Care Home: Bede`s View

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What the care home does well Interactions between the people who live in the home and the staff are good. They reflect positive and valued relationships in peoples lives. People have good menus for the food offered in their home. They have choices of healthy, tasty and well prepared food. People have good access to health professionals who in turn offer good support in the meeting of peoples health needs. People receive good support in the meeting of their medication needs. People live in a home that is clean throughout. People are supported to personalise their own rooms, making them individual and to their own taste. What has improved since the last inspection? Risk assessments are now in place to support people in living their lives as they choose and undertaking activities of their choice. People attend a variety of activities both within the home and their local community. The maintenance work required within the home is planned to start. Staffing levels have been addressed and are now better organised to meet peoples needs. Staff have received training that helps them in their knowledge and in supporting people with the meeting of their needs. What the care home could do better: Peoples files could be better organised with old or out of date documents being removed to reduce the risk of confusion and the time taken to find the correct information for each person with the meeting of their needs. Records relating to the maintenance of peoples health must be kept up to date and clear so that they are can be used to help people maintain their health. The conservatories could have better systems for the control of temperature so that they are kept at an acceptable and comfortable level. Risk assessments should be kept up to date and concise so that they are easy to use and accurately reflect peoples up to date needs so that these are correctly met. There should be private space for people when their friends or relatives wish to visit or for when confidential meetings take place. There should be adequate storage facilities in the home so that people do not have to share fridges and bathrooms do not need to be used as storage. Windows should be of sound construction so that they can be seen through and so they do not cause rooms to be unnecessarily cold. Evidence should be available to evidence that staff recruitment meets the required standards and peoples needs are fully met without their safety being compromised. Staff should be regularly supervised so that they receive appropriate assistance in fulfilling their roles and in meeting the needs of the service users. Key inspection report Care homes for adults (18-65 years) Name: Address: Bede`s View Wasdale Avenue St Bede`s Close Wivern Road Kingston upon Hull East Yorkshire HU9 4HZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Rodmell     Date: 1 5 0 1 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 35 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) 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 Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Bede`s View Wasdale Avenue St Bede`s Close Wivern Road Kingston upon Hull East Yorkshire HU9 4HZ 01482788078 01482788098 sheila.carmichael@hullcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kingston upon Hull City Council care home 11 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: 11 The registered person may provide the following category of service only: Care home only to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD, maximum number of places 11 Date of last inspection Brief description of the care home Bedes View is a purpose built establishment, managed by Hull City Council Social Services Department that provides accommodation for eleven service users who have a learning disability and/or physical disability. Accommodation is in single rooms although none of these are en-suite. The home consists of two bungalows each having its own kitchen and dining roomlounge area. A secure garden area is available for service users to utilise. The home has parking facilities. A variety of aids and adaptations are available to meet the needs of service users with mobility problems. The home is located to the east of Hull within a residential area. Shops are close by Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 11 Brief description of the care home and several buses travel to the city centre. All bedrooms are for single occupancy. Client contributions to the weekly fees range from GBP51.95 to GBP78.00. Additional charges are made for the following newspapersmagazines and sweets, hairdressing, chiropody and transport for social activities. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The inspection report was based on information gathered by the Care Quality Commission (CQC) since the last inspection of the home on 29 January 2009, including information gathered during a site visit to the home. It began at 9.30 am and ended at 4 pm. On the day of the visit the inspector spoke to the manager and staff. None of the people who live in the home are able to formally participate in the site visit. Inspection of the premises and a close examination of a range of documentations including three care plans were also undertaken. The manager completed the Annual Quality Assurance Assessment (AQAA) and Care Homes for Adults (18-65 years) Page 6 of 35 returned this to us within the given timescale. The AQAA is a self assessment document that provides information about the home. The manager did not know the fees for living in the home and did not forward them to the CQC as requested. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Peoples files could be better organised with old or out of date documents being removed to reduce the risk of confusion and the time taken to find the correct information for each person with the meeting of their needs. Records relating to the maintenance of peoples health must be kept up to date and clear so that they are can be used to help people maintain their health. The conservatories could have better systems for the control of temperature so that they are kept at an acceptable and comfortable level. Risk assessments should be kept up to date and concise so that they are easy to use and accurately reflect peoples up to date needs so that these are correctly met. There should be private space for people when their friends or relatives wish to visit or Care Homes for Adults (18-65 years) Page 8 of 35 for when confidential meetings take place. There should be adequate storage facilities in the home so that people do not have to share fridges and bathrooms do not need to be used as storage. Windows should be of sound construction so that they can be seen through and so they do not cause rooms to be unnecessarily cold. Evidence should be available to evidence that staff recruitment meets the required standards and peoples needs are fully met without their safety being compromised. Staff should be regularly supervised so that they receive appropriate assistance in fulfilling their roles and in meeting the needs of the service users. 