Care Home: 8 Stickley Lane

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What the care home does well There is user-friendly information and ways to try out the home. People, families and funders are involved in care planning and reviews. People have support the way they want and need to promote independence to look after their appearance, personal hygiene, money and to take part in the running of the home. Each person has emotional support and meaningful activity for their individual development, in the home and community and can follow their own interests and hobbies. Personal care is discreet. People like the food. There are family events sponsored by people and the home. The views of people and others are sought and acted upon to develop the service. There is good access to health care. Conditions and medication are understood; health and wellbeing is monitored and good support is provided in an emergency. Medication is well managed to protect people. Behaviour is managed appropriately, if necessary. Personal safety needs are well provided for. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 There are checks by Head Office before staff and volunteers start work so that people are safe. Delegation of roles is taking place so that there will be experienced senior staff and continuity for the service when the current manager retires, which is good practice. The premises and garden are homely, safe, and well maintained. Rooms are individual; people choose colour schemes and furniture, and have the equipment they need. It is clean and smells fresh and there are measures in place to prevent and control the spread of infection and illness. The home works well with us to protect people. There is an experienced manager, and people can have confidence that the home is well run. What has improved since the last inspection? A new assessment questionnaire was introduced so that people`s needs and key risks are identified, planned for and reviewed. Everyone has health screening and regular medication reviews. A volunteer now assists with outings for exercise. Food intake is monitored more closely. The medication procedure, system, and recording were improved to protect people. The laundry room and storage was improved, and bedrooms were decorated. The garden now has a gazebo with wind chimes for sensory stimulation, new furniture and a bird feeding station. There is a new complaints log so that action and outcomes can be recorded if they arise. A new quality assurance system was introduced and the Langstone Society achieved Investors in People Award and a PIQASSO award. What the care home could do better: Terms, conditions and fees must be transparent and accurate. Financial decision-making needs development and accountable oversight. There are recurring issues from the last inspection about the timely provision of mandatory training appropriate to staff and management roles. Older care records need to be archived so that relevant records can be readily found when they are needed. Staff records were not made available for inspection in accordance with an agreement with the Commission. The complaints procedure could be more accessible for people living in the home. Policies and procedures are in place but have not been updated to reflect new laws and duties, best practice and national guidance. This can8 Stickley LaneDS0000025016.V376136.R02.S.doc Version 5.2 hamper effective management of performance and quality assurance. Quality checks and audits should ensure that policies and procedures are followed. Timely reports about unannounced spot checks by the Langstone Society will assist the manager to progress any needed action for people`s health, welfare and safety. Financial queries were promptly responded to by the Langstone Society, and there was full cooperation under the local adult protection protocol as a result of our visit. There is a conflict of interest in the management of people`s financial affairs that needs change to fully protect people`s financial interests. Key inspection report CARE HOME ADULTS 18-65 8 Stickley Lane Lower Gornal Dudley West Midlands DY3 2JP Lead Inspector Tina Smith Key Unannounced Inspection 21st January 2009 08:30 8 Stickley Lane DS0000025016.V376136.R02.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. 8 Stickley Lane DS0000025016.V376136.R02.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 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Stickley Lane Address Lower Gornal Dudley West Midlands DY3 2JP 01902 662076 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) Langstone Society Clive Lingard Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 8 Stickley Lane DS0000025016.V376136.R02.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 the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 6 The maximum number of service users who can be accommodated is: 6 9th October 2006 Date of last inspection Brief Description of the Service: Stickley Lane is a care home in a residential area, with shops and public transport nearby. There is parking at the front and across the road. Premises are owned by Black Country Housing Association and run by the Langstone Society, who manage furnished licensed tenancies and 24 hour care services to a maximum of six people with learning and physical disabilities. Both are notfor-profit voluntary organisations. There is wheelchair access to the ground floor only, where there are two bedrooms, bathroom and walk in shower, lounge, dining room, kitchen and laundry. A staircase leads to the first floor where there are four bedrooms, bathroom with shower and toilet, separate toilet, and the main office. There is an enclosed garden, and two cars are used for transport. Fees are individual according to the level of assistance required and activities, and the fee range is not published in the homes information. Enquiries should be made at the home. 8 Stickley Lane DS0000025016.V376136.R02.