Care Home: Broadoak Park Care Home

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What the care home does well A very relaxed community atmosphere is evident in and around the complex and we can see that staff, people using the service and relatives maintain good relationships. Staff spoken with are kind and caring and committed to their job role, they are able to discuss people`s individual needs and the support that they require to ensure that they lead a fulfilling and satisfying lifestyle. People using the service and their relatives speak highly of the staff and the support received and people feel comfortable and settled living at the complex. People using the service are enabled and supported to lead an active lifestyle and pursue further education should they wish, and there are facilities at the complex to keep people occupied during the day and evening. People using the service are supported and enabled to meet their religious and cultural needs and maintain contacts that are important to them and be part of the wider community. People tell us that they enjoy the food that is on offer and there are choices available. Staff tell us that they feel supported in their job role, training and development. What has improved since the last inspection? The deputy manger tells us that the preadmission process has been improved since the previous inspection, however we were unable to fully evidence this due to some records not being available and also because there have not been any new admission since we last visited the complex. Staff are working at improving the care planning process so that these are more person centered and provide staff with sufficient information to support people using the service thus ensuring that their needs are met. People using the service and their relatives are also now more involved in this process so that they are enabled to make their own decisions and choices known to staff. The risk assessments in place have also been improved upon working towards ensuring that people are fully protected from highlighted risks. We can see that some staff have undertaken further training, working towards ensuring that all staff have the required knowledge and skills in supporting people using the service. The environment has improved as repairs and refurbishment have been completed and the general maintenance receiving more attention. What the care home could do better: Although improvements have been made since the previous inspection, the manager needs to set time aside to focus on achieving compliance with the outstanding requirements in regard to general management, staff training, care planning, risk assessment and the preadmission process. It is of concern, that it has taken 11 months for the developments to date and the issue of the outstanding requirements and additional requirements in regard to availability of records and the environment set at this inspection must be addressed quickly to ensure better outcomes for people using the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Broadoak Park Care Home Nuncargate Road Kirkby Woodhouse Kirkby-in-Ashfield Nottinghamshire NG17 9DS     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: Karmon Hawley     Date: 0 2 1 2 2 0 0 9 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 42 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 42 Information about the care home Name of care home: Address: Broadoak Park Care Home Nuncargate Road Kirkby Woodhouse Kirkby-in-Ashfield Nottinghamshire NG17 9DS 01623721924 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: noelallcock.broadoak@googlemail.com Mr John William Nunn,Mrs Barbara Nunn care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Mr John William Nunn and Mrs Barbara Nunn are registered to provide accommodation and personal care at Broadoak Park Care Home for persons of both sexes whose primary care needs fall within the following category :- Learning Disability LD (30) The maximum number of service users to be accommodated at Broadoak Park Care Home is 30 Date of last inspection Brief description of the care home Broadoak Park is a residential complex for up to 30 people with a learning disability. Accommodation is provided in purpose built bungalow style units, each comprising of single rooms, mostly with en-suites, and with a kitchen and lounge area. The design and layout of the bungalows would be suitable for a person with physical difficulties living at Broadoak Park. There are also self-contained flats available. The entire complex has been landscaped with gardens all around. There is a central clubhouse with a bar area. Care Homes for Adults (18-65 years) Page 4 of 42 Over 65 0 30 0 6 0 1 2 0 0 9 Brief description of the care home The current fees for the service are from £1,460 to £3,200 per week depending upon on individual needs. Prices include most activities and aromatherapy. Extra charges are made for hairdressing and toiletries. Copies of the inspection report are kept in the staff office should people wish to view these. Care Homes for Adults (18-65 years) Page 5 of 42 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 focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period. A review of all the information we have received about the home from the provider and the general public since the last inspection was considered in planning this visit and this helped decide what areas were looked at. The main method of inspection we use is called case tracking which involves selecting the care plans of 3 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Care Homes for Adults (18-65 years) Page 6 of 42 The Deputy Manager, members of staff, relatives and people who use the service were spoken with as part of this visit. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of people using the service. A partial tour of the complex was undertaken, communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. The provider sent their latest Annual Quality Assurance Assessment which is a document that outlines the services development over the last year and areas where they intend to make improvements, some information received in the AQAA has been utilised within the main body of the report. On the day of our inspection the manager was unfortunately not available and due to unforeseen circumstances a set of keys that allow access to a filling cabinet had not been left at the complex. This hindered the inspection process as we were unable to access some information. The deputy manager sent us some further information 5 days after the inspection and this has been acknowledged within the main body of the report. Care Homes for Adults (18-65 years) Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: Although improvements have been made since the previous inspection, the manager needs to set time aside to focus on achieving compliance with the outstanding requirements in regard to general management, staff training, care planning, risk Care Homes for Adults (18-65 years) Page 8 of 42 assessment and the preadmission process. It is of concern, that it has taken 11 months for the developments to date and the issue of the outstanding requirements and additional requirements in regard to availability of records and the environment set at this inspection must be addressed quickly to ensure better outcomes for people using the service. 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 42 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 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to use the service may not be able to access all the information that they need to make an informed decision about whether the service can fully meet their needs. Nevertheless people are given the opportunity to visit the complex to aid their decision making and to ask questions if they want to. Evidence: So that people have all the information that they need to make a decision to move into the care home a statement of purpose is available. This is person friendly with the use of pictures and symbols to ensure that it is readily accessible to people with a disability. To ensure that staff are able to meet peoples needs before a decision to move into the complex is made, senior staff visit people in the community to carry out an assessment. People who may wish to use the service may come and spend time at the complex, be it for a few hours or overnight, so that they can get a feel for what it would be like to Care Homes for Adults (18-65 years) Page 11 of 42 Evidence: live there and to see if they would settle in. Family and friends are also included in this process so that they can spend time getting to know the staff that will be offering support. A requirement was set at the previous inspection, in regard to involving people already using the service in the admission process, so that they can make an informed decision about who moves in. The deputy manager tells us that people that are already using the service are given the opportunity to meet people who may move in to the complex and are given chance to talk with them if they want to. In order to evidence this a new process has been put into place; however we were not able to examine this at the time of the inspection, as it was stored in a cabinet which the deputy manager did not have access to. Also there have not been any new admissions since the last inspection to implement this; therefore we are currently unable to fully assess this standard. Staff spoken with tell us that they receive enough information about people before they move into the complex and that people are introduced to the service gradually, some people know other residents as they have stayed at the centre before on respite care. When people are being introduced into a bungalow they are left to chat with the others that already live there so that they can get to know each other before they move in. They also have a general orientation and may stay for tea and a few hours, or for the night before they move in so that it is gradual, and before admission people come to look around, they have About Me books and can ask staff if they are able to meet their needs. It is important to recognise the things that are important to them, during this time parents can also get to know and trust staff. Two relatives spoken with tell us that their relative was visited before they moved into the complex and that staff carried out a preadmission assessment and had everything ready for when they moved in. Care Homes for Adults (18-65 years) Page 12 of 42 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. Improvements in the care planning process has taken place and despite some plans of care and risk assessments not containing specific actions that staff may need to take to ensure that people are supported as needed, staff are able to demonstrate a very good understanding about the support that people do need. Although there is little documentary evidence available to demonstrate that people using the service are enabled and supported to have their say about the choices and decisions that they make, people using the service feel that they are enabled to do this. Evidence: People using the service undergo various assessments so that staff are aware of their needs and the areas in which people need support. Following these assessments, plans of care are then negotiated with people using the service and their relatives to ensure that they receive support in their preferred way. To ensure that staff are aware of peoples needs, the case files that we examined all have plans of care in place in regard to peoples highlighted needs, such as behaviour that may be challenging, going out into the community and epilepsy. All About Me files are also available so Care Homes for Adults (18-65 years) Page 13 of 42 Evidence: that staff have individual information about people, such as what is important to them, their