Care Home: Abbottswood Lodge.

Similar services:

• Coopers Mill Ltd
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• Newton Court (1-2)
• Kings Lane (32)
• Pemdale

What the care home does well The new Manager has been helpful during our visits and provided us with information that we have requested. She is keen to make improvements at the Home and has started to work towards the requirements. A member of staff has been recruited to assist residents with activities. Some of the residents bedrooms have been decorated with plans in place for further redecoration and improvements throughout the Home. We spoke to staff who are positive about working at the Home and keen to make improvements for the residents who live there. What has improved since the last inspection? The Manager now works supernumerary hours so that she is no longer part of the staff rota. This enables her to spend more time carrying out management tasks, including working alongside staff as appropriate. The staff no longer work excessive hours without appropriate breaks. This follows the issuing of an Immediate Requirement at the Inspection in July 2010. The Manager has implemented resident and relatives meetings. These have been used to start involving residents in making decisions about what happens at the Home. The menus have been reviewed to ensure that healthy options are included for the main meal. What the care home could do better: Concerns were raised at the time of our visit in April 2010 about the Homes ability to meet the needs of two of the residents and about the decision to admit them to the Home initially. The residents continue to reside at the Home and concerns continue about this. The Manager is liaising with the local authority about the residents moving to somewhere more appropriate. Since the new Manager has been in post one resident had been admitted. There was no pre admission information or care plan available to enable staff to meet the individuals needs when they first moved to the Home. There are ongoing issues relating to the provision of staff. The number of staff on duty is not adequate and, despite a requirement to increase the staff, the staffing has actually been reduced at night. The staff have not received appropriate mandatory training, nor training specific to meet the needs of individual residents. Staff do not have the appropriate skills or experience to meet the needs of the residents in a consistent way. The residents views are not sought on a regular basis. They are not encouraged to make their own decisions about issues that affect them. A lack of training for staff about effective communication limits the ways in which the views of the residents are sought. The residents are not supported to take part in meaningful activities. Apart from the few residents who attend day services there are very few, if any, opportunities for residents to take part in activities away from the Home. The care plans are not satisfactory. They do not contain relevant information about individual residents needs and do not contain detailed guidance for staff about how to meet residents needs in a consistent way. Risks are not identified and assessed appropriately. The premises are not homely and many areas are in need up upgrading and redecorating. There is little evidence of residents being encouraged to personalise the Home. Key inspection report Care homes for adults (18-65 years) Name: Address: Abbottswood Lodge. Church Lane Swanton Abbott Norwich Norfolk NR10 5DY     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lella Hudson     Date: 1 3 0 8 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 36 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 36 Information about the care home Name of care home: Address: Abbottswood Lodge. Church Lane Swanton Abbott Norwich Norfolk NR10 5DY 01692538455 01692538725 abbottswoodlodge@abc-care-solutions.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Abbottswood Lodge Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 22 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: Learning Disability - Code LD Date of last inspection Brief description of the care home Abbottswood Lodge is a period residence that has been adapted and extended to provide residential accommodation for up to 22 adults with learning difficulties. The property is in a very rural location outside the small village of Swanton Abbott, south of North Walsham. The majority of places are in single rooms and nine of the rooms are located in a bungalow next to the main house. This has its own lounge and kitchenette. People accommodated within the main house generally have higher care Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 22 2 6 0 5 2 0 1 0 Brief description of the care home needs. The home in addition has spacious communal accommodation and an activities room. The premises stand in extensive grounds overlooking farmland. Fees generally range from around £450 and are dependent on individual needs and support assessed at placement. A statement of purpose and service user guide is kept in the main office and is available on request. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: At the previous Key Inspection of the Home (June 2008) it was given a GOOD quality rating. Following incidents notified to the Commission we carried out unannounced Random Inspections in April, May and June 2010. Requirements for improvements were made following the Inspection in April 2010. Further requirements were made at the Inspection in July 2010. This report contains information gathered about the Home recently, including the Random Inspections and a further unannounced visit to carry out a full Key Inspection on 13 August 2010. This visit was carried out by two Compliance Inspectors. During this visit we spoke to the Manager, staff and residents. We looked around the Home and we inspected a selection of records. The previous Manager and deputy manager left the Home in May 2010 and a new Manager started work at the end of May 2010. The organisation had not identified the Care Homes for Adults (18-65 years) Page 6 of 36 areas of concern prior to our visits despite regular visits made by the area Manager and Responsible Individual. The majority of the requirements issued in April and July 2010 have not been met. The Responsible Individual provided the Commission with an action plan in June 2010 and the dates within this for action have not been met either. Further requirements have been issued following this Inspection of the Home. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Concerns were raised at the time of our visit in April 2010 about the Homes ability to meet the needs of two of the residents and about the decision to admit them to the Home initially. The residents continue to reside at the Home and concerns continue about this. The Manager is liaising with the local authority about the residents moving to somewhere more appropriate. Since the new Manager has been in post one resident had been admitted. There was no pre admission information or care plan available to enable staff to meet the individuals needs when they first moved to the Home. There are ongoing issues relating to the provision of staff. The number of staff on duty is not adequate and, despite a requirement to increase the staff, the staffing has actually been reduced at night. The staff have not received appropriate mandatory training, nor training specific to meet the needs of individual residents. Staff do not have the appropriate skills or experience to meet the needs of the residents in a consistent way. The residents views are not sought on a regular basis. They are not encouraged to make their own decisions about issues that affect them. A lack of training for staff about effective communication limits the ways in which the views of the residents are sought. Care Homes for Adults (18-65 years) Page 8 of 36 The residents are not supported to take part in meaningful activities. Apart from the few residents who attend day services there are very few, if any, opportunities for residents to take part in activities away from the Home. The care plans are not satisfactory. They do not contain relevant information about individual residents needs and do not contain detailed guidance for staff about how to meet residents needs in a consistent way. Risks are not identified and assessed appropriately. The premises are not homely and many areas are in need up upgrading and redecorating. There is little evidence of residents being encouraged to personalise the Home. 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 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is not able to evidence that it can consistently meet the needs of the residents. Evidence: The Home has admitted two residents whose needs are outside the Homes category of registration. The needs of these residents are not being met at the Home. The Manager is working with other professionals to ensure that more appropriate accommodation is found for these residents. There has only been one admission since the new Manager started work at the Home. During the Random Inspection in July 2010 we asked for the pre admission information relating to the new resident but there was not any available. Neither was there a care plan available for the resident to provide staff with information about how to meet their needs. Care Homes for Adults (18-65 years) Page 11 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans do not provide staff with clear guidance about how to meet individual residents needs. Risks are not identified and approrpiately assessed. Residents are not supported to make decisions about their lives. Evidence: At the time of our first Random Inspection this year (April 2010) we made requirements about the need for improvements to the care plans and for risks to be identified and appropriately assessed. The Responsible Individual provided us with an action plan that stated that the care plans would be reviewed by 19 July 2010 and that the risk assesssments would be completed by 30 June 2010. We monitored compliance during our Random Inspections in May and July 2010 and also during this visit to the Home. The requirements have not been met. Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: The care plans contain outdated information which, in some instances, conflicts with current information. For example, one of the residents care plan states that the resident has drinks of a normal consistency but then another document states that they have thickened drinks. We saw examples of care plans that did not contain any information about the residents current needs. For example, one of the residents has pressure sores but the care plan does not include any information about the treatment for these, any preventative care needed nor information about the involvement of the District Nurse. Another residents care plan has no information relating to the fact that they have lost weight lately and that a referral to the Dietician has been made. There is no nutritional assessment and the Manager was not aware of the appropriate assessment to