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 stars. This means that the people who use this service experience good outcomes. Our inspections focus on the outcomes for people who live in the home and their views of the service provided. Prior to our visit the home supplied information to us each year from their legally required Annual Quality Assurance Assessment (AQAA). The AQAA provides information about what has improved and is planned for the future, and current information about the running of the home. Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us notifications, and we receive reports from other sources, including surveys sent to people, relatives and staff. One inspector visited the home over one day, and the morning and afternoon routine was observed. The home was not informed that we would be visiting. We talked to people and staff, and examined three records closely. We sampled records about other people, staff and the running of the home and discussed our findings with management. There were 15 outstanding requirements from a previous inspection, and we found most were fully met. No immediate requirements were met as people were healthy and safe. A list of requirements and recommendations as a result of our visit are at the end of this report. What the service does well: There is user-friendly information and ways to try out the home. People, families and funders are involved in care planning and reviews. People have support the way they want and need to promote independence to look after their appearance, personal hygiene, money and to take part in the running of the home. Each person has emotional support and meaningful activity for their individual development, in the home and community and can follow their own interests and hobbies. Personal care is discreet. People like the food. There are family events sponsored by people and the home. The views of people and others are sought and acted upon to develop the service. There is good access to health care. Conditions and medication are understood; health and wellbeing is monitored and good support is provided in an emergency. Medication is well managed to protect people. Behaviour is managed appropriately, if necessary. Personal safety needs are well provided for. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 6 There are checks by Head Office before staff and volunteers start work so that people are safe. Delegation of roles is taking place so that there will be experienced senior staff and continuity for the service when the current manager retires, which is good practice. The premises and garden are homely, safe, and well maintained. Rooms are individual; people choose colour schemes and furniture, and have the equipment they need. It is clean and smells fresh and there are measures in place to prevent and control the spread of infection and illness. The home works well with us to protect people. There is an experienced manager, and people can have confidence that the home is well run. What has improved since the last inspection? What they could do better: Terms, conditions and fees must be transparent and accurate. Financial decision-making needs development and accountable oversight. There are recurring issues from the last inspection about the timely provision of mandatory training appropriate to staff and management roles. Older care records need to be archived so that relevant records can be readily found when they are needed. Staff records were not made available for inspection in accordance with an agreement with the Commission. The complaints procedure could be more accessible for people living in the home. Policies and procedures are in place but have not been updated to reflect new laws and duties, best practice and national guidance. This can 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 7 hamper effective management of performance and quality assurance. Quality checks and audits should ensure that policies and procedures are followed. Timely reports about unannounced spot checks by the Langstone Society will assist the manager to progress any needed action for peoples health, welfare and safety. Financial queries were promptly responded to by the Langstone Society, and there was full cooperation under the local adult protection protocol as a result of our visit. There is a conflict of interest in the management of peoples financial affairs that needs change to fully protect peoples financial interests. 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. 8 Stickley Lane DS0000025016.V376136.R02.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 8 Stickley Lane DS0000025016.V376136.R02.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): 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. People have user friendly information and ways to try the home. Terms and conditions need to be clear and accurate so that informed decisions can be made. Thorough admission, review and discharge processes confirm whether needs can be met. EVIDENCE: People told us they had enough information about the home, and they were asked if they wanted to come to live there. There is a service user guide and statement of purpose about their approach, and needs that can be met. Information is user friendly, with symbols and photos, and it is written in Plain English. During the past year there was one new admission, and on the day of our visit there were no vacancies. Six people are funded by the council. In three care records we saw a thorough pre-admission assessment by trained staff, with flexible opportunities to visit, meet other people, and try the home at the persons own pace. After admission there is a trial period and a formal review 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 10 with people, their families and