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standard 2. Peoples needs are assessed by the home to make sure that they are fully understood and can be met. Evidence: The information recorded in the AQAA included, Information is kept up to date within the service users individual file with input from our health partners which include risk assessments. We hold six monthly reviews using a person centred approach and FACS reviews held annually by the care management team. Any changes to the service users needs would be documented and action plans would be put in place to meet individual requirements. There have not been any new admissions to the service since the last key inspection of the home. We looked at the files for three of the people who live in the home. All of the people Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: have lived here for some time now . Their individual files include a variety of assessments containing a large amount of information to help to make sure that their needs are known and that staff have the information available to meet these needs. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 6, 7 & 9. People are supported though the care planning process to have their needs met and to make decisions in their lives. However poor record management does not ensure the effectiveness of this and could reduce the quality of support offered. Evidence: Information recorded in the AQAA included, each service user has an up to date individual plan. This plan details how each service user needs to be supported in making choices and decisions as well as how to recognise when they are making informed choices. The plan also specifies who to contact in supporting them to make choices on their lives, this including relatives and other professionals. We also recognise the need when support is needed from other professionals when a service user lacks capacity. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: We looked at the files for three of the people who live in the home. Each person has more than one file that contains their information and plan of care. The information covers a variety of areas including assessments from other professionals, a service user guide, statement of purpose, reviews, details of the care to be provided, including personal care and leisure details. However due to the large amount of information included in the files it was difficult to determine which was the current care plans or information for each individual or to obtain a picture of the person. This would make it difficult for a new member of staff to be able to support the individual as it would take them a longer amount of time to find and understand the information. This was discussed with the manager as an area that needs addressing. At the last visit to the home a requirement was made that continued improvement and development of service user plans must take place. This requirement has not been met. Peoples files included the details of times when people either made decisions or due to their individual needs were supported to make a decision. For example, one persons files recorded that they decline to go swimming and then they declined a foot spa. Another persons file recorded that a best interest meeting had been held for this person. This type of meeting is held when an important decision is needed for this person and the person themselves are unable to make the decision. People who are involved in this meeting include professionals and relatives, who will meet and discuss the information available which then helps them to decide if the suggested activity is in the persons best interest. Peoples individual files held a variety of information that also included risk assessments. These were varied and addressed a range of areas including, for example, the risk of going swimming, using a minibus and using pain relief medication. Additionally there were health professional risk assessments and relapse management plans in place. Again due to the volume of paperwork in each file it was initially unclear when some of the risk assessment had last been reviewed and if they were still valid, for example, we saw a risk assessment for the use of the toilet dated 2005, and the swimming risk assessment was dated 2008.Although there would be overall review forms. Again the duplication of documents should be addressed to reduce the confusion and ensure that people are receiving the correct care. A previous requirement that there were individual and generic risk assessments has been met, however they must be updated and be more concise. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 12,13,15,16 & 17. People are supported to have their dietary and social needs met, including the maintenance of important relationships. Evidence: Information recorded in the AQAA included, We tailor activities to meet service users likes and interests, we employ programme workers to ensure these go ahead. We support service users to visit their family and also plan with their family members to meet them for days out, the service users are supported by staff to do this. We consult with our health partners to ensure our risks are identified and managed before undertaking the activities. We gather information from people who know the service users well. We offer a healthy balanced menu which was devised by joint working with dietitians and out health partners. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: We observed throughout our visit that people were supported by the staff to undertake activities outside of the home. Some people supported local sports teams and in addition to attending sports fixtures with staff they had been supported to decorate their bedrooms with sporting memorabilia. People were also supported to meet up with their family. Peoples records included details of activities that they undertake and these included, for example, watching television, listening to music, going for a drive out, xmas shopping, going to a pub, going to a farm and going to a cafe. Staff told us that people undertake activities that included swimming, football, bowling, cycling, music activities in the community, ice hockey and rugby matches. They also told us that people had been on holiday and that people are supported to meet up with their family. The previous requirement that service users are enabled to access a wide range of activities in the community is now met. We observed that staff and service user interactions were appropriate and respectful, with staff chatting with service users and not only with each other. We observed that where people are able they can choose when to spend time with others and when to be alone, and they have free access around their own home. Staff were aware of peoples preferences and people were offered time alone in their own rooms to relax during the day. There are planned and organised menus within the home, with the service receiving an award for these. We observed the lunchtime meal which was of a good quality and was appealing. People appeared to enjoy their food and were offered choices. Lunchtime was a relaxed and unrushed experience for people. There is limited storage across the two bungalows and one bungalow contains the fridge for the other bungalow due to the lack of space. This is not ideal and should be considered as part of the refurbishment. Care Homes for Adults (18-65 years) Page 16 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 18, 19 & 20. People are supported in the meeting of their health, personal and medication needs. However poor record keeping jeopardises the quality of the support offered in the meeting of needs. Evidence: Information recorded in the AQAA included,Annual Health screening is up to date and in place and is facilitated by the local GP practice and the community nurses at Bedes View.Fortnightly learning disability nurse led clinics are held at the establishment to give advice and support on an individual need. Staff have specialist training on providing postural management, bowel massage, and feeding and swallowing. All staff promotes service user privacy and dignity, choice in a respectful manner.Staff and service users have one page profiles.Staff are trained in the administration of medication, and have specialist training in the administration of Buccal Midazolam. End of life documentation is on place for those who chose to share this information. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: We looked at the care files for three of the people who live in the home. These files included a large amount of information, including health details for each person. It was clear that there had been a large amount of professional input from specialist nurses for people with learning disabilities and their colleagues, for example, the physiotherapist, occupational therapist and psychologist. Documents included Health Action Plans, risk assessments from Learning Disability services, details of peoples communication needs and letters from professionals. There were additionally monitoring charts for different needs, for example weight or epilepsy monitoring charts. However in one persons file the monthly epilepsy monitoring chart had not been completed since June 2008 and in another persons file, the weight chart had not been completed between March and November 2009. Without accurate records peoples conditions cannot be monitored and any changes realised in order to help maintain peoples health and have their needs met. The previous requirement that there must be continued improvement in health screening including a health action plan has not been met. We spoke to a health professional who visited the home. They told us that they have no problems with the service, that staff attend specialist training that she offers and that they always follow professional advice and instructions. They also said that staff are always pleasant and polite and welcome them into the home, and that they will ring and seek advice as necessary in order to meet peoples changing needs. We also noted that two people have had additional medical support to have specialist assistance with managing their health conditions. We looked at the medication procedures and records held in the home. A member of staff told us that when medication is received into the home the details of this are checked by two members of staff. Each person who lives in the home has an individual file for their medication details. The file includes a photo of the person, their name and address and any allergies. There are letters regarding medication, medication administration records and stock control sheets. We looked at the records for administration and these appeared to be up to date. Each person has an individual travel bag and risk assessment for any medication that they may need if they go out of the home on an activity. Additionally people who suffer from epilepsy have specific management plans. Records are kept of the temperatures of the cupboard where medication is stored and of the fridge that medications that are required to be kept cool would be stored. There were no medications that would be described as controlled held in the home at the time of the visit. Care Homes for Adults (18-65 years) Page 18 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 22 & 23. People are supported with policies and procedures in the home to make sure that they could raise concerns and are protected from harm. However, failure to keep policies up to date could prevent these situations from being handled correctly. Evidence: Information recorded in the AQAA included, Record complaints and compliments and follow departmental policy and procedures. Staff have POVA training. Responses to physical and verbal aggression are dealt with appropriately and care management are alerted, guidance is sought from our health partners and appropriate risk assessments and management plans are put in place for staff to follow to ensure a consistent approach. We saw that there is a policy and procedure for the handling of complaints that includes the timescales for responding. It included details of the CSCI which are the