use. The care plans do not contain clear guidance for staff about how to manage behaviours which may be challenging. There are no risk assessments in place for the residents whose behaviour may be agressive to other residents or staff. There is little, if any, cross referencing within the care notes. For example, in one of the residents care notes it states that the nurse had advised that a referal was made to the wheelchair service about a more appropriate chair. There was no further information about what action had been taken about this. When we asked the Manager she said that the referral had been made. The daily notes are of a poor quality. They are not detailed and, in some instances, are not completed at all. The Manager showed us the new care plan formats that she has started to complete. None of these have been completed yet and were not available for staff to use at the time of our visit. Risks are still not being identified and adequately assessed. For example, there are no risk assessments for residents who self medicate or who take medication away from the Home. There is no risk assessment for a resident who does not have bedrails but does have a mattress on the floor in case of falls. We looked at risk assessments relating to the two residents who smoke in the bungalow. These are not adequate and incorrectly identify the risk of fire as being low. There are few opportunities for residents to make their own decisions and make Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: meaningful choices about issues affecting them. The Manager has implemented residents meetings since she started work at the Home at which residents are encouraged to be involved. Many of the residents have communication difficulties and the staff have had little training about appropriate communication methods. Three of the residents have severe sensory loss and the local Sensory Support Team have provided some training recently with some further dates planned. However, staff told us that not all staff have the skills to communicate effectively with all of the residents. The staffing levels are such that staff have little time to spend with residents, other than assisting them with personal care. Many of the residents would need visual prompts to make choices about day to day issues such as what they would like to wear, to drink, to eat etc but staff do not have time to do this effectively. We did observe staff asking some residents for their choice of meal and drink but at other times residents were not given a choice at all, for example, at lunchtime every resident was given blackcurrant squash in a plastic tumbler. The care records do not include any evidence that the individual residents have been involved in planning their care or that their views have been sought. We looked at the arrangements in place for looking after residents money. The local authority have taken over the appointeeship for several of the residents in the last few months. The Manager showed us the system in place for looking after money and the records kept relating to this for one of the residents. Records of money coming into the Home and of expenditure are kept as well as copies of receipts. We looked at the records relating to the money held for one of the residents. There were errors as the records did not tally with the cash held for the individual resident. Care Homes for Adults (18-65 years) Page 14 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are not supported to take part in meaningful activities Residents said that they enjoy their meals. However, they do not all receive the support with regard to nutrition and mealtimes that they need. Evidence: At the last Key Inspection (June 2008) a requirement was made for residents to be able to take part in activities away from the Home. This requirement has not been met. The Home is situated in an isolated, rural area which does not have access to public transport. The Home has a seven seater car which some of the staff are able to drive. Two of the residents use wheelchairs and are not able to use an ordinary car. It is not known how long it has been since they have left the grounds of the Home but the Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: Manager told us that they had not done so since she started work at the Home 10 weeks ago. During this visit the Manager said that the Proprietor has agreed to purchase a suitable adapted vehicle for wheelchair users. Each day during the week between 4 and 6 residents are picked up to attend day services. The other residents remain at the Home. A member of staff has been recently recruited to work as an activities co-ordinator. The activities are all based within the Home, including the arts and craft room, and mainly consist of crafts, games and puzzles. We observed three residents enjoying a game with the activities co-ordinator during our visit. The Home has large, attractive grounds and there are suitable outdoor chairs and tables for residents to use in warmer weather. One off events, such as a Sports Day and a Fete have been planned for the summer. The staffing levels do not enable staff to spend much time supporting residents to take part in meaningful activities. Staff told us that they have short periods of time when they are not involved in assisting residents with personal care tasks or household tasks. The Manager said that she was coming to the Home on a Saturday to support residents to go to a nearby Table Top sale. The care plans contain little, if any, information about the residents likes and dislikes with