have comprehensive records of health issues to enable them to monitor any concerns. When we looked at the care plans we did find health, (particularly mental health and behavioural) issues are being monitored via daily records but there was no specific health care plan in place in the three care plans we saw in spite of people having needs to do with Epilepsy and weight management. The people we spoke with told us, I think my health is ok, my mental health certainly is much better. If I need to see a Doctor I arrange this myself. I have a mobile phone and can make my own appointments. Another told us, I feel quite well, my head is getting sorted, I just need to keep taking my medication now. Staff we spoke with told us, we have good relationships with Community Nurses, residents also have annual health checks and one person sees the Doctor monthly . We do not have any ongoing input from general health professionals. The women get access to cervical smears and breast checks when needed. We ask people if they want to go to the Doctors surgery alone, sometimes we will accompany. The chiropodist and opticians assess people and most people have a dentist. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they arrange for regular medication reviews, but they acknowledge that the staff need medication training and they have booked this for February. They have also told us that they need to improve their audits of medication and improve their systems. We looked at the arrangements for medication generally and specifically at the medication for a person we case tracked. The medication cupboard is not secured to the wall, and the acting manager has been advised to check whether this should be changed to meet best practice guidelines. Most of the medication is in dosette boxes but some is in boxes. There is no audit system in place to check that the medication remaining in boxes tallies with the records of medication received into the home and given. Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: When we checked the records we found that staff have been giving tablets at non prescribed times, changing the time for the administration of a prescribed medication without authorisation from the Doctor and omitting a prescribed dose without explanations on the Medication Administration Record (MAR). We found that for the person we case tracked, had too much medication left in respect of 4 prescribed medications, meaning staff had signed to say medication has been given when it has not. We also found that the person had too little medication left in respect of 4 prescribed medications, meaning staff have given medication but not signed to indicate this. We also found loose tablets which need to be recorded and destroyed and we found there are no records of medication destroyed or returned although staff told us they do find loose tablets in the medication cupboard. All of this means that people are not getting their medication as their Doctor prescribed. We left an immediate requirement at the service for them to put things right and we have received an action plan from the acting manager and provider telling us what action they have taken to comply with the requirement. We are satisfied with this response. People who live at the service told us, the staff give out the tablets, they put them into a pot, show the other staff member and we take them one at a time. I have managed my own medication before but have not done this whilst I have lived here. I am happy with the current arrangements. The staff we spoke with know the safe way to give out tablets and they talked us through this. They told us, I think we have a lot going on in the morning and you might get a distraction, which might account for the errors you found. Whether we are all following the procedure, Im not sure. Its a better procedure than we have had in the past when we used to give out medication alone. We thought we had cracked it. I have had training but it was about three years ago. Care Homes for Adults (18-65 years) Page 21 of 39 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 can raise their concerns and be assured that these will be responded to appropriately. The staff at the service do not have the training or understanding of safeguarding issues necessary to ensure people are fully protected from harm. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that there is a copy of the complaints procedure in each house, but they have not had any complaints. They tell us that people who live at the service are aware of complaints procedure and are encouraged to express any concerns. We have not had any complaints made directly to us about the service since our last visit. When we looked around the building we saw the complaints procedure displayed prominently in both houses. We looked at the record of complaints, none have been made but there is a pro forma specifically for this purpose and we noted that on the last visit by the provider she checked if any complaints had been made. The people we spoke with know they can complain and know how to do this, they told us, I have never had to complain, but I would and Im sure they would deal with it. Another said, I have complained before and they sorted it. I was happy with the result. Staff we spoke with know to report concerns and complaints, they told us, I have Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: never received a complaint, but if I did we would fill in a form and give it to the manager who would respond appropriately. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they policies and procedures in place for reporting bad practice, whistle blowing, confidentiality and access to records/residents finances, protection and prevention of abuse, restraint and physical intervention. When we looked in the care plans a person has been appropriately referred for an assessment under the Deprivation of Liberty safeguards (See YA7). There have not been any other safeguarding referrals, although peoples risk profiles indicate some people are potentially vulnerable to abuse. Where this is the case, there should be a risk assessment written by the service in the care plan to ensure staff are aware and that steps can be taken to ensure people are properly protected. We saw that the service has a CD Rom on Safeguarding, but this has not been used yet, and the records we saw shows it has been some time since staff received safeguarding training. There is a copy of the local safeguarding procedures at the service. People who live at the service told us, I have never seen staff behave inappropriately or other service users being aggressive. I would report any concerns to the manager, or to the owner if it was the manager, I wouldnt hesitate. Another told us, I feel safe here, I think the staff look after us well. The staff we spoke with were not altogether sure of their responsibilities in terms of safeguarding, and told us, if service users challenge each other, I would report this as safeguarding, but only if it was over time as that makes it more serious. People tend to live well together you know. I have never seen any member of staff behave badly, I would report to the manager at first, call the Police if it gets worse or if its not dealt with. I am in charge sometimes, but not altogether sure of what to do. Im not sure where the procedures are now to be honest. Care Homes for Adults (18-65 years) Page 23 of 39 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 live in a safe, clean and comfortable environment which meets their needs. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that the home is safe and well maintained, providing a very homely environment. They feel the home suits the needs of people who live at the service, that the home is clean and hygienic, and free from odours. We did a partial tour of the accommodation, including a sample of bedrooms to make sure the home is safe, clean, well maintained and comfortable. We found the service to be homely, comfortable and bedrooms are personalised according to taste, people can choose the decoration themselves. Whilst we were at the service, a new boiler was being fitted. There was one toilet with a pronounced odour, but the acting manager did explain that the cleaning had not been done at that point. People who live at the service told us they like the accommodation, I think the environment you live in really affects your mood and how you feel and it is so relaxed, comfortable and homely here. They are very good at dealing with repairs, my bed broke and I had a new one ordered the same day. The home is also lovely and clean. Another told us, I like it here and I like to smoke, I think its disgusting that I have to Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: go outside; its too cold in this weather. I like my room, the home is clean and they do fix broken things, like the boiler. Other people told us in their surveys, (the home is) Clean and tidy, they do well with hygiene. Staff we spoke with told us, we have a new maintenance book, we record things straight away, any major jobs which need doing. We also state when the job is done. Small appliances we wait a while longer for repairs. I did have infection control training, but quite a while ago, I have done my Health and Hygiene training recently though.Other staff commented to us, (its a) very homely environment, and a cleaner is recommended so we have more time for the residents. Care Homes for Adults (18-65 years) Page 25 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff who work at the home are kind and caring but they have not been recruited in a safe way or been given up to date training to help them understand and carry out their role safely, this potentially places people living at the service at risk. Evidence: The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that 50 of the staff employed have already achieved their National Vocational Qualification Level 2 in care. Staff we spoke with confirmed that they have achieved this qualification. People who live at the service commented to us in their surveys that the staff are helpful. The people we spoke with during our visit confirm this, the staff are lovely, very good, they help me. I think the staff look after us well. They told us there seem to be enough staff on duty, there are two or three staff on during the day, it seems to be enough. Staff we spoke with told us, it depends how many service users are in the building as to how many staff are on. The acting manager needs more time to do her paperwork we could do with another staff as we do the cleaning as well and getting people ready. We dont get very much time for them in the mornings. Other staff told us in their surveys, there should be more staff meetings, and a cleaner is recommended so there is more time for the residents. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: Since we made our visit we have been told by the acting manager that her supernumerary hours have been increased so she can concentrate more on managing the service. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that all of the staff who work at the home have had a Criminal Records Bureau Check and 2 written references. We looked at the staff files of three people to check they have all of the documents and information required by Law to make sure they are suitable to work with vulnerable people. Only one staff file we saw had any written references, and then it was only one. One person had no evidence of a Criminal Records Bureau Check or a Protection of Vulnerable Adults First check. Only one person had a completed application form on file and only one person had evidence of supervision which had been undertaken in November 2008. We were very concerned about this and although the manager insisted that all of the information and documents had been received, they could not be found. We sent the provider an urgent action letter about this matter and they have written to us and told us that all of the documents will be in place by 3rd March 2010. A staff member we spoke with confirmed she has had a Criminal Records Bureau Check, provided two written references and completed an application form. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they work with the common standards induction. When we looked at the staff files we could find only one example of a person completing a common induction standards training. One person had a completed induction checklist in their file and two had no evidence of induction. We also found no clear evidence of recent training taking place, the most up to date training certificate we saw was from 2008, although both the acting manager and staff told us there has been recent training in Food and Hygiene and Fire Safety. Evidence of training is required by Law. Since our visit we have received an assurance in writing from the acting manager that all remaining statutory training had been booked and will be delivered between March and July this year. The people who live at the service told us, the staff seem knowledgeable. The staff we spoke with told us, I have done training on Health and Safety, Fire, but have not had any on Control of Substances Hazardous to Health. I have had no training on mental health as such, a psychologist did come and talk about a particular womans Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: health that was brilliant. Care Homes for Adults (18-65 years) Page 28 of 39 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 service is not being run and managed effectively and in a way which is in the best interests of people living there. Evidence: We send out an Annual Quality Assurance Assessment (AQAA) to each service which they must complete and return to us by a set time every year. We did not receive this within the timescale we set. The return of the document is a legal requirement and failing to return it on time can lead to enforcement action. The service has an acting manager who has not applied to become registered as required. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that the acting manager is experienced and will apply to become registered as soon as possible, they also told us that the acting manager is proficient at networking and building good relationships/communications with outside agencies, families and building a good reputation for the home. As can be seen from this report there are a number of areas where the management Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: of the service needs to improve (YA6, 7, 9, 19, 20, 23, 34, 35 and 39.) The evidence we have gathered shows that the acting manager did not have enough time to attend to her paperwork and ensure that the service was being managed properly as she only had two days a week allocated for this work. We have received written assurances since our visit that she now has four days a week to manage the service, and hopefully this will help bring about some improvements. People living at the service told us, the home is really well run and managed. I think its brilliant and I love it here. Staff we spoke with told us, I have no comments about the manager or how the service is run. Another commented in a survey, (we need) more one to ones with a chosen senior staff member, so that it is more comfortable for staff to discuss their grievances openly. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that they could improve by ensuring more regular/effective quality assurance recording systems are in place and by conducting relative/resident surveys. We asked to see the most recent quality assurance done by the service, but we were told none has been done. We looked at the last report of the monthly visit by the provider, this was dated 8th October 2009. The provider and acting manager agreed that one has been done since but no report has been produced. Even with this, there is no evidence that the service is being visited once a month, with a report being produced by the provider about how the home is being conducted. Given that the acting manager is not registered and that a number of areas of concern have been highlighted by this visit, it is essential the provider evidence to us that she is checking on the areas of concern highlighted by our visit. People who live at the service told us they attend residents meetings but have not been asked for their views on care. The staff we interviewed confirmed that there has not been any quality assurance questionnaires done with them or the people living at the service. Tow people commented to us in surveys that said that there should be more input from the proprietors at the service. The acting manager and provider told us in their Annual Quality Assurance Assessment (AQAA) that the Health and Safety testing has been done at the required intervals. Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: As stated in YA 36, several of the statutory Health and Safety training courses have not been completed, though the acting manager has written to us since our visits to give us the dates for this training to be undertaken. Staff we spoke with told us, Im not sure if my health and safety is looked after, (a colleague) has been looking at this as a to do thing. Care Homes for Adults (18-65 years) Page 31 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 41 14 The registered person must keep all records up to date. To ensure the safety of people. This requirement will be extended for a final time but failure to comply with it may result in enforcement action being taken. 18/02/2009 Care Homes for Adults (18-65 years) Page 32 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 Care plans must be kept under review. To make sure they reflect the current needs of people who live at the service 07/05/2010 2 6 14 People must have a plan of care which is written by the service after consultation with them which identifies their needs, strengths, wishes and preferences and how these should be met. To ensure that people receive help in a planned and consistent way. 07/05/2010 3 7 12 Staff should have training on 07/05/2010 the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards So that they can apply this in their day to day practice and ensure that people have the right to make their own decisions and have minimal Care Homes for Adults (18-65 years) Page 33 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action restrictions on their freedom. 4 9 13 Care plans must contain risk 07/05/2010 assessments which are specific to the person where the need arises. To make sure that staff know how to manage the risks and uphold peoples rights. 5 19 13 Peoples healthcare needs must be the subject of a plan of care and risk assessment where appropriate. To make sure staff have access to the key information they need to minimise risk, uphold choice and maintain peoples health and wellbeing. 6 20 13 There must be a record of all 02/03/2010 medication which is returned to the Pharmacist or destroyed by staff. To enable proper auditing and to ensure that medication is safely handled. 7 20 13 An appropriate and safe system for medication must be developed and maintained. 02/03/2010 02/03/2010 Care Homes for Adults (18-65 years) Page 34 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that medication is safely stored, handled, recorded and administered. 8 23 13 All staff must have training on safeguarding and must understand the local procedures and their reporting responsibilities. To ensure that staff take the right action to protect people from harm or abuse. 9 23 13 If people are vulnerable to 02/03/2010 being abused there must be a risk assessment within the care plan addressing this. To ensure staff are aware of the risks and can take appropriate steps to protect people if necessary. 10 34 19 The missing documents from 03/03/2010 the staff files we saw must be obtained and all other staff files must contain the information and documentation required by Law. To ensure the people working at your service are suitable to work with vulnerable people. 03/03/2010 Care Homes for Adults (18-65 years) Page 35 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 11 35 18 There must be documentary evidence of all of the training undertaken by staff as required by Schedule 2. To ensure people are supported by well trained and competent staff. 03/03/2010 12 35 18 Staff must be given the 27/07/2010 training required by Law and any other training necessary for them to be able to understand and support people who live at the service To ensure people are supported by well trained and competent staff who understand their needs. 13 37 9 The management of the service must improve significantly to address the issues raised in this report To ensure the service runs in the best interests of the people who live there. 31/05/2010 14 39 24 The Annual Quality 24/03/2010 Assurance Assessment (AQAA) must be returned on time and be fully completed. Failure to do this may lead to enforcement action. Care Homes for Adults (18-65 years) Page 36 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To enable us to form an opinion about the quality of care being provided for people living at the service. 15 39 24 The providers must visit the 10/03/2010 home at least once a month and produce a report on this visit after speaking with people living at the service, their relatives and the staff. A copy of this monthly report must be sent to us until further notice. To ensure the providers are demonstrating their fitness and checking that the home is being conducted appropriately and in the best interests of people who live there. 16 39 24 The quality assurance 30/04/2010 system for the home must include formally gathering the views of people who live at the service and their relatives . To ensure that these inform the annual development and business plan for the service. Care Homes for Adults (18-65 years) Page 37 of 39 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 6 There should be a consistent format for care plans so that staff know and where to locate key information about people living at the service. Staff should be given information to enable them to discuss and support people with their sexual relationships and signpost them to relevant support services. To maintain their health and wellbeing. Consideration should be given as to how the privacy and dignity of the named person can be maintained in their bedroom. Consideration should be given to providing a more sheltered smoking facility for people living at the service to ensure their comfort. Consideration should be given to the staffing levels to to undertake the range of tasks allocated to them and to make sure there are enough staff to support people when they need it. 2 15 3 25 4 28 5 33 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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