likes and dislikes. The staff are currently in the process of updating and changing the care planning process, working towards meeting the requirement set at the previous inspection. They are making plans of care more person centred, with sufficient information to guide staff in supporting people using the service as needed and introducing signs and symbols so that people with communication difficulties may understand these better. Whilst these changes are taking place, we still found that most care files have a lengthy assessment of the persons needs recorded, which is still not always followed by clear instructions for staff, to ensure that peoples needs are fully met and they are supported to lead a varied and individualised lifestyle. Nevertheless staff spoken with are able to describe in depth the support that people need to ensure that their needs are met and they tell us that plans of care contain sufficient information in them for them to be able to support people using the service effectively as long as they are kept up to date. The deputy manager tells us that he is aware that further improvements are still required and states that 40 of care plans have now been completed to a higher standard. We can see that plans of care are updated as required to ensure that staff have the necessary information available to them ensuring people receive continuity of care. Care reviews also take place on a six monthly basis and during our inspection we saw two families come to the service to undertake these with staff. Following the review one relative tells us that these happen six monthly and that they are good as they are kept informed of their relatives needs and any changes, they also feel that they are involved in the care planning process and that staff listen to and act on any suggestions made. Within plans of care we can see that risk assessments are in place for peoples highlighted risks such as road safety whilst out in the community, falls, and behaviour that may be challenging, to ensure that these risks are managed and reduced. This information is then ustlised within the plan of care to ensure that staff support people using the service to remain safe. However within one case file there was no instructions for the action that staff should take in the event of behviour that may be exhibited due to certain situations to ensure that the person was supported effectively during this time. Within plans of care we can see that people using the service are supported and Care Homes for Adults (18-65 years) Page 14 of 42 Evidence: enable to make their own choices and decisions in regard to their daily life. Throughout the inspection we can see that staff follow the plans of care and people are spending their time as they wish, doing the things that they want to do. Staff show patience and understanding whilst communicating with people using the service, so that people are given the time and the opportunity to express themselves about the things that they want to do. The deputy manager tells us that residents meetings are not held due to peoples complex needs, however people using the service do have 1-1 sessions with staff where they are able to express their views and opinions; however these are not generally recorded to demonstrate that people are being given the opportunity to have their say. People using the service tell us that they are very happy with the care that they receive and that they feel settled and well looked after. Relatives spoken with also agree with these statements saying; we are very happy with the care that is delivered and our son has improved since he has been here, the staff are very good, he is in safe hands, and my relative is settled and well looked after. Staff spoken with feel that the most important thing for people using the service is that they receive a high standard of care and that good relationships are maintained between staff and people using the service. They feel that it is important to be aware of peoples needs and that some people are more capable than others and where necessary they may need to think for people, read the signs for what they want as they have individual ways of communicating and doing things and by knowing this you can offer people choices. Care Homes for Adults (18-65 years) Page 15 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and enabled to live a life of their choosing and maintain contacts with people that are important to them. Evidence: There is a resource bungalow that is available for people to use to carry out activities should they wish and they are supported by an activities coordinator 4 days a week. Part of the planned refurbishment of this bungalow has taken place, however the building was very cold on the day of the inspection and one room remains out of use as it is currently being used as a storage room. Different kinds of activities such as arts and crafts, computers accessing the Internet and aromatherapy are on offer to people using the service. In addition to this, events such as discos and luncheons are also held in the club house on a weekly basis and people are supported to attend events within the local community. Care Homes for Adults (18-65 years) Page 16 of 42 Evidence: Staff also support people using the service to carry out activities of their choosing and during our visit we saw staff interacting with people well whilst supporting them to do what they chose. One person using the service tells us that they have completed a course in beauty therapy and hand massage and are waiting for their certificate. They tell us that they enjoyed this course and showed us how they do a hand massage. Some people using the service also attend college and are undertaking vocational qualifications and others work on a farm. One person using the service spoken with tells us how they enjoy going to college three days a week and that they also enjoy going out shopping with staff. People using the