Care Home: Better Care Residential home

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What the care home does well This is a small service offering homeliness and informality. The questionnaires we circulated in 2009 contained few commentaries by the respondents on this occasion but most of our questions were ticked as positive; for example, “Are there any aspects of this care home that cause you concern?” and in each case the response was “No”. Over the course of our three visits this year the residents have told us they like ‘The Better Care’, which they say is, “A nice, small friendly home, like a family home”. They say, “We like it here, we get on well together”. One resident told us that she would be, “Moving on to more independent accommodation in the future” and this had proved to be the case. A new resident told us she chose the home because it was small and informal. One resident did not wish to respond to the survey. A care coordinator spoke very positively about the service and told us that the home is ‘highly regarded by them and the staff work well with the mental health team’. What has improved since the last inspection? The main and essential improvement in this service is that Mrs Coker has introduced some administrative support to help her manage the documentation. Mrs Coker has failed over a series of inspections to acquire an up to date copy of the standards that apply to Better Care and so she has inevitably failed to meet those standards. With the arrival of a person who can deal with administration he has revised and improved much of the documentation required to support good care. Secondly, Mrs Coker has begun addressing the many shortcomings in the environment, including matters of safety and décor.Better Care Residential homeDS0000055368.V376501.R01.S.docVersion 5.2 What the care home could do better: These improvements noted above need to be sustained if the service is not to lose its improved star rating. The manager might consider putting in place a house committee comprising for example the manager, administrator, a carer, a resident and possibly an external professional such as a care coordinator to periodically review progress in addressing care standards. This would also contribute to the home’s quality assurance monitoring (which is also a national minimum standard, standard 39). The manager has several very useful management tools, manuals to help in the running of a care home but she has yet to acquire the Department of Health book, “Care Homes for Adults, National Minimum Standards”, 2nd Edition and without this the other guidance tools will make little sense. It is noted that the new administrator has given a commitment to buy a copy without further delay. The certificate of registration requires that the small room on the first floor be used as communal space and with the installation of a computer in this room it is now used for more than just a staff sleep-in room - but it still needs to be refurbished if it is to be a space more readily useable by residents. For example remove the double bed and install a convertible sofa/bed and chairs so the room can be used as a lounge or meeting area. Some areas such as the kitchen have been repainted but the floor in this area needs replacing again. Key inspection report CARE HOME ADULTS 18-65 Better Care Residential home 211 Brighton Road Purley Surrey CR8 4HF Lead Inspector Michael Williams Key Unannounced Inspection 15th July 2009 09:45 Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Better Care Residential home Address 211 Brighton Road Purley Surrey CR8 4HF 020 8763 9796 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Agnes Harriette Lucinda Coker Mrs Agnes Harriette Lucinda Coker Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The undersized bedroom will be used as a communal space, with the existing dining room becoming a bedroom. The French windows out of the upstairs bedroom will be permanently locked with ventilation being provided by other means. 28th July 2008 Date of last inspection Brief Description of the Service: Mrs Coker is the individual owner and she calls this service ‘The Better Care Residential Home’; it is a registered care home for up to four residents who have mental health difficulties. The home’s Insurance policy displayed in the entrance, confirms these details and the person in charge did not advise us of any changes to the name or ownership of Better Care. The home’s aim is to provide support to enable female residents to develop skills for independent living. The home itself is a large, converted family home situated on the busy A23 road near Purley. The home is near local shops and has good transport links including buses and trains. The home’s accommodation is on two floors; the ground floor has a single communal lounge/dining room, a kitchen, a toilet, a shower room, and one, single bedroom. The first floor has a further three single bedrooms, a bathroom and a small office and a room which the owner is using as a staff sleeping-in room but which conditions of registration require to be used as part of the residents’ communal space, such as a lounge. To the rear of the property there is a garden with a small paved area and a grassed area; to the front of the building there is driveway, which can accommodate several cars. Fees were £509 per week as at January 2008. The provider, Mrs Coker states ‘extras’ may be charged ‘by negotiation’ but has not specified what those additional charges will be. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This report is based upon three site visits including an extended unannounced random visit on 20th January 2009, a brief unannounced visit on 15th July and a further on 17th July 2009. Mrs Coker the owner/manager was present for the first two visits but not the third one. For each visit the lead inspector Michael Williams was accompanied by a second inspector David Lacey. During each visit we assessed the manager’s progress in meeting national minimum standards for this type of service – a care home for younger adults. In doing so we met with residents, checked documentation, and checked the premises for comfort and safety. We also took note of comments from other sources such as the local mental health team and other visitors. We also took note of any information provided to the Commission since our last key inspection in July 2008. What the service does well: What has improved since the last inspection? The main and essential improvement in this service is that Mrs Coker has introduced some administrative support to help her manage the documentation. Mrs Coker has failed over a series of inspections to acquire an up to date copy of the standards that apply to Better Care and so she has inevitably failed to meet those standards. With the arrival of a person who can deal with administration he has revised and improved much of the documentation required to support good care. Secondly, Mrs Coker has begun addressing the many shortcomings in the environment, including matters of safety and décor. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 2: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that they will receive all the information they might expect before, or immediately after, deciding to live in Better Care, nor that the initial assessment information will be fully utilised to inform the home’s future care planning. EVIDENCE: In May 2008 we required Mrs Coker to ‘provide an accurate Statement of Purpose and resident Guide’. They have now been amended so as to include more sensible information but also we advised that it should be available in a format that can be given to residents and other people that may request a copy. This was not the case when we re-visited in July 2009. The new administrator is in the process of revising all documentation including the service user guide and statement of purpose but without the ‘national minimum standards’ to guide him these documents were not well laid out nor readily available to us or other people that may want copies. Placing authorities are giving the home very detailed assessment information but the home’s own assessment format was for elderly people not young mentally ill people and here again the administrator is using the management manuals to devise more appropriate care planning documents and formats for the manager and staff to use in future. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 9 Areas of strength include the efforts to improve information but it is still not being delivered to residents as intended. This section, about choice, is assessed as adequate but the Commission expects this area will improve quickly with the support now available to the manager. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 6, 7 and 9: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident can be assured that their changing needs, goals and risk-taking are reflected in suitable care plans. EVIDENCE: Care plans were addressed in requirements we issued in 2008 and we assessed these as partially met since residents are moving on indicating progress is being made by residents living in this care home. The care plans we saw earlier were somewhat historic. We advised you that care plans must in future address the initial care and risk assessments and must be more clearly and thoroughly addressed in your care planning and risk assessments and to this end the administrator is devising more suitable formats for the home to use. At your suggestion we have met with staff at the local mental health centre and they confirmed that they provide guidance on the care plans and programme of activities for a particular resident. So although the home’s care planning is still not to a high standard yet, because they did not translate information provided by the mental health team into your in-house plans, the residents benefit by having care planning and risk Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 11 assessments provided by the care coordinator and this is achieving good outcome for residents. It is suggested that in future care plans need to more closely reflect the assessments of residents needs. Assessment and care planning will be monitored in future inspection visits. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: NMS 11 to 17: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. This home allows residents to participate in a range of community and leisure activities and to develop self-help skills so they can prepare for more independent living. EVIDENCE: Because this is a very small home each resident can lead an individualised lifestyle; so for example, the bathroom is usually available for them to use at a time of their choosing and the kitchen though small is big enough for each resident to prepare their meals individually. Residents are young and active people and they can all make use of the community such as the local recreation centre to use the gym’ and swimming pool and the local shops. It was evident that residents are making good use of the community resources in the local area. Residents told us about their contact with family and friends and how staff in the home is supporting them to sustain these relationships in a positive way, mindful of both their right to maintain these contacts but with due regard to risks to their mental health. Staff support residents to prepare meals, again mindful of the need for a healthy diet. This area of work seems to be reasonably well managed and is assessed as good. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 18, 19 and 20: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the care planning in Better Care is supplemented by care coordinators’ input and the home’s care planning is improving we can now assure residents that their personal and healthcare needs can be fully met by this home. EVIDENCE: Residents have access to health care services in the community. The community mental health team take the initiative in maintaining contact with their clients, because residents are entitled to ‘Aftercare’ within the meaning of the Mental Health Act, and the care home staff support residents to keep in touch with their care coordinators. Residents in Better Care do not require specialist aids and adaptations such as hoists and lifts but they do need access to facilities that will support their rehabilitation such as access to a domestic scale kitchen; a suitable laundry services or facilities; access to suitable washing and bathing facilities; freedom to maintain their own bedroom and so forth. Better Care can provide these facilities though not to a high standard as we report in the section about the environment. As we have identified in earlier sections of this report, the home’s own care plans, which should guide the actual delivery of care, are somewhat limited in Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 14 scope and detail but they are supplemented by care planning by the care coordinator. Quite correctly the home has not recently admitted without first obtaining enough information about the resident to make a decision about whether or not her needs can be met by the home, its staff and services. The home therefore has a detailed history and documentation listing identifiable risks to mental health and to safety. When we checked care plans in detail we identified in the information given to the home, by the mental health team, no less than 12 specific and readily identifiable areas that were indicative of issues that could arise in the future. Mrs Coker had devised just three and these were not particularly well documented, they are rather vague and without clear guidance and contingency planning. The use of phrases such as, “staff to monitor…” and “staff to prompt…” are examples of their lack of detail and clarity. The new administrator has been introducing more relevant care plan formats so that in future care planning can be more professional in appearance and content. The senior member of staff we spoke to thought more information could have been provided by the mental health team; but we concluded that a great deal of background information had already been sent to the home but was not being used to compile the home’s own action plans for the resident. There seems little point in asking for more information if what they already have is not being used to compile more effective plans of action. We checked medication information and record keeping and noted that it had improved from 2007 so that a record of incoming medication was in place and residents were not only being supported to administer their own medication with support and ‘monitoring’ but they were also being encouraged to keep a written record on a standard medicine chart. We do not see this as a requirement nor a statutory record and is not to be confused with the home’s obligations to keep a record of medicines received and administered but we see this is a positive step by the home to help residents to be careful about taking their medication consistently. Residents tell us that they are happy with the way that staff deliver their care and respect their dignity and rights, so, for example, they told us they had no complaints to make when we asked about the care and support they receive in this home. The mental health coordinator is very satisfied that the care provided is enabling residents to recover well and to make progress towards independence and this means health-care outcomes for residents are good. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 22 and 23: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has in place a suitable complaints procedure and staff are aware of the safeguarding procedures so residents know they will be listened to if they have any concerns. EVIDENCE: The home seems to have an open culture that allows residents to express their views and concerns in a safe and understanding environment. The home appears to be run very informally and so residents seem free to voice their opinions and concerns both to on site staff and to their care coordinators and other agencies they think relevant to tell. Since this is a very small service with just one owner/manager the lines of communication are very short indeed, within the home complaints and concerns can be raised with the owner, Mrs Coker. Thereafter residents would need to approach other support agencies such as Social Service Departments, Mental Health Teams or the Commission. Residents were not being given a copy of the Residents’ guide that should contain details of the complaint procedure but the administrator has updated the complaint guidance on the new computer so each resident can now be given suitable copy. This is an example of the sometimes poor quality of management of this home is gradually improving; having been prompted by the Commission to prepare suitable documentation such as the Resident Guide, which should include a complaint procedure, this was not being followed through by Mrs Coker until very recently much we are pleased see progress is now being made to meet standards including standards associated with complaints and safeguarding matters. We cannot at this stage confirm whether Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 16 or not these updated documents could be made available in other formats and languages if a resident or other party requested it. We interviewed staff about ‘safeguarding’ matters, that is, the procedures for reporting suspicions or allegations of abuse and we are satisfied that the staff know they must protect residents from harm and report untoward incidents. They also know about ‘whistle-blowing’ - reporting to external agencies any such problems. We understand from other inspections we have made that restraint is not used in this home. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 24, 27, 28, and 30: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents say this is a nice, comfortable family sized home that they like living in. It is now being run to a more adequate standard of hygiene and safety. EVIDENCE: This care home although it has not long been registered is not well presented. The front drive is barren, without ornamentation or flowers and compares poorly with adjacent properties but since our last visit the front railings have been painted and this is an improvement. What was built as a family home has been modified to meet fire safety standards, such as smoke detectors and fire doors. The home has a single lounge/dining room on the ground floor; four bedrooms; one on the ground floor and three on the first floor. None of the bedrooms have modern facilities such as an ensuite toilet or shower. Some of the furniture is already looking old and worn, we note as an example a chest of drawers the varnish is fading exposing the name of a hotel suggesting this is second-hand furniture. The first floor bathroom was particularly poorly presented and not a welcoming room for residents who may wish to use this facility to relax and ‘unwind’ as Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 18 their mental health team suggests. Some improvements are underway and the shower room and bathroom were both being upgraded whilst we were visiting in July 2009. The shower room was much better whilst the bathroom is still being worked on. The kitchen has been painted and we are told the deadlock is no longer in use for the back door and so this is now a safer route for fire escape. The kitchen floor needs improving because the vinyl covering recently installed is again broken and damaged. Many care homes choose to put protective covers over radiators so as to reduce the likelihood of heat burns if a resident comes to rest against one; in this home we are told resident are unlikely to do so and no covers have been fitted. When we previously checked some of the windows we found they were not restricted, and could be opened to at least 30 centimetres and since the home has admitted a new resident it would have been wise to take precautions by fitting restrictors at this time. These have now been re-fitted and though restricted only to normal double-gazing standard and not with additional security restraint we are told that this is sufficient for current client group who do not pose risks in this area. The garden would still benefit from landscaping since it is not a very attractive area for residents and visitors. The person in charge agreed various areas of the home needed ‘freshening up’ and has she tells us she has decided to work on improving environmental standards in Better Care even though she homes to move to more suitable premises before too long. Meanwhile, it is regrettable that staff are not alert to these various deficiencies and advocating on behalf of residents to get the home restored to a better standard throughout. The home has no visitor’s room and the first floor room that should have been allocated as communal space is still not readily available as such. The manager was advised she could ask for this condition in her registration to be removed rather than risk prosecution for failing to comply with a condition of registration – despite a commitment to do so the certificate remains unrevised and Mrs Coker was adamant when we raised the matter earlier in the year that no further communal space will be provided for residents. However, when we visited in July 2009 a computer has been installed in this room and we understand that changes will be made to improve accommodation for residents and so meet this registration condition. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 32, 34, and 35: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. On this occasion we can be a little more confident than on previous inspections that the home is reasonably staffed so residents know there are usually enough staff to support and protect them. EVIDENCE: As on other occasions Mrs Coker left the premises for a private appointment shortly after we arrived to begin our unannounced inspection in July 2009. The person in charge was an experienced ex-nurse who worked with us very patiently and professionally during our visit over several hours and her hospitality is acknowledged. We also acknowledge that Mrs Coker has responded to our previous requirements to improve staffing to a safer level. Although the staff duty roster was very difficult to read because it had alterations, deletions we nevertheless conclude that since the arrival of a third resident there have been two staff on duty each but not every day. For example when Mrs Coker left at 10:30 am on 30th July she was not replaced by another member of staff; leaving one person as carer and in charge of the home. But we understood the person in charge to advise us that that reduction in staffing reflects times when residents are away from the premises. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 20 Leaving only one member of staff on duty tends to demonstrate that Mrs Coker makes progress in meeting requirements very reluctantly, slowly and does not maintain improvements consistently - by failing on this occasion to make alternative staff arrangements for her own absence – however we note that whilst we were on site there was only one resident in the home. The person in charge as long-term member of the small staff team advised us that she has received training in various aspects of her work including for example the protection of vulnerable adults. The training records though in disarray tend to show that staff have received training as required by the Commission including training in mental health. Staff have also had some supervision meetings, in one instance the records show that a member of staff had one meeting in January and another in May, indicating they are not receiving support at two-monthly intervals as they might expect. We checked a member of staff’s recruitment to confirm that the correct checks had been made and this appeared to be the case although once again the actual staff files are poorly set up and not indexed. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 37, 39, and 42: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We can currently assure residents that this is a reasonably well run service and that policies, procedures, and records are maintained or improved in their best interests. EVIDENCE: The owner/manager, Mrs Coker has advised us that she has passed her RMA (Registered Manager’s Award). She is registered with the Commission as the provider and also as the manager of Better Care. Mrs Coker has received a series of not very positive reports from the Commission. She has given various commitments to work with the Commission to improve standards but despite these assurances Mrs Coker took until very recently a quite unresponsive attitude to the Commission’s regulation of her care home. With the appointment of an administrator and the ongoing redecoration of the home we are now seeing some tangible evidence of improvements and a more positive Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 22 approach by the owner/manager to meeting national minimum standards. It remains disappointing that the administrator was not supplied with copy of the standards but he has taken the initiative and will be acquiring one shortly we are told. A computer is now up and running and is shortly to be connected to the internet, this will allow the home to down load relevant guidance from the Commission’s professional web site (www.cqc.org.uk). As we explain throughout this report we find there have been other key improvements. Staffing levels have improved. Staff training has been put in place. Documents such as the Statement of Purpose and Residents’ Guide were amended to more accurately reflect the service. These and other improvements do point to an effort on Mrs Coker’s part to improve services for residents and this is reflected in an overall improved rating from a ’adequate’ service to an ‘good’, 2 star service. The Commission remains concerned that Mrs Coker may not be able to sustain improvements but at this stage the necessary changes have been made or are underway so we can now assess the home is providing a good outcomes for residents. Areas of strength: Although there remain shortcomings in this service we do not overlook the fact that more than one resident has moved on to more independent living and the local mental health team told us they are very confident about the services provided in Better Care. Where we found requirements to have been partially met and ‘in progress’ we have restated them as recommendations so that the manager does not lose sight of the need to finish and maintain the improvements she has been making in recent weeks. Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 X X Version 5.2 Page 24 Better Care Residential home DS0000055368.V376501.R01.S.doc Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA28 Regulation 16(2)c Timescale for action Conditions of registration must be 30/09/09 complied with including the provision of adequate communal space on the first floor. This is so as to ensure residents have adequate communal and private meeting space. Section 24 of The Cares Standards Act 2000 also applies. We saw this work is now in progress and is restated so as to ensure work is carried through to completion. Statement of Purpose: the provider 30/09/09 must provide a Statement of Purpose in a form that can be taken away; this is so that residents or inspectors may have a copy if they request one. We saw this work is now in progress and is restated so as to ensure work is carried through to completion. Service User Guide: the home must 30/09/09 provide each resident with Guide so they have relevant information about the service. We saw this work is now in progress and is restated so as to ensure work is carried through to completion. Requirement 2 YA1 6 3 YA1 6 Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA18 Good Practice Recommendations Staff files: It is recommended that all staff files be properly managed by being methodically filed and indexed so as to show that all necessary checks are made before recruitment are in place and that induction, supervision and training are in place. This is to demonstrate good management of these important documents. We saw this work is now in progress and is restated as recommendation to ensure work is carried through to completion. Kitchen: it is recommended that the kitchen is thoroughly cleaned including the area around the back door and that Food Standards Agency guidance is followed. This is to ensure food is stored, prepared, cooked and served in hygienic conditions for the safety of residents. We saw this work is now in progress and is restated as a recommendation to ensure work is carried through to completion. Care Plans should reflect those issues identified in the assessments provided in accordance with Standard 2.2 so that the resident knows their needs can be met. Staff Supervision, each member of staff should be given formal supervision in accordance with the guidance at Standard 36. We saw this work is now in progress and is restated as a recommendation to ensure work is carried through to completion. 2. YA30 3. YA2 4. YA36 Better Care Residential home DS0000055368.V376501.R01.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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