regard to activities and leisure pursuits. One of the care plans states that a resident likes shopping and going for walks but there was no evidence of this taking place, other than when they were at the day centre. Another residents care plan states that they like to look around garden centres. There was no evidence of them being supported to do so in the 5 weeks that they have been living at the Home. We observed that relatives were welcomed at the Home during our visit and that the staff had made arrangements to provide transport for them to get to the Home. Staff said that relatives are invited to take part in events such as the recent Sports Day and the forthcoming Fete. The Home has a cook who works five days a week. One of the care staff works in the kitchen on the cooks days off and is now rostared to do this. We spoke to the cook about the provision of meals. She said that the menus had been discussed at a residents meeting and that changes have been made to ensure that a healthy option is always avialable at lunchtime. The cook said that there is always enough supplies of food and drink for the residents. She said that residents are able to help themselves to fruit and cakes from the kitchen. We saw that there was plenty of fresh fruit and Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: homemade cakes on the side in the kitchen. Two of the residents told us that they enjoy their meals. The main meal is provided at lunchtime and if residents are at day centres their meal is plated and reheated in the microwave for tea. The meals that we saw that were plated did not look very appetising by the afternoon. The Home does not have any kitchen staff after 2pm and so one of the care staff has to prepare tea and clear up afterwards. There are only three care staff on duty during the afternoon and so for the time that someone is in the kitchen there are only two staff to support all of the residents. The Manager said that there are 6 residents who are able to get their own breakfast and make their own packed lunches. None of the residents are involved in shopping for food or cooking meals. Staff told us that residents are asked in the morning for their choice at lunchtime. This is done verbally as there are no alternative methods of offering residents choice. Residents receive their meals already plated rather than being able to help themselves with regard to portion size. We observed the lunchtime meal during this visit. The residents who live at the bungalow come to the kitchen to pick up their plated meal. They then walk with this back to their rooms or the dining room in the bungalow. On the day of our visit it was pouring with rain and residents still walked back and forth between the bungalow and the main house. The dining room has two large tables. Staff were present to support the residents. All residents were given the same cold drink with no-one being offered a choice. Some of the residents are supported to have their meals in the lounge. There are at least three residents who need full support at mealtimes. There are two residents who have blended meals. We observed different practice with regard to the support provided to residents during meals. Some staff stood over residents and did not speak to them whilst assisting them whilst others sat next to the resident and explained what they were doing and chatted to the resident. One of the residents does not have appropriate seating for them to be able to have their meals comfortably. None of the staff have had training with regard to dementia and the specialist advice Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: available about meeting the nutritional needs of people with dementia. None of the residents have got up to date nutritional assessments. Care Homes for Adults (18-65 years) Page 18 of 36 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 poor 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 needs of the residents are not met in a consistent way. Medication is not managed safely. Evidence: The staffing levels are not sufficient to ensure that the residents needs are met in a consistent way. There are only four members of staff on duty in the morning and three in the afternoon/evening. There are two waking members of night staff. There is a cook on duty each day until 2pm. The Home does not employ domestic staff currently. The Manager said that there are at least five residents who need full support with personal care. This includes two residents who need two members of staff to support them with mobility as well as they use the hoist. At least one other resident requires two members of staff to assist with personal care. Four of the residents have behaviours which can be challenging. Discussions with staff confirm the Managers information. They said that they do not Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: have much time to spend with residents, particularly as they are currently having to do all of the housework as well. Residents have little choice about what time they get up or go to bed due to the constraints on the staff. There are times when there are no staff in the bungalow. Staff carry walkie talkies as the Home does not have a call bell system. Some of the residents who have a bedroom in the bungalow would not be able to call for assistance at all due to their communication difficulties. The Home has admitted two residents whose needs are outside of their category of registration. The staff have not had any training, nor have the skills, to meet the residents needs. Both of the residents