service are also supported to go on an annual holiday if they wish and one person using the service tells us that they went to Skegness with their key worker which they enjoyed. They also tell us that they enjoy going out to the local pub where they have a drink of lemonade. People using the service are supported to attend religious services and celebrations according to their cultural needs. To enhance the feeling of community and to maintain established contacts with friends and family some people attend church where they used to live, rather than attending a local one. One relative tells us that staff have been very supportive in assisting their relative to meet their cultural needs and that they are working with them to continue to improve this. Daily records are kept for each person using the service and these show us that people are spending their time doing various activities such as watching television, playing pool in the clubhouse, going out shopping and making things during a craft session. People using the service also tell us, I am happy here, I have a nice bungalow and have friends here, the staff are nice and friendly and I went out to the pub with them last night, I like playing pool and beating the staff, I am happy here, I have passed the hand massage course, I enjoy making cards and doing activities, and I like watching the TV and my DVDs, everything is alright. Staff spoken with offer the following comments; key workers play a big role in peoples lives as they support them in everything that they do, we encourage and support people in their aims and ambitions, there are enough activities to stimulate people using the service; some go to college, and the farm. Some have done a course in hand massage and beauty therapy, we have regular discos and people go out into Care Homes for Adults (18-65 years) Page 17 of 42 Evidence: the community to go shopping or to the pub, peoples family can come and join in or take people out. Relatives tell us; my relative goes out on trips and they are supported in their religious needs, I am kept informed about events, they are settled and happy and living a good life, and what is nice is when he goes out there is always someone there waiting for him when he comes home. Staff spoken with feel that people are supported in regard to their cultural and diverse needs and they are able to discuss the support that is offered to people to maintain these; some people go to church every Sunday, a driver takes them in the mini bus, they can see their friends as well as meeting their religious needs. They also comment on the fact that there are staff of different cultures which helps with the understanding of and meeting peoples different needs. To ensure that people are enabled and supported to maintain contacts with people that are important to them there are no restrictions on visiting and people may see their visitors in private. During the inspection we saw that visitors are made very welcome by staff and that good relationships are maintained. People may also go out with their relatives and spend time with them at home. All bungalows have space to enable people to have some private time should they wish, and a choice of two main sitting areas. We can see that staff ask permission with a knock and enter approach before entering peoples bungalows and that they show people respect at all times. People living together appear to get on well and described each other as friends, one person tells us that they have made a lot of friend at the complex. There is no actual fixed menu followed, however the meat of the day is the same for each bungalow. The staff then make meals of peoples choosing from this meat and the main stocks of food available in each bungalow. On the day of the visit we could see that each bungalow had made a different meal from the stock of food that they had and one person using the service tells us that they have what they want to eat everyday. Daily records show what people have to eat and this shows us that people are receiving a balanced diet. People have access to snacks and drinks at all times. There is the option for staff to eat with people if they want them to. Staff spoken with tell us that people can request what they want to eat and make their own choices and those who are able cook their own meals. Care Homes for Adults (18-65 years) Page 18 of 42 Evidence: People using the service tell us that the food is nice and that there are choices. Care Homes for Adults (18-65 years) Page 19 of 42 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. People are supported to access specialist services, however their health care needs may not be fully met due to the lack of care planning in place. Evidence: We can see from case files examined that people using the service are enabled and supported to access specialist services such as the doctor, optician and psychotherapist as required. Staff tell us that they take people to see their GP if needed and give those who have the capability a choice as to whether or not they see their doctor in private. One person using the service tells us that they can see the doctor when they need to and that they generally see them at their home, I can see the doctor here if I need to and I have got new glasses, the optician came here. We could not see whether people are being supported to access age/sex appropriate services such as cervical screening and birth control, on speaking with staff they tell us that people are supported with contraception but they did not think a plan of care was in place for cervical screening or menstruation where appropriate. This was discussed with the deputy manager who stated that he will address this issue. Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: People do not have a specific plan of care in place for health care, however a health care plan book is in use for each person using the service; this is in an easy read format which helps people to become involved in planning their own health care. Doctors visits, optical and dental checks are all recorded in this book to demonstrate that people have been supported to access these. Within plans of care we can see that a medication assessments have taken place so that people who need assistance with their medication are given this as required. Staff who administer medication have been trained to do so and on examining medication records we can see that people using the service have received their medication as prescribed. Although medication received on a monthly basis is checked in on the medication record we can see that handwritten entries are not always signed by two members of staff to show that these have been checked as correct to ensure that people using the service receive their medication as prescribed. Each persons medication is kept in their bungalow so that it is close by and accessible if needed in an emergency and the medication keys have now all been labelled to ensure that staff are able to access these more quickly. Care Homes for Adults (18-65 years) Page 21 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be listen to and acted upon, however due to the current practices in regard to recording peoples personal allowances these may not be fully protected. Evidence: The complaints procedure has not yet been supplied to people using the service in an easy read format so that they can understand this better; however the deputy manager tells us that this will now be done as a new computerised system is in place which will enable this to take place. Nevertheless on speaking with people using the service and their relatives they are aware of how they may make a complaint should they feel the need to and who they can talk with if they are unhappy. We can see that the service has received 2 complaints since the previous inspection in regard to a lack of communication and that these have both been dealt with and resolved quickly. One person using the service tells us, I have a key worker, she is nice, I get on well with everyone, if I was unhappy I would talk to Noel (the manager). Staff spoken with are able to discuss what they would do if they received a complaint to ensure that this was dealt with. Care Homes for Adults (18-65 years) Page 22 of 42 Evidence: One relative spoken with tells us that when they needed to make a complaint that this was dealt with quickly. Staff have been trained in safeguarding vulnerable adults and when spoken with they are aware of their roles and responsibilities in keeping people safe. There have been four safeguarding incidents since the previous inspection in regard to physical abuse between people using the service and one in regard to a member of staff. We can see that all of these with the exception of one have been concluded and the appropriate action has been taken. The deputy manager tells us that the staff regularly liaise the community disability nurse who is made aware of any incidents so that they can give staff advice as to whether the incident needs reporting to the Local Authority. Some people using the service need physical intervention by staff to kept them and other people safe. Staff tell us they are trained in non-interventive techniques using NAPPI (non-interventive behaviour management) training to levels one and two. One member of staff tells us that they feel confident in this area; dealing with peoples behaviour is about communication, finding out what is wrong, not just wadding in there and restraining people but talking with them, as a lot of things are due to frustration, by communicating we can find out and re divert their attention, it helps and we get a lot better results by doing it this way. Some people can not express how they are feeling and by restraining them you are invading their personal space and could make things worse. Plans of care and records of physical intervention are kept as needed to show when these methods are to be and have been used. On checking peoples personal allowances we can see that regular checks are made to ensure that peoples accounts are correct; however one of the allowances we examined did not correspond with the accounting sheet. The staff member spoken with tells us that this was due to the person going home and the money had not been logged in and out. In all other instances the money matched the amount stated on the accounting sheet. We can see that where necessary receipts are available for transactions. People may access their money when needed and see saw one person doing this during our inspection, they tell us that staff look after their money but they do have some in their wallet. Care Homes for Adults (18-65 years) Page 23 of 42 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. People using the service live in a comfortable environment, however further maintenance work would ensure that they can use all of the resources available and be safe from trip hazards. Evidence: The complex of bungalows each have their own gardens and we can see that these are well kept for the time of the year. A large club house is also available for people to use if they want to and regular events take place here. We can see that ongoing maintenance is taking place and the issues brought to attention at the previous inspection have been addressed to ensure a more comfortable and well maintained environment is available for people using the service. On the day of the visit several rooms were being decorated and new furniture was waiting to be put into place following this. When we met people using the service they showed us their rooms which are personalised with their own belongings. One person tells us they like their room and that they keep it clean and tidy themselves. Care Homes for Adults (18-65 years) Page 24 of 42 Evidence: The respite bungalow has been refurbished and is now comfortable and well maintained. The resource room has been part refurbished