funders; thereafter at least annual reviews with interested parties are held. One person moved to a nursing home for a few days and returned after nursing care was no longer necessary at the request of a doctor to avoid hospital admission. Admission, discharge and care planning policies must include consulting statutory advocates where applicable, as the law has changed. Currently everyone in the home has active family representatives, who signed license agreements with the home and are involved in reviews, so updating policies is important in future circumstances. The Langstone Society manages everyones financial affairs. If this is a necessary condition of admission then this needs to be made clear in the terms and conditions and public information, as well as who is consulted about financial and charging decisions. This should comply with the Mental Capacity Act code of practice. Terms and conditions of the housing association and Langstone Society are set out in two versions of a licence agreement - Easy Read and a more formal format. In addition to individual fees, these set out rules and responsibilities of tenants (people in the home), the landlord and Langstone Society, facilities and care services included or attracting extra charges. We had to query a number of policies and the housing management agreement in place about roles, entitlements and charging as these are not clear or have changed from the 2005 versions seen. For example, contracts with the council differ for each person, and changes were made about activities and holidays to be included in fees since the last inspection. Security of tenure in the two versions did not match. This was queried with the Society and amendments will be made so that four weeks notice can be given by either party to leave the home. The home confirms that peoples challenging behaviour needs can be met before admission. It would be useful for the homes information to clarify how a tenancy can be withdrawn without notice on the grounds of behaviour, and how compatibility is matched. The license agreement specifies communal areas for use, but not the room to be occupied or how decisions are made about changes to rooms or facilities, which affected two people in the home. It should be clear to the public: who offers and withdraws tenancies, decides rent, care and other charges, any pooled arrangements for transport, who does repairs / refurbishment, and how often room furniture is replaced. Currently there is no breakdown of the fee, or detail of charges for rent, tv licence, care (including care and activity hours commissioned by the council from the home and other providers), transport, and any assessed contributions from people, and we did not see commissioned care plans attached. The homes contract was not fully addressed following the last inspection. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 11 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): 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 have support to make decisions and choices, or best interest decisions are made about health, wellbeing, and personal safety. Thorough assessments of needs balance risks and risk taking so that personal development and independence are promoted. Financial planning needs development. EVIDENCE: A sample of care records were examined and we spoke to staff and people in the home. Communication tools and modes are used to support people to make daily decisions about their lives, and to participate in care planning. When people are unable to make decisions, these are made in their best interests. Everyone in the home has family representatives who are consulted along with professionals, and attend reviews. New comprehensive assessment formats were introduced since the last inspection, and care plans 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 12 now have more detail. This ensures staff have clear guidance and direction to support people the way they want and need. Peoples likes and dislikes are known and checked periodically. Risk assessments are kept under regular review. Independence is promoted by individuals participating in their own care, such as brushing teeth, applying prescribed cream, caring for their belongings, and taking part in the running of the home in accordance with peoples abilities and daily choices. There are meetings with individuals and as a group to plan ahead about meals, activities, outings, shopping for their own needs, and holidays. Some people have pre-planned funerals, two people have life insurance and one has investments they arranged themselves, with staff or family support. Some hold keys to a lockable tin in their room, and one person walks or takes public transport unassisted to visit their family. We confirmed that previous requirements were met after viewing good plans and monitoring measures about managing cellulitis, epilepsy, continence promotion and care, mobility, personal safety and challenging behaviour. Care plans are reviewed when there are changes and at least 6 monthly and annual reviews are held with people, representatives and funders. Goals are undergoing change, as the council are reducing day service provision and the home are now providing more day time support, which is under negotiation. Two people have multi-sensory stimulation sessions in the home. The home tried one person with an electric wheelchair for more independence, but the person did not find it comfortable. We observed a staff handover when shifts changed, and saw how staff use this so there can be continuity of care and sensitivity to moods. We complimented staff on good practice they described, about handling difficult behaviour affecting the public during an outing. Some people need two staff escorts for outings. One person needs to be fed, and others need to be supported during meals. Staffing levels ensure needs are met. The kitchen is locked if staff are not present, for personal safety. People are assessed to lack capacity to manage their financial affairs, and the Langstone Society act as everyones appointee. Some people can use their bank account to some extent, and understanding of the value of money differs for each person. There are individual plans about how people need to be supported with money, shopping and travel. One persons support is for confidence as their eyesight has deteriorated. All financial records we saw accounted for savings, transactions, had receipts and tallied. There are regular checks about this by senior staff, and returns are sent to Head Office three or four monthly. However checks have not identified queries we made. The manager is not involved in financial decisions and delegated management of peoples money to seniors at the home. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 13 Peoples money was used to top up the homes petty cash, and people were then reimbursed. Charges were made for room furniture and carpets that appeared to be included in the terms and conditions. Reimbursements for meals out had not always been made, and the subsidy is low and has not been reviewed for many years. An extra day trip for someone we were told does not like going out or to day services, appeared excessively expensive due to staffing costs. We explored how financial best interest decisions are made after our visit with the Langstone Society, because reviews and care records do not show consultation with others or forward planning. All decisions had been made within the home, which is not in keeping with the Mental Capacity Act code of practice or Langstones own policies and procedures. No external independent audits were arranged after our recommendation at the last inspection. We advise that families, social services or advocates should have statements as no one is able to query whether charging, expenditure and saving strategies have been in the persons best interests. Some people have savings accruing. One person lost rights to welfare benefits and the manager is appealing this decision, but another is also at risk. An administrator at Head Office is the named appointee, and they are not currently involved in care reviews, where financial plans should be agreed. Care home managers can make spending decisions up to £500; above this must involve Head Office and social services. This did not occur at Stickley Lane regarding financial decisions affecting several people. Immediate action was taken by the Society to investigate matters raised. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 14 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: 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. Individuals help in the home, follow their own interests in the community. Relationships with families are maintained and family events are held. There is choice of nutritious food and dietary needs are catered for. EVIDENCE: There are age, peer and culturally appropriate activities and use community facilities such as bowling, parks, pubs, a gym, and lunches or other meals out. Some people have opportunities to learn and use practical life and social skills, at day services and in the home and community. Some people keep their room clean and tidy, make their bed, and help to prepare food. One person lays tables and loads the dishwasher one day a week. Most people have weekly 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 15 exercise at a gym, or music and movement. People often go shopping, and choose their own room furniture and colour schemes. Each person has their own interests, and music collections and one person is a football fan. Another reads the daily newspaper. Some people attend a day service one to three days a week, and one person now has all their activities provided by staff after a best interest decision was made with the council. One person has a retirement plan and attends day services less often. Some people are calmed or stimulated by multi-sensory experiences and hand massage. Management know they need to expand activity opportunities and are in negotiation with the council about this. Religion is noted in each care record. No one currently shows an interest in attending services. Friendships and relationships are maintained and staff help people to keep in touch. Two people visit relatives each week and families visit the home. Holidays and outings are usually taken in friendship groups, but some people respond better to day trips or short breaks. Most people took extra holidays or trips during the past year. Some people have literacy and numeracy skills. They are supported to manage their own money. There are two vehicles used for transport, fully funded by the Langstone Society. The home are applying for travel passes so that public transport can be used. There are choices at each meal about food, and people have appropriate assistance to eat. Drinks and healthy snacks such as fresh fruit are available throughout the day and night. One person has a soft diet, and others have diabetes catered for. All staff prepare food, have food safety training, and people told us they like the food. We sampled food intake monitoring records, menus and looked around the kitchen. The food on offer is nutritious, varied and large stocks are not kept. We watched staff assist each person differently at meal times. People were served and did not get their own food from a hatch. One person does not like certain drinks and we queried their fluid, vitamin and calcium intake with staff, and were assured their diet is monitored. Meal times were unhurried, and some staff ate with people. This is good practice that creates a homely atmosphere conducive to eating well. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 16 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): 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. Personal care and health are met in the way people prefer and need, with dignity. There is good access to health care and support in emergencies. The medication system is managed by competent staff so that it protects people. EVIDENCE: People and relatives told us in surveys that staff listen and act on what they say, and they are always treated well. Staff accurately told us about peoples needs, risks, what people prefer and how care is safely provided. Assessments note peoples abilities to participate in self care and their preferences, such as having a bath or shower, and choosing clothing. Staff assist as needed with washing, dressing, oral care and continence, and this is adjusted and recorded on a daily basis according to peoples cooperation and mood. On our visit people had good personal hygiene. Their appearance and clothing was 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 17 appropriate for the temperature, their age, culture and tastes. Personal care was provided discreetly. People have privacy when it is wanted. There is only one female in the home, who prefers the men to be out when she showers, which is respected. People shower or bath as often as they want. People have choice of gender for help with personal care. No one in the home has pressure sores. A wheelchair user who cannot mobilise independently has periods on the settee during the day for prevention. Mobility aids and equipment match peoples needs and were used safely. There are detailed plans for healthcare, night-time, sensory, mobility and communication needs. These provide staff with directions and guidance to prevent falls, for manual handling, and how to recognize non-verbal signs of wellbeing, discomfort or pain, which is good practice. Four people have special communication needs and three people need help from two staff for personal care. Staff have downloaded information about peoples conditions and medication and used this to form detailed guidelines so they can respond appropriately, for instance about epilepsy and diabetes. On our visit, one person was newly diagnosed with a contagious illness and is under treatment. Precautions have been taken for others under medical advice. There are excellent daily monitoring records of food intake, activities, choices and wellbeing. People with diabetes have annual blood tests. Chiropody was irregular for one person, but this is now improved. Two people have checks four times a day for cellulitis, and emergency plans as one persons flairs up rapidly. Recently the home supported the person during a brief move to a nursing home, on medical advice. They provided excellent support during the daytime so that the person did not become distressed. One person is at risk of falls out of bed. A lower bed has been purchased as rails are not appropriate for their needs. There is a listening device so that staff can attend immediately. Everyone has nutrition assessed so that cultural and dietary needs are met. Food intake and output is monitored and people are regularly weighed, so changes can be identified. Medication storage is appropriate for peoples current needs. There are secure cabinets, maintained within the safe temperature range so that medication is stable. No one currently needs medication stored in a fridge. There is a register for controlled drugs, but no cabinet - one should not be used without the other. No one, however, is currently prescribed controlled drugs at the home. There was a blood monitoring kit in the cabinet which we learned had been donated by a relative. There is no one in the home needing this and it was not clear whether it was new or used. Staff had been uncertain what to do with it, so it was stored. It was discarded during our visit. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 18 Medication is safely checked into the home and disposed of. No one manages their own medication but one person applies a prescribed cream while staff observe. We watched medication administration, which is undertaken by two staff privately with the person. We complimented how people are asked first for their consent in a way they will understand. There are two sets of recording - one by staff who appropriately used the monitored dose blister pack and gave medication, and the other by a witness. The witness understood they were confirming that the right person had the right medication dose at the right time of day. On our visit there were no gaps in administration records but there were a few gaps in witness logs which were discussed with seniors. Regular audits of medication take place - by the home and by the pharmacist three monthly. Staff said that stocks are checked, but not all homely remedies are counted. The home is accountable for medication checked in, and need to ensure that it does not go missing. Staff were last trained to administer medication in 2005. There are senior staff appointed since then who are trained to witness but not administer medication. The AQAA told us that the home is having difficulty locating accredited training. We advise they discuss this with their pharmacist, who frequently provides this to other homes. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 19 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): 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 know who they can report a concern to and can have confidence it will be taken seriously and acted upon. Staff are trained to recognise and report abuse in line with national guidance and local protocols. Peoples financial interests need to be further protected. EVIDENCE: People told us who they would tell if they were unhappy, and they have confidence it will be sorted out. We saw that they have good relationships with staff. There is a complaints procedure but it was written some time ago and could be made more accessible for people, especially those without verbal communication. There were no complaints since the last inspection, but the home has a new log so that the process and outcomes can be recorded. The procedure has appropriate timescales and a clear process to investigate matters so that there can be satisfaction for people or their representatives. Personal safety precautions we saw are proportionate to the risks assessed, and there is balance so that individuals can develop, which involves risk taking. There are several policies to safeguard people but policies were written some time ago, pre-dating new legislation and best practice about new rights and duties. Policies need regular review and staff need updating, for instance 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 20 about physical and chemical restraint (covert medication) and restrictions on rights leading to deprivation of liberty. Behaviour plans we saw use distraction techniques, which are least restrictive of peoples freedom of movement. There are risk assessments of people with no road sense, and two staff escorts may be provided. This is good practice, however physical restraint or restrictions may be necessary for personal or public safety. The home are working with specialists where necessary to review challenging behaviour. The use of a listening device may be justified as necessary to respond to falls but it is an invasion of human rights and needs a recorded best interest decision after consultation with others, and we did not see this is one persons records. Safeguarding is taken seriously and there is a whistle blowing policy. Staff have training to recognize and report abuse inside and outside the home, in accordance with the local council protocol. They have detailed guidance to recognize when people without communication express dislike or distress so that they can enquire further. There have been no adult protection concerns since the last inspection. Following our visit we raised concerns under the multi-agency protocol about peoples financial interests. The Langstone Society investigated rapidly and reimbursed people where appropriate for unintentional error. The controls in place are not being used, are insular and insufficient to ensure peoples financial interests are fully protected, as discussed earlier. There is a conflict of interest, which is clearly outlined in the mental capacity act code of practice and in CQC guidance about care providers acting in formal roles in peoples financial affairs. There are alternatives so it is not necessary for the home to act as appointees. If this continues, controls must be robust to prevent exploitation, which is financial abuse. We found there is a lack of accountable oversight for managing peoples financial interests at Stickley Lane and at Head Office. The manager said that they have not been trained yet about mental capacity law, but council fliers about free training were received. There is also free government training that can be downloaded. We discussed preparation for a new law about Deprivation of Liberty safeguards so that any necessary authorisations can be made when it is enacted on 01/04/09. The home make all decisions for some people in their care. Following the inspection the provider confirmed that this training was arranged. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 21 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): 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 live in a homely, clean and safe environment, personalize their room and equipment they need is looked after. There are checks and timely repairs for health and safety, and to prevent the spread of infection. EVIDENCE: The home is in a residential area, with access to local shops and public transport. There is no sign distinguishing it as a care home. It is homely and comfortable, with a good standard of decor and furnishing. Car parking for the homes vehicles at the front has improved privacy and safety as local young people used to peer in the windows. One persons ground floor room window has privacy screening as they prefer to keep the curtains open and lights on at 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 22 night. Windows on the ground floor have locks; on the upper floor have restrictors. This reduces risk of falling and intruders. The premises and enclosed garden are accessible for wheelchairs. Stickley Lane is secure so people do not wander into the road. The doors to the patio and kitchen are kept locked. The garden is safe and enclosed; people can use it when they ask or indicate. There are two vehicles used for transport and the home are seeking travel passes for public transport. We looked around the building and bedrooms with people. Rooms suit their age, culture and lifestyle. People have music, DVD collections, some have TVs, and one has a multi-sensory chair. People said they chose the bedding, new furniture, colour schemes and carpets. Each room is individual, with photos of family, friends and outings, and one football fan has a lot of momentoes. There is lockable space for valuables and some people hold the key. Doors can be locked and rooms used whenever people want privacy. Personal belongings have been growing and we were told some people needed more storage space. Two wardrobes seen are kept locked. People said they ask staff to open them, which they are happy with. This prevents disturbance of possessions by someone in the home. Black Country Housing Association maintains and checks the premises or uses contractors, and repairs are timely. Management make health and safety checks. We did not see any hazards, but the front hallway became a bottleneck and some people were agitated when they needed to wait there for long. There are low-surface radiators and the water is tested to prevent bacteria and scalds. Electrical devices and plugs have regular