pose a possible risk to the other residents. The staff have not had training to meet the needs of the residents with sensory disabilities who live at the Home. Several of the residents have developed more complex physical and mental health needs as they have grown older. The necessary training for staff has not been identified or provided. We looked at the medication system during this visit. Due to our concerns about the way in which the medication is managed a referral has been made to the Commissions Pharmacy Inspector as well as requirements made in this report. The keys for the medication trolley and the controlled drugs cupboard were not being stored securely. The Manager addressed this situation prior to us leaving the Home. The Manager said that all the senior staff had received medication training but when we looked at records we could see that this was not accurate. The Manager agreed that some staff are administering medication without appropriate training. The Manager said that the Home are changing to another pharmacy and so training has been arranged for the following week for senior staff with regard to using the new system. The Manager, nor the area manager, have carried out any audits about the medication system in use. The Home does have policies and procedures relating to medication but these are not being followed. The requirement made in June 2008 for the Home to have safe cold storage of medication was met in July 2010 with the purchase of a medicines fridge. Not all the residents have photos attached to the Medication Administration Records (MAR) and there is little, if any, information relating to any allergies that residents Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: may have. There is no record of sample signatures to use in audits. There are no risk assessments or care plans in place for residents who take medication away from the Home, for example to Day Centres. There are no risk assessments for residents medication which is prescribed as required (PRN). No consideration has been given to those residents who may be able to look after their own medication. Some records are not being completed accurately. For example, one of the residents is prescribed a cream to be applied twice a day but there are no records of administration for this month so far. Records are not being kept of variable doses. There are also gaps in the MAR charts. From the notation in the chart and from discussions with staff it appears that medication has not been available. For example, one of the residents had not had one of their medicines for two days as it was not available. Another resident had not had a medicine since the 4th August despite this being prescribed for them. One of the residents had been prescribed a medicine for use when needed for acute diarrhea but records show that they had been administered the medicine daily for at least 11 days. We also noted that medicines that had been discontinued were still in the cupboard which means that there is a risk that they may be administered. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home has a complaints procedure. The residents are not fully protected with regard to safeguarding vulnerable adults from abuse. Evidence: The Manager is aware of the need to keep a record of complaints. Due to the lack of training for staff about communication it is difficult to see how some of the residents would be able to raise any concerns. The implementation of the residents meetings does give some of the residents an opportunity to raise concerns. The Commission were notified of concerns about the Home in March 2010 through an anonymous complainant. These related to poor management of residents behaviour, the behaviour of staff and concerns about the general care of residents. During the Random Inspection in April 2010 we made a requirement for the Safeguarding procedure to be updated to ensure that it is accurate. The Responsible Individual has sent the Commission two updated copies but it is still not accurate and so this requirement has not been met. A requirement was also made at that time for staff to have Safeguarding training. During this visit the Manager told us that ten staff attended this training in July 2010 Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: and that she is waiting for further dates to book the other 5 staff places. In the last two months the Manager has made two safeguarding referrals appropriately. These both relate to residents hurting another resident. The lack of staff training and skills with regard to communication and working with people with complex needs means that some of the residents are at risk from the behaviour of other residents. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home, in general, is rather institutionalised and not homely. Evidence: During this visit we were shown around the Home by one of the staff. The Home is situated in attractive grounds in a rural location. The Home consists of a large main house with a bungalow situated a few feet away. There is no covered walkway to the bungalow and so residents and staff get wet when it is raining and they are moving between the two. The seperate locations mean additional pressures on the staffing levels. The main house has a large dining room and a large lounge, both of which have lovely views of the garden. The Manager said that there are plans for decking to be provided alongside these rooms to improve the facilities outside. The lounge has a mix of sofas and armchairs. At least one of the sofas is in need of replacement. The