and it is planned to complete this once the furniture stored in there has been removed, nevertheless the heating in the bungalow is inadequate and people would not be able to sit comfortably and use the resources. We also saw that the room where furniture and equipment is being stored is not locked to ensure people using the service remain safe from associated risks. The deputy manager states that this room is usually padlocked, however it must have been an oversight by the decorator as he has been in the room fetching equipment. Within one bungalow visited we saw that the flooring in the kitchen is very loose fitting and ridged in places which could be a trip hazard. Staff spoken with tell us that maintenance issue get dealt with quickly and they did not feel that there are any issues of concern with the exception of the aforementioned kitchen flooring. Staff keep the bungalows clean and tidy and if people using the service wish to and are able they also assist staff. Care Homes for Adults (18-65 years) Page 25 of 42 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff who trained to support them effectively and they are protected from unsuitable people being employed. Evidence: Throughout the inspection we saw that staff are available to support people using the service as needed. Staff spoken with tell us that they feel that there are enough staff available to meet peoples needs and working in three teams means that there is a good skill mix and level available. Staff also tell us that they are allocated to the same bungalow each day which gives them the chance to get to know people and their needs. On examining the staff rota, this shows us that staff work in teams, however it still does not show staff allocations to each bungalow and the designation of the staff member to demonstrate that sufficient staff are available to meet peoples needs. 18 members of staff have undertaken the National Vocational Qualification (a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in supporting people) level 2 or above and 5 are working towards this qualification. Most staff have also undertaken a NAPPI (non-interventive Care Homes for Adults (18-65 years) Page 26 of 42 Evidence: behaviour management) course which was run by the manager, who is a qualified instructor. We can see that new staff undertake an induction when they first start working at the care home, however this is not at a recognised standard and is very brief. One member of staff spoken with tells us that all new staff undertake an induction and they work with more senior members of staff so that they can get to know the routine and the people they are supporting. Due to the manager not being at the service on the day of the visit and because the keys had not been left we were unable to access some of the records that we needed to examine, such as the staff personnel and training files. We did see however that that the staff application form has been updated to ensure all the necessary information is sought as required at the previous inspection. The deputy manager faxed us the required information following the inspection, which demonstrates that all the necessary documentation such as references and proof of identity are in place to ensure that people using the service are protected from unsuitable people being employed. We can see that several training events such as safeguarding adults, the mental capacity act, health and safety and fire have taken place since the previous inspection and that some staff have attended these. On receiving staff files following the inspection we can see that staff are working towards completing all mandatory training such as health and safety, first aid and food hygiene to ensure that they have the necessary knowledge and skills to support people using the service. Staff spoken with tell us that they enjoy working at the service and that they feel supported in their training and development; I feel supported and I have done all my training, the training has made me a better person and given me life skills, its about using your common sense, it makes you look at things differently, I have had enough training to be able to do my job, to look after and understand people, it is important to get to know them and understand their individual needs. Care Homes for Adults (18-65 years) Page 27 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service could be better, people are not always enabled to have their say about how the service is run and managed, and we remain concerned about the speed at which improvements are being made towards the requirements set at the previous inspection. Evidence: The manager has worked in care since 1982, and has worked in a management capacity since 1996. He has achieved the Registered Managers Award (a nationally recognised work and theory based qualification designed to enhance management knowledge and skills) and an advanced certificate in care management. He also has a management qualification and is an approved NAPPI trainer. The manager is still working at another home which is owned by the provider so his time is divided between this home and the other which may affect the time available to him to work towards achieving compliance. People using the service tell us that the manager is nice and that they can talk with him. Care Homes for Adults (18-65 years) Page 28 of 42 Evidence: Staff spoken with say; Noel is lovely, very approachable a real person, it is a complex service and it is well run, it is home from home. We have staff meetings and these are helpful, getting to meet others and being able to discuss any problems, fears and expectations, and if anything goes wrong I go straight to the bosses, they are approachable. The manager is using a system called quality tree devised by Nottinghamshire Social Services, to monitor the service, however when we looked at this no information was recorded. No questionnaires have been sent out to people