previous contact details for the CQC and this must be addressed. The last recorded complaint was in June 2009 and although it appeared that this had been addressed the outcome for this was not recorded. The commission has not received any complaints regarding this service. The manager confirmed to us that they hold a copy of the Local Authorities policy on Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: the Safeguarding of Vulnerable Adults. Staff records show that staff have received training in the protection of vulnerable people. The Commission have been notified of incidents in the home and as necessary these are reported to the appropriate people within the Local Authority. We observed staff handling peoples monies. Records are kept of all monies entering and leaving the home. People sign for monies that they remove from the home, for example when they are supporting a service user with an activity, then sign again when it is returned. Records are kept of each individuals monies and checks are made. Care Homes for Adults (18-65 years) Page 20 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 24 & 30. People live in a home that is currently being refurbished and will hopefully better meet their needs when this work is completed. However small amounts of additional work may compromise this. Evidence: Information in the AQAA recorded, Risk assessments are in place to safeguard service users, staff and visitors.Daily bathing temperature checks are carried out along with weekly temperature checks these are recorded. We have two cleaners from City services who come Monday to Friday three hours each day. Gardens are maintained to a good standard to enable the service users to safely spend time in the grounds. Care staff attend risk assessment training. Additionally, it recorded in the plans for improvement, In January 2010 a refurbishment programme will take place at Bedes View which will include new flooring and soft furnishings, shower facilities and better office space. This will improve the environment at Bedes view for the people who live at Bedes View for the people who live there and the staff who care for them. As this is now taking place the previous requirement for a maintenance plan is now met. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: We completed a tour of the premises and noted that one of the bungalows had been packed in preparation for people moving out whilst the refurbishment was undertaken. People own bedrooms are personalised to individual tastes reflecting peoples personalities. We saw that weekly checks are undertaken of the hot water supply and that this is recorded in the home. We checked the hot water in one bathroom and noted that although the temperature control on the bath recorded the hot water supply at 45.7 degrees the thermometer recorded the hot water at 46.3 degrees. The member of staff was made aware of the need to address this. The home was clean and comfortable throughout and no offensive odours were noted. There is one laundry room that is shared by both bungalows. The cupboard drawers and doors in here were in need of attention as a drawer front was missing and a door did not fit correctly. There was no evidence that that home meets the requirements of the Water Supply (Water Fittings) Regulations 1999 and the manager agreed to forward this to the CQC; this has not been received. We noted that the conservatories in the home were both cold and uncomfortable to be in. There is heating in these areas but the heating is designed to heat the whole of the home and these areas being colder than the rest do not receive enough heat. One professional told us that they cannot work in these areas as they are either too hot or too cold. It would be recommended that this is addressed as part of the refurbishment so that people could comfortably use these areas of their home throughout the year. Fire extinguishers were in place and they had last been serviced in August 2009. We saw that there are checks of the fire systems in the home. This included the fire activation points, door lights, and emergency lighting. There are fire risk assessments for each individual service users room and these were completed in 2009. There is a generic risk assessment for the home as a whole. However this was dated 2008 and must be updated. There is also an emergency and crisis contingency plan. Environmental issues from the previous inspection included: There is only one small office for the manager and staff to use. This covers both bungalows and is not sufficient for the needs of the home. It is very cramped and there is only room for one person to use it safely. On the day of the visit a file was seen to fall off an overfilled shelf and nearly struck the manager on the head. A member of staff told us that the office is being made larger as part of the Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: refurbishment of the home. There is no other private space for staff and managers to conduct meetings or supervisions. If they need to discuss things in private with relatives or visiting professionals there is nowhere for this to happen. The manager told us that there are no plans to introduce a room for this purpose as part of the refurbishment of the home. The requirement from the previous report regarding these remains. A plan of maintenance and renewal needs to be developed. At the time of the visit the majority of the contents were packed ready for people to move out in the next 2 days so that a refurbishment could take place. Staff currently use the conservatory or lounge , which is meant to be peoples communal space and affects their quality of life. As an interim measure the sensory environment / room has been turned into an office for the senior care officers to use for meetings. The staff told us that this practice has ceased and that they currently hold meetings off site. Around both bungalows there is damaged plasterwork and chipped paint. This is to be addressed as part of the refurbishment. The bath in Rowan bungalow is inadequate for the needs of the people who live there. It is an old bath that lowers to the floor. This bath is to be replaced as part of the refurbishment. Staff told us and we observed that there is very little storage space, meaning that cupboards that house boilers and tanks are used for storage and wet clothes are dried in bathrooms. Boiler cupboards are now empty, although staff continue to hang