Home does not have a passenger lift. There are two staircases, one of which has wide steps and handrails. The main house has bedrooms on the first floor and the ground floor. We saw some of the bedrooms. Some have been decorate and have lots of personal items around. Some are in need of redecoration and are not very homely. The Manager said that the decorators are due to start work on the redecoration of the Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: Home next week and that new flooring will also be put in some of the bedrooms. The Manager also said that the builders are due shortly to alter two of the bathrooms to improve the facilities for residents. Currently the majority of the bathrooms are in need of upgrading to make them easier for residents to use. They also need redecorating and making less utilitarian. Some of the baths are stained and there are marks where a hoist has been removed from one of the bathrooms. We saw that there was handsoap and paper towels available in the bathrooms. However, the flannels and towels that we saw in the residents bedrooms were old and tatty. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels are not adequate to meet the needs of the residents. Staff do not have the appropriate skills or training to enable them to meet the needs of the residents. Evidence: At the time of our first Random visit this year (April 2010) we made a requirement for staffing levels to be improved to ensure that adequate staffing is provided to meet the needs of the residents. The action plan provided by the Responsible Individual stated that this would be achieved by 11 June 2010. We checked for compliance with this requirement during the Random inspections in May and July 2010 and during this visit to the Home. The requirement has not been met and the staffing levels at night have been reduced since the requirement was made. The current staffing levels are for there to be four care staff on duty between 8am and 2pm with three staff on duty between 2pm and 10pm. There are now two waking night staff on duty although during previous visits to the Home there had been two sleep in staff in addition to the two waking night staff. The staffing levels are not increased at weekends or at holiday times when all of the residents are at Home during the day. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: The Home has a cook each day between 8.30am and 2pm. One of the care staff is allocated to work in the kitchen on the cooks days off. This is now in addition to the care staff on duty. The Home does not employ domestic staff currently although the Manager said that she is recruiting to this post. Therefore, the care staff are responsible for all household tasks including cleaning and laundry. The care staff are also responsible for the preparation of the evening meal and clearing up after this. The Manager and the care staff said that the staffing levels are not adequate to meet the residents needs. As previously stated in this report there are several residents who need two staff to assist them with personal care or with regards to difficult behaviours. This report also includes examples of how residents needs are not met and records are not maintained. At the time of our Random Inspection in July 2010 we issued an Immediate Requirement as we found that some of the care staff were working excessive hours without a suitable break in between shifts. Some staff were working all day, then working a waking night and then another morning shift. The Manager addressed this situation immediately. The Manager said that they have recently employed an agency member of staff as well as some staff having moved from another Home owned by the Responsible Individual to work at this Home. During the Random Inspection in May 2010 we issued an Immediate Requirement with regard to the need to have evidence that appropriate checks have been carried out prior to a member of staff, or volunteer, working at the Home. This requirement has now been met. At the Random Inspection in April 2010 a requirement was made about the need for staff to have appropriate training to enable them to meet the needs of the residents by 30 June 2010. Staff had not received sufficient mandatory training, nor training with regard to the specific needs of individual residents. The action plan stated that this would be done by the 31st August 2010. We have monitored progress towards this requirement during our visits and this requirement has not been met and will not be met by 31 August. The Manager said that 10 staff have received Safeguarding training and that the majority of staff have attended sign language workshops provided by the sensory Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: support team. She said that further communication training is booked for September and October 2010. Training is booked for August 2010 for the use of the new monitored dosage system. The Manager said that no other training has been booked for the staff team. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the Home is not robust. The organisation does not have effective quality assurance systems in place. The health and safety needs of the residents and staff are not protected Evidence: The previous registered Manager left in 2009 and the new Manager who was appointed at that time left the Home in May 2010 without having been registered with the Commission. The deputy manager left in June 2010. A new Manager was appointed in June 2010 but there are no plans currently to employ another deputy manager. The new Manager has not got current experience of working with people with a learning disability but does have experience of working with people with dementia. The Manager said that she has booked to attend Dementia Mapping training in September 2010 and will be updating the Train the Trainers course for Moving and Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: Handling in November 2010. The Manager has worked hard to try to make improvements at the Home. However, the support provided to the Manager has not been adequate to enable her to carry out her role effectively. The organisation does not have an effective quality assurance system. The area manager visits regularly and writes a monthly report as per Regulation 26. These are not detailed and the issues that we have identified had not been picked up during these visits. Very few audits are carried out and, where they are, no action has been taken to address issues. There is no overall improvement plan in place which prioritises actions, identifies who is to do them and by what date. The Responsible Individual provided an action plan when requested to do so but the dates within this for improvements to be made have not been met. During our Random Inspection in April 2010 we issued an Immediate Requirement as we had found that the fire safety equipment had not been serviced at the time when it was due. This was particularly concerning due to the fact that two of the residents smoke in their rooms. We were informed by the previous deputy manager that this had been carried out but when we visited in May 2010 we found that the Emergency Lighting still had not been serviced. This was done shortly after the visit in May. This report includes examples of health and safety issues that have not been adequately identified or addressed. We looked at the accident records. The Manager does not currently audit these and was not aware of one of the accidents. We looked at the policies and procedures and found that these are out of date with no recent reviews. The Manager said that the Responsible Individual is going to provide a new set of revised policies and procedures. Care Homes for Adults (18-65 years) Page 30 of 36 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 6 15 It is required that the care plans contain detailed information about how residents needs should be met To ensure that staff have clear guidance about how to meet residents needs 31/05/2010 2 9 13 It is required that risks are 14/05/2010 identified and that appropriate assessments are carried out. To ensure that risks to residents and staff are minimised 3 14 12 That every resident has a regular opportunity for outings or activities outside the home, to ensure their needs are met. 28/11/2008 4 23 13 It is required that the Safeguarding adults procedure is reviewed and updated To ensure that staff have clear guidance to follow if needed 23/04/2010 5 23 13 It is required that all staff receive appropriate 31/05/2010 Care Homes for Adults (18-65 years) Page 31 of 36 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 Safeguarding Adults training To provide protection to the residents from abuse 6 33 18 It is required that staffing levels are adequate to meet the needs of residents To ensure that residents needs are met 7 34 19 That appropriate recruitment 14/07/2010 checks are carried out To provide protection to the vulnerable residents 8 35 18 It is required that staff receive appropriate training to carry out their roles effectively To ensure that staff have the appropriate skills to meet the needs of the residents 30/06/2010 30/04/2010 Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 19 13 Clear guidance must be in place for the administration of PRN (as required) medicines To ensure that residents receive medicines appropriately 27/08/2010 2 20 13 Effective arrangments must be made to ensure medicines discontinued and no longer prescribed are promptly removed to reduce the risk of being incorrectly administered To ensure the safe administration of medicines 27/08/2010 3 20 13 Arrangements must be made to ensure that medication administration records are accurately maintained and that the reasons for nonadministration of 27/08/2010 Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action medicines are recorded. To ensure the safe administration of medicines 4 20 13 Arrangements must be 27/08/2010 made for the safe storage of the keys to the medicine cupboards To ensure the security of medicines 5 20 13 Only staff who have received 27/08/2010 appropriate training are able to administer medicines To ensure that medicines are administered safely 6 20 12 The stock control of medicines must ensure that medicines prescribed for residents are available for administration To ensure the safe administration of medicines 7 24 23 The Home must ensure that the Home is upgraded and decorated to provide suitable accommodation for the residents. To ensure that the residents live in a Home which is comfortable and which meets their needs 30/11/2010 27/08/2010 Care Homes for Adults (18-65 years) Page 34 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 27 23 The Home must provide bathrooms which meet the needs of the residents To enable residents to have a bath/shower comfortably and safely 29/10/2010 9 39 24 The Home must have an effective quality assurance system To ensure that the quality of the service provided to the residents is regularly monitored and improvements made as necessary 17/09/2010 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 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!