using the service or relatives. There is no other system in place except the reviews to gather feedback or to promote people using the service having a say about how the service is run and managed. The environmental risk assessment has now been located and is available for staff to read to ensure that staff have access to all information about hazards in the environment and that they can use this information to keep people using the service safe. We could not access the records in regards to servicing of equipment; therefore we were unable to fully assess this standard. At the previous inspection we found that the fire fighting equipment had not been tested since 2007, we have therefore requested that this information is sent to us so that we can establish if this has been done. 5 days after the inspection we received evidence to demonstrate that the gas and electrical testing has taken place to ensure that these are serviced and working safely. Staff are now using the hand held walkie talkies so that they can call on staff if the need arises, staff spoken with confirm that this system is in use and that it is effective. Accident records examined how us that accidents occurring are minimal and when these have occurred the relevant action is being taken to ensure that people using the service receive the attention needed. On examining the fire log, we can see that the fire alarm systems have not always been tested as required by the Fire Authority. There is also no evidence of staff undertaking fire drills. The deputy manager tells us that due to peoples complex needs an attempt at evacuation during a fire drill has not taken place and he has liaised with a fire officer about this to try and establish a way to deal with this. One Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: member of staff spoken with tells us that despite them being employed for over a year they have not had a fire drill in all that time. Care Homes for Adults (18-65 years) Page 30 of 42 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 2 14 Records kept in each persons 28/02/2009 care file must be able to show all the pre-admission assessment, planning and visits that have taken place. All records, including assessments by social services or health must be dated and signed to show when they were done and who carried out the assessment. There must be records kept to show that people already living in the home have been properly consulted and that staff have fully assessed the impact of the new admission on them, before a new admission is made into their flat/bungalow. This is to ensure the home can demonstrate through records, that people have been properly assessed as to their suitability for admission to the home. Also, to show that the rights of people already living in the home have been upheld and their views considered. 2 6 15 Any care plans developed must be written in a format that is accessible to the individual, taking into 28/02/2009 Care Homes for Adults (18-65 years) Page 31 of 42 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 account their level of ability and individual communication style. Care plans must be available to them and completed with their input and/ or that of their advocate. This is to ensure that any care and support provided is user-focused and that peoples rights make choices about their life are upheld. 3 6 15 All people living in the home 28/02/2009 must have detailed instructions for staff in the form of a care plan, to show how they will meet the persons identified care needs. These must show what staff need to do to support the person both in the present, and also how they can support them in the future to achieve their aims and ambitions. This is to ensure staff know what they must do to support people and to prevent care needs being overlooked. 4 9 13 4 c) All people living in the home must have a detailed and individualised risk assessment in place. This must then provide instructions on what measures staff must take to ensure any risks are 28/02/2009 Care Homes for Adults (18-65 years) Page 32 of 42 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 reduced, and be subject to regular review. To ensure people are kept safe. 5 33 18 1a) Staffing rotas must 31/03/2009 accurately record the numbers of staff provided for each shift, their designation, the delegation of duties, sleep in cover and the management cover for the home. This is to show that people are being supported by sufficient numbers of staff at all times. 6 37 12 1)2)3) There must be management time allocated for the development of the service and for the undertaking of quality assurance. This must be shown on staffing rotas and through a written plan of improvement for the home, with timescales and who is responsible for carrying out such actions. This is to ensure the necessary improvements to the service take place in a timely way, for the benefit of people living there. 7 42 23 4)iv) All fire fighting equipment must be serviced 28/02/2009 31/03/2009 Care Homes for Adults (18-65 years) Page 33 of 42 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 and maintained at appropriate intervals. This is to ensure the safety of people living in the home. Care Homes for Adults (18-65 years) Page 34 of 42 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 2 14 Records kept in each persons care file must be able to show all the pre-admission assessment, planning and visits that have taken place. All records, including assessments by social services or health must be dated and signed to show when they were done and who carried out the assessment. There must be records kept to show that people already living in the home have been properly consulted and that staff have fully assessed the impact of the new admission on them, before a new admission is made into their flat/bungalow. This is to ensure the home can demonstrate through records, that people have 07/01/2010 Care Homes for Adults (18-65 years) Page 35 of 42 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 been properly assessed as to their suitability for admission to the home. Also, to show that the rights of people already living in the home have been upheld and their views considered. We were unable to fully assess this standard due to being unable to access appropriate records. 