peoples best clothes up in the bathrooms for drying. There are no plans to increase storage space as part of the refurbishment. Wheelchairs and specialist chairs do not fit through the doorways very well, creating bumps and knocks to the person and damage to the walls and risk of injury to both staff and the people who live in the home from knocks and jolts. Staff are unaware of any plans to address this as part of the refurbishment of the home, although they did feel that the incidences of this have reduced now there is a ceiling track in the home and hoists do not have to be used in the communal areas. The windows are very old and instead of glass they are plastic panes: these are damaged and cannot be seen through or cleaned. Staff report that the window frames Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: are very drafty. There are no plans to address these issues as part of the refurbishment of the home. The staff told us that the window frames are to be painted. Staff reported that there was not enough ventilation in the kitchens ,the doors have to be closed when cooking to ensure the safety of the people who live there and the windows are very small. The manager told us that there are no plans to change this within the refurbishment of the home. Another requirement was regarding the lack of ceiling track to assist in the moving of people. This had been identified as being required within a moving and handling assessment from Hull City council on 21/1/09 as being required. This is now in place. Other requirements included that the carpets were worn and stained and that there were not enough cleaning hours provided. The hours for the cleaners have been increased and the manager told us that new flooring is to be provided as part of the refurbishment of the home. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 32,34,35 & 36. People are supported by adequate numbers of well trained staff. However the lack of records to confirm good recruitment practices and the lack of adequate staff supervision could compromise the safety and standard of support offered. Evidence: Information in the AQAA recorded, Service users are cared for by trained competent staff. Staff are encouraged to develop their role which is encouraged through PPD (Personal Performance and Development.) Staff work well with health professionals and have a good understanding of the service user needs.Staff are starting to work using a person centred approach and tools. We provide a knowledgeable and consistent staff team. Staff are given regular 1:1 supervision. The manager told us that there is now only one vacancy for a carer, and that there have not been any staff recruited externally since the last visit, although staff sickness levels have been high. Consequently the home has used agency staff to cover shifts and sometimes this has meant that there have been two agency staff to one permanent member of staff on a night shift. The manager told us that they use the same agency staff each month and have done so for some time. This ensures Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: continuity for the people who live in the home and in standards of care. The previous requirement for adequate staff numbers has been met. A member of staff told us that there have been changes to the duty rotas to help to assist with people moving out of the home whilst it is refurbished. She told us how people were undertaking additional senior care duties to ensure that the people who live in the home continue to receive the correct amount of support. She told us that there are usually three staff working in either bungalow during the day, either 7.45 to 3.45 or 2 until 10 and that this allows for a handover period for staff to share information and help with continuity of care. The requirement that there is a review of the staffing structure in order to make sure there are sufficient staff to meet peoples needs has been met. A member of staff told us how the cleaning staff have been given additional hours to help ensure that the home remains clean. The previous requirement for this has now been met. We looked at the records for three of the staff in the home. Records were not available to show that people had completed application forms or that two written references were undertaken on them prior to employment. Correct recruitment procedures help to make sure that only people who are suitable to work with vulnerable people do so. There was evidence that a Criminal Record Bureau Check (CRB) had been completed and these help to check that the people employed in the home do not hold a criminal conviction that may prevent them from working with vulnerable people. There was one record that a member of staff had attended a Learning Disability Award Framework (LDAF) course; this is a specialist course for people who commence work with people with Learning Disabilities. There were no additional records that staff receive an induction into the home that meets with the Skills for Care requirements or that people are employed within the General Social Care council (GSCC) code of conduct. We also looked at the training records for the staff. Each file included a Personal Performance and Development plan (PPD), although these were not all up to date. One person received a PPD in May 2009 with a review date of November 2009, but there was no record of this. Peoples records included a training plan for 2009-2010 and records of courses undertaken included Infection control, moving and handling, Equality and Diversity, Health and Safety, Food hygiene, Medication, safeguarding of Vulnerable Adults, Autism, Challenging Behaviour, and Deprivation of Liberty training. The previous requirement that staff have the skills to meet peoples needs and that Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: staff receive service specific training are now met, as is the requirement that there are individual training plans. We looked at the supervision records for staff. These again were not up to date. One persons records included that over the last year they had only received one supervision in December of 2009, their records reflected that they had attended a staff meeting in May and July of the same year. This does not meet the recommendation that staff receive a minimum of 6 supervisions a year. The previous requirement for staff to receive the support and supervision required has not been met. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 37, 39 & 42. People are supported to have their needs met. However omissions in management and maintenance systems do not ensure that they receive the correct level of support in having their needs met. Evidence: Information in the AQAA recorded, The registered manager has many years of experience and is qualified and competent, who also welcomes support and advice from our health professionals along with developing the Senior care team. Qualified consistent, flexible, supportive senior group working towards improvement and furthering the development in relation to life long learning. Currently working to build a person centred plan. Up to date policy and procedures to safe guard service users. Seniors who are fully trained in dignity at work and equality and diversity. Since the last visit to the home the staff team appear to have remained stable. At the Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: time of the visit people were positive and cheerful in their roles. However there has been a change in the management of the home and there is a new manager in post. They have been in post since August 2009 but have not yet applied to register with the CQC and must now do so. The manager told us that she is experienced in her role, and that she has attended training on infection control, the Protection of Vulnerable People, First Aid and transforming teams. She was supportive throughout the inspection and keen to hear the findings of this visit to utilise these as benchmarks for improvement. The requirement that the registered person ensures that the home continues to be managed effectively remains as there has not been the opportunity for consistency in management. There is a quality assurance system in the home that seeks the views of other professionals, relatives and carers. It includes that a report is compiled based on the findings and includes details of the results. The previous requirement that there is a quality assurance system has been met. Reports are forwarded to the Commission of incidents in the home ,and also to the Safeguarding Adults team. However it was noted that the detail varied between the two documents with the report to the safeguarding team being more detailed. The manager must ensure that all of the necessary information is included in all reports to the Commission. We saw that there were some records of maintenance in the home. These included the tumble dryer, bath hoist and fire alarm inspection. The maintenance for the bath had been due in August of 2009 and was overdue, as was the Landlords Gas Safety Certificate which was due on July 2008. The manager agreed to forward this to the CQC but this has not been received. Additionally there were records for the weekly maintenance checks of the wheelchairs, however, but these were not up to date. Care Homes for Adults (18-65 years) Page 29 of 35 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 (1 and 2) 17 The registered person must continue the improvements being made in the development of service user plans for all of the people that live in the home so that are aware and able to meet peoples needs. 31/12/2008 2 9 13,17 The registered person must 31/12/2008 continue the improvements in the individual and generic risk assessments and ensure that they are maintained and reviewed regularly so that people are protected from harm. 3 19 13 The registered person must 31/12/2008 continue the improvements in the development of health screening; health action plans and access to health professionals and records of outcomes are maintained so that peoples health needs are met. 4 24 16,23 The registered person must ensure that there is a meeting room/office fit for purpose that is private and 31/12/2008 Care Homes for Adults (18-65 years) Page 30 of 35 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 separate to the communal space so that peoples privacy is maintained. (Timescale of 1/6/06, 31/12/06 and 30/6/07 not met) 5 36 17 (6 f) 18 (2) The registered person must 31/12/2008 ensure that staff receive the support and supervision required and must include all of the areas specified in 36.4 of this standard so that staff are competent in their role. (Timescale of 1/9/03, 31/08/06, 18/05/07 and 22/05/07 not met) 6 37 9 The registered person must 31/12/2008 ensure that the home continues to be managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. Care Homes for Adults (18-65 years) Page 31 of 35 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 22 22 The complaints procedure should include the contact details of the Commission. This provides people with the correct information if they wish to contact the Commission for support with concerns they may have. 26/02/2010 2 24 23 Windows should not compromise the heating of the home and should offer views for people. This helps people to live in a comfortable home. 26/02/2010 3 24 23 Ventilation and heating in the conservatory areas of the home must be suitable to maintain adequate temperatures. This will help to ensure that people are able to use these areas and be comfortable. 26/02/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 4 24 23 Doors and cupboards in the laundry must be kept in a good state of repair. This heps to reduce the risk of injury and protects peoples safety. 26/02/2010 5 32 19 Evidence must be available to show that good recruitment practices are followed, including application forms and references. This helps to make sure that the correct staff are recruited who can fully support people and their safety is not compromised. 26/02/2010 6 36 18 Staff must receive adequate supervision in their roles. This helps to make sure that they are competent and supported in their role. 26/02/2010 7 42 13 Maintenance of equipment in 26/02/2010 the home must be up to date, with written evidence available to the CQC. This includes the gas systems and the wheelchair maintenance. These help to make sure that people live in a maintained home that is safe for their use. Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 17 24 24 37 There should be adequate storage space for all of the food to be stored within the individual bungalows. There should be adequate ventilation in the kitchen. There should be adequate storage space in the home. The manager should be registered with the Commission. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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