checks in peoples rooms for personal safety. People have the equipment they need for their independence and mobility, and this is regularly maintained. There are manual handling assessments so that staff help people safely. Toilets and bathing facilities suit peoples needs and have door locks. Fire drills are held twice a year, and we were told the last fire officer visit was satisfactory. So was a recent Environmental Health Report about food safety. Staff have inductions and training in safe working practices. All staff have food safety training, and most but not all have infection control training. This needs to be progressed as it was also noted at the last inspection. People told us the home is always clean and smells fresh, and some help to keep it this way. There are best practice infection control and food safety measures. We advised removal of a cloth towel we saw in addition to paper towels in the staff toilet as a further precaution against any infection spreading. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 23 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): 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 have the help they need day and night and when there are changes because there are competent staff with the right skills, who work well as a team. Checks are made before staff start to work in the home so that people are safe. EVIDENCE: Some staff have worked in the home many years, and there is such a low turnover that no staff have left in the past year. No temporary staff have been needed to cover sickness and staff holidays. Staffing hours are kept under review and these match peoples needs day and night. There are usually 3 staff on at peak times. At night there is one waking and one sleeping care staff. There is a qualified first aider on each shift, and this qualification is kept up to date so there is effective help in an emergency. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 24 There is a diverse workforce, so people in the home can have choice of who helps them with personal care. Cooking, laundry, domestic tasks and activities are done by all staff alongside people. Each person has a key worker who takes a special interest in them. Staff pass information to each other about people and the home at each shift change, and keep records up to date so people have consistency of care and support. There are regular staff meetings that seek staff views on the running of the home. We were told that staff records are held at Head Office and we were not provided with information in the home in accordance with an agreement with the Commission during our visit. We confirmed information we needed to know through the manager and Head Office by phone. This should be examined in more depth at the next inspection. Long-standing staff have police and government list checks periodically to ensure they remain safe, which is good practice. We saw a chart about police and government list checks, induction and mandatory training for all staff and volunteers. An appropriate risk assessment was described by the manager about the volunteer as checks were incomplete at the time of our visit. The volunteer is never alone with people and have not yet been to the home, but had an induction to safe working practices and a longer training programme is underway. Staff and volunteers have good opportunities to obtain care qualifications, and qualifications exceed the minimum standard. Some staff have qualifications specific to learning disabilities. We did not see records of additional training in peoples conditions, such as epilepsy, or update training in medication but the home use downloaded guidance to draw up detailed care plans. Staff understood peoples conditions and what medication is used to treat, symptoms to watch for. Management have been considering equality and diversity training for staff since the last inspection. Staff have clear roles. We were told that performance and learning needs are appraised annually, so that a staff development plan can be reviewed. Appraisals, including medication practice, were not seen on the premises but were noted on a matrix. As at the last inspection, some mandatory training has not been progressed in a timely way so that people are protected from inexperience. Formal supervision meets minimum standards. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 25 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): 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 can have confidence that the home is well run by an experienced management team, and the environment is safe. Views of people are used to develop the service. Policies and systems need updating and accountable control measures so that peoples rights are fully promoted and protected. EVIDENCE: Stickley Lane has a very experienced manager who has an NVQ 4 qualification, and told us they attended leadership training recently to keep up to date but does not hold the Registered Managers Award. The manager undertakes hands-on care and provides oversight in most regards, while delegating some 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 26 managerial tasks to senior staff in preparation for retirement. This is good practice to ensure continuity for people in the home, and the development of staff, but oversight, accountability and development of all systems, such as service user finances, is required by the registered manager. Management and staff are approachable and respond quickly and effectively to requests and any concerns noticed or reported. This was evident from surveys, our observations and records seen on our visit. The AQAA was returned on time. It had all the information we requested and provided a critical and forward looking self assessment. The homes certificates are on display. Since the last inspection Langstone introduced a new quality assurance system