2 6 15 All people living in the home must have detailed instructions for staff in the form of a care plan, to show how they will meet the persons identified care needs. These must show what staff need to do to support the person both in the present, and also how they can support them in the future to achieve their aims and ambitions. This is to ensure staff know what they must do to support people and to prevent care needs being overlooked. Some development has taken place, however further development is still required to achieve compliance. 04/02/2010 Care Homes for Adults (18-65 years) Page 36 of 42 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 3 6 15 Any care plans developed must be written in a format that is accessible to the individual, taking intoaccount their level of ability and individual communication style. Care plans must be available to them and completed with their input and/ or that of their advocate. This is to ensure that any care and support provided is user-focused and that peoples rights make choices about their life are upheld. Some development has taken place, however further is required to ensure full compliance. 04/02/2010 4 9 13 4 c) All people living in the home must have a detailed and individualised risk assessment in place. This must then provide instructions on what measures staff must take to ensure any risks are reduced, and be subject to regular review. To ensure people are kept safe. 14/01/2010 Care Homes for Adults (18-65 years) Page 37 of 42 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 Some improvements have been made, however further developments are required to ensure full compliance. 5 19 13 People must have a health care plan in place that identifies all health needs and gives directions to staff on how to support peoples health care. To ensure that peoples health care needs are not overlooked and that preventative health measures are in place. This requirement has only been part met and further development is required to achieve full compliance. 6 23 13 7) Those people who exhibit 22/01/2010 challenging behaviours must have a clear behaviour management plan in place that provides staff with clear directions as to how they manage this behaviour. This is to ensure that people are being kept safe. This requirement has only been part met and further development is required to ensure compliance. 20/01/2010 Care Homes for Adults (18-65 years) Page 38 of 42 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 7 23 13 You must ensure that systems are in place to protect peoples personal finances. This will ensure that people are protected from financial abuse. 30/12/2009 8 24 23 You must address the inadequate heating in the resource bungalow. This will ensure that people using the service are able to use this resource in comfort. 04/01/2010 9 24 13 You must ensure that areas that are being used for storage are kept locked at all times. This will ensure that people using the service are protected from hazards. 23/12/2009 10 24 13 You must replace or make good the flooring in the identified kitchen. This will ensure that people using the service are safe from trip hazards. 23/12/2009 11 34 17 You must ensure that 23/12/2009 records in respect of staff personnel and training files are at all times available for inspection in the care home by any person authorised by Care Homes for Adults (18-65 years) Page 39 of 42 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 the Commission to enter and inspect the care home. This will ensure that the Commission can monitor the service and ensure that people using the service are protected from unsuitable people being employed. 12 42 17 You must ensure that records relating to health and safety are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. This will ensure that the Commission can monitor the service and people using the service are protected. 13 42 23 You must liaise with the Fire Authority in regard to the fire alarm system testing and fire drills. This will ensure that people using the service are protected from the risk of fire. 06/01/2010 23/12/2009 Care Homes for Adults (18-65 years) Page 40 of 42 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Continue to develop plans of care so that these are more person centred and are available in a format that people using the service fully understand. When holding 1-1 sessions with people using the service document these to demonstrate that people are being given the opportunity to express their views and opinions, thus ensuring they are able to express their choices. Health care support plans should be written in a way that is accessible to people such as easy read, or Makaton, so they can be fully involved in the decisions made about their health care needs. Handwritten entries on medication administration records are signed by two members of staff to show that these have been checked as correct to ensure that people using the service receive their medication as prescribed. Ensure that the complaints procedure is available to people using the service in a format that they will understand. Further develop the induction process and consider the use of one at a recognised standard. The manager should actively seek to engage people and their relatives/advocates to find out their views about the service and to enable them to have a say in the running of the home. This should be recorded. 2 8 3 19 4 20 5 6 7 22 32 37 Care Homes for Adults (18-65 years) Page 41 of 42 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. 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