and has achieved Investors in People and PIQASSO awards. The views of people, relatives and staff are sought in regular meetings, and by questionnaires. Families and professionals are also contacted. The results are published, and we saw that in June and July 08 changes were made about times people went to bed. There are Langstone business and service development plan to meet changing expectations of people, families and commissioners. There are health and safety monitoring checks by the home, by Langstone, and maintenance checks by the housing association so that the home runs safely and smoothly. There are quality monitoring checks that the home told us they want to improve. The manager introduced a useful checklist for seniors on each shift after the last inspection. The homes risk assessment and fire safety plans are up to date, and other regulator reports did not require any actions to be taken. Unannounced visits by the registered provider used to take place at the same time as the managers supervision, we were told, but this has now changed and there are separate visits. During our visit there were no written reports about this so that the manager can address any necessary actions in a timely way, and progress can be checked. These Regulation 26 reports must be kept on the premises. Policies and procedures need updating. This could hamper how staff performance is managed and quality assurred. The Langstone Society confirmed they plan to address this. We advised prioritising the restraint policy in preparation for a new law. After the last inspection the home manager proactively wrote a medication administration policy for the home. Management highly value staff and invest in their support, development and training, and appraise their performance and knowledge. The staff development plan needs to ensure staff have training for their roles in a timely way so that there are safe working practices and oversight of staff. This was also an issue at the last inspection. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 27 There are a large number of records kept in the home about people. It was difficult to find the most up to date and relevant records quickly in each folder seen. Older records should be archived so that current information is readily accessible to staff. Most systems are well organized. The process of managing financial affairs and making financial decisions needs development at Stickley Lane and by the Langstone Society so that it is consistent and peoples financial interests and rights are fully protected. There is a conflict of interest because the Society makes charging, contractual and spending decisions, and this needs internal and external control measures or alternative arrangements so that people are effectively represented. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 28 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 2 2 3 3 X 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 4 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 2 2 X 3 2 Version 5.2 Page 29 8 Stickley Lane DS0000025016.V376136.R02.S.doc No Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5 Requirement Terms and conditions in the license agreement and homes public information must be transparent and accurate. These must include all the requirements under this standard and 16.11 so that informed decisions can be made and checked by all relevant parties. Easy Read and formal versions must match. The registered manager and responsible person must ensure that the system of managing peoples money is appropriately conducted, and accountable charging decisions are made in accordance with the homes policies and peoples license agreements. Timescale for action 31/08/09 2 YA42 15, 20(3) 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 30 No. 1 Refer to Standard YA7 Good Practice Recommendations Care plans and reviews should have goals and objectives about peoples financial affairs that are in keeping with their current and future needs, priorities and lifestyle. Best interest decisions must have consultation in accordance with the Mental Capacity Act code of practice. All homely remedies should be counted during audits to ensure that any medication checked into the home is accounted for and does not go missing. Consideration should be given to installation of an approved controlled drugs cabinet. It is advised that families receive regular statements about service user monies managed by the Langstone Society, with consent or in best interests, so that anomalies can be queried on their behalf. Independent audit of residents’ finances should be undertaken periodically. For instance, by families, social services or advocates, in advance of care reviews. The use of a listening device must be least restrictive of a persons rights, and should have a recorded best interest decision in consultation with interested parties. It is advised that cloth towels should not be on display in communal or staff toilets for further infection control for peoples health. Senior staff with a job description requiring them to administer medication should have accredited training so that they can undertake this role and supervise others. Regulation 26 reports of visits to the home should be timely and available on the premises so that the manager can progress any action needed. The Commissions guidance should be checked about staff records needed on the premises or the agreement in place so that these are available for examination during inspections. All staff should receive should receive training in infection control. 2 YA20 3 4 YA20 YA23 5 YA23 6 YA30 7 YA31 8 9 YA39 YA41 10 YA42 8 Stickley Lane DS0000025016.V376136.R02.S.doc Version 5.2 Page 31 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT 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. 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