Care Home: Bullpond Lane

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What the care home does well Despite continued changes in the management of the home staff have managed to meet service users’ needs. Care plans and risk assessments require some development but staff have worked to ensure that care plans reflect people’s needs and contain up to date information even if this has not been incorporated into a support plan. The home has a friendly and welcoming atmosphere and staff continue to make the focus of the service the people who live their despite the changes to staff and management. Each person has an activity plan and staff participate in devising the plan to ensure that people have a range of educational and leisure activities. This has been facilitated by the purchase of an extra vehicle. The service has continued to move forward and make plans for the future. Staff are discussing holiday plans with people who use the service. Staff ensure that they are equipped to meet people who use the service’s needs by ensuring that staff are available at peak times. Despite some of the staff being new to the service thy have made efforts to get to know individuals and this was observed during our visit. Despite the recent challenges of staff and management changes people who use the service have remained the focus of the staff. What has improved since the last inspection? A new dishwasher and television have been purchased. This has maximised staff spending time with service users rather than completing household tasks. People who use the service enjoy watching a variety of DVDs and TV programmes and having a working television is important. Pictorial menus were displayed to enable people to see what menu choices are available. Recruitment records had improved and reflected that appropriate checks were taking place. What the care home could do better: Bullpond LaneDS0000070212.V378407.R01.S.doc Version 5.3 As stated earlier some further development is needed regarding care plans and risk assessments. Work has commenced since the previous inspection but examples are given further in the report of areas that need more information. This is also where a permanent manager would assist with ensuring that care plans are reviewed regularly and contained relevant information. A permanent manage is needed in the service to ensure the development of the service and that service users’ can feel settled in their home and not endure constant change. A current registration certificate must be displayed. Key inspection report CARE HOME ADULTS 18-65 Bullpond Lane 60, Bullpond Lane Dunstable Luton Beds LU6 3BJ Lead Inspector Angela Dalton Key Unannounced Inspection 17th November 2009 10:45 Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 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. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 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 Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Bullpond Lane Address 60, Bullpond Lane Dunstable Luton Beds LU6 3BJ 01582 472580 01582 478875 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) londonroad@tiscali.co.uk Voyage Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 6. 2. Date of last inspection 23rd January 2009 Brief Description of the Service: Bullpond Lane home is owned by Voyage (formerly Millbury Care Services) a subsidiary of the Paragon Healthcare Group. The company has been established for 18 years to provide residential care to people with challenging behaviours due to their complex needs. The home had been developed from a private property located in a residential part of Dunstable in Bedfordshire, in close proximity to local facilities (Dunstable town centre) and transport links. Bullpond Lane has six en-suite bedrooms - two of these were on the ground floor. Each was fitted with a toilet, hand basin, bath, and overhead shower. The smallest bedroom, according to the home’s Statement of Purpose was 12.4 sq m excluding the en-suite and the largest 24.05 sq m. All of the bedrooms have been individually decorated and included a bed, a chair a table, a touch operated lamp and matching curtains and bed linen. Service users can individualise their bedrooms with pictures and small items of furniture from home if they wished. In addition to the bedrooms the premises included a lounge, quiet room, conservatory, dining room, kitchen, laundry, office, a number of store cupboards, a downstairs toilet, a fully enclosed garden and parking for several cars to the front and side of the property. The home had been decorated and furnished to a high standard. A TV and 2 music systems were available for service users within the communal areas. Weekly fees range from £1450 to £1500. A review has been held since the previous inspection but the range remains unchanged. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One inspector conducted this unannounced site visit on 17th November between 10.45 pm and 5.30pm. We were assisted by an expert by experience and their support worker for part of the inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Experts by experience do not need to have experienced an identical service but know what it is like to need a service. The phrase ‘experts by experience’ is used to describe people whose knowledge about social care services comes directly from using social care services and have chosen to become more closely involved with the organisation developing their skills, knowledge and expertise. The views and experiences of people who use services are central to helping us make a judgement about the quality of a service. Two people were case tracked: The inspector followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process crossreferences all the information gathered to confirm that what Inspectors are being told is actually happening and reflects the Statement of Purpose, which contains the aims and objectives for the service. It included discussion with service users, staff and the manager. We looked at a variety of documentation which illustrated how the needs of people who use the service are met. The service completed an Annual Quality Assurance Assessment (AQAA) report and we received surveys completed by people who use the service and staff which provided us with additional information. We spent time talking to staff and people who use the service and observed lunch and dinner preparations. One of the acting managers was present for most of the inspection People who use the service are well cared for and staff focus upon individual needs and ensure that people develop their skills and independence. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 6 The summary of the expert by experience was: Overall I thought the home was clean and tidy and the staff I met were warm and friendly. The Service Users appeared to be happy in their company. I noticed that there were photos of staff and Service Users on the wall in the dining room along with the menu for the week. There was a conservatory attached to the home where Service Users could enjoy playing games and listening to music, but unfortunately there was no heating which meant that it could not be used on cold days especially in the winter months. I think it would be advisable to have some form of heating supplied to make use of this facility all year round. The garden at the rear of the home requires a ramp to enable all the Service Users to gain access to the raised lawn area, as two Service Users could not use the steps provided. I noticed that all the windows in the home were chained up; they could only be partially opened. This was done because one Service User had injured themselves by climbing out of the windows on a number of occasions. I felt that this could be a safety hazard and brought it to the attention of the Inspector (they were aware of the issue). I was also concerned that one Service User was able to engage in stimulating conversation and was unable to have any conversations with other Service Users due to their disabilities and could only be stimulated by having conversations with the members of staff. I feel that this Service User could benefit from having another Service User with similar abilities to be placed in the vacancy that exists in the home. I feel that they were capable of living a very independent life that would empower them. I felt the ratio of male to female staff was unbalanced and should be reassessed. I was also concerned that there had been four acting managers in the last eighteen months at the home. I feel it would benefit both staff and Service Users to have a permanent manager appointed as soon as possible. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 8 As stated earlier some further development is needed regarding care plans and risk assessments. Work has commenced since the previous inspection but examples are given further in the report of areas that need more information. This is also where a permanent manager would assist with ensuring that care plans are reviewed regularly and contained relevant information. A permanent manage is needed in the service to ensure the development of the service and that service users’ can feel settled in their home and not endure constant change. A current registration certificate must be displayed. 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. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 9 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 Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 10 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): 1,2,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have the information needed to help them make an informed choice about moving into the home and individual needs are assessed to ensure that they can be met. EVIDENCE: The service users’ guide is in a pictorial format and contains photographs of each person who uses the service’s bedroom. This is kept by each individual and is personalised so that it relates to their home. It contains sufficient information for people who use the service to make an informed choice about where to live. It includes the skills and experience that members of the staff team have and also those of the senior management team. The staff are exploring ways to make it more user friendly to those who may not be able to read and are more familiar with Makaton and other ways of communicating. The service currently has one vacancy but has not had any new admissions since the previous inspection in January 2009. There was evidence that the Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 11 needs of people who use the service had been assessed and documentation was able to demonstrate that the service could meet the identified needs. As the management of the service is being shared between two managers from other services assessments are being conducted by the Operations Manager. The needs of existing people who use the service will be a major consideration to ensure that everyone is happy with the potential changes that may occur when a new person moves in. One person who lives in the service told us they hope that the person who moves in is able to communicate verbally so that they have someone to talk to and become friends with. The moving in process would occur over a period of time building up from tea visits to overnight stays. This would ensure everyone was familiar with the process to minimise disruption. Each person who uses the service has a contract which details the terms and conditions of the service and the expectations that they can have of their home. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 12 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): 6,7,9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are the focus of the service but care plans must be expanded to illustrate how the needs of people who use the service are monitored, managed and met. EVIDENCE: As stated earlier the service has experienced frequent changes in its management structure. Some work has occurred to ensure that care plans are updated and reflect the needs of people who use the service. Work has yet to commence to further explore how the layout can be more user friendly but some sections are in a pictorial format. We looked at three care plans which were personalised and focused upon how individual needs are met. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 13 As identified at the previous inspection more information is required. Each care plan provided an overview of needs and a review but more details are needed. The service needs the consistency of a permanent manager to develop the style and content of information and provide guidance to the staff team. A high standard of care is being delivered but there is not always evidence to reflect how this is achieved. Work has been completed by members of the multi disciplinary team to assist staff to manage an individual’s need. This had not been incorporated into a care plan and it was not possible to identify if this guidance was successful or reflect if staff were following professional advice. As identified at the previous inspection more specific information is required to guide staff to meet for identified health needs. One person has psoriasis and also receives treatment from an aromatherapist but there was no reference to what complications may occur. One person was receiving hospital treatment following fractures but there was no associated care plan to reflect how staff had implemented professional advice or daily care. The service has experienced some challenges over recent months: one service user has developed more complex needs, which the service has needed to manage. This has resulted in increased risks being presented. There was evidence of risk assessments being devised but more development is needed to evidence how risks are monitored managed and met. One example is a risk of getting lost was identified but the ‘control measure’ for the risk identified that the service user had an excellent knowledge of the local area as they had lived there all their life. The risk assessment did not adequately guide staff and advise of the action needed if a person went missing or of management strategies that were in place. Staff have worked with the fire officer to gain advice on lockable window restrictors being fitted to ensure the safety of a service user who has jumped from windows. Risk assessments reflect how the environmental safety of service users is assured and how staff manage the situation. Advice has been given by members of the multi disciplinary has not been incorporated into risk assessments or care plans. Staff told us there are plans for this to occur as care plans are currently being reviewed. Moving and handling assessments have been updated and improved to reflect the level of support each individual requires. This information was not clear at the previous inspection. A chores list has been devised with the people who use the service and they ensure that everyone takes responsibility for tasks within their home. Each person has a set day to complete their laundry and receives one to one support from staff. A menu is also devised with their participation and this was Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 14 on display in pictorial form to ensure service users who cannot read to know what is available. Regular house meetings occur and minutes are recorded. Staff have successfully ensured that meetings have continued in the absence of a permanent manager. An advocacy group is available if people who use the service wish to access it but all currently receive support from their families. People who use the service stated that they met with friends and family and that staff observed their choices. We saw this in action when individuals were asked what they wanted to do on their return from day care or offered choices if they were spending the day at home. Work has not yet commenced on introducing person centred planning but staff have dates to attend some drop in workshops run by social services that they plan to attend. This will enable information to be available about individual wishes and aspirations and some information exists within support plans that can be transferred. The acting managers have overseen that the care plans are regularly reviewed to ensure there is up to date guidance for staff to follow. The expert by experience spoke to people who use the service and staff and found the following: ‘I asked if they could choose what to wear.’ Service User One said “yes I am able to”. The member of staff said that Service Users Two and Three chose their clothes with help from the staff. ‘I asked if they went out to any clubs.’ Service User One said “yes I meet friends there, a member of staff drops me off and picks me up later” ‘I asked do you choose what to eat’ Service user One said “yes” The member of staff said that Service Users Two and Three chose what to eat with the aid of a picture menu. ‘I asked Service User if staff told them their rights.’ Service User One said “yes they do tell me my rights “. The member of staff said that all Service Users were explained their rights. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 15 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: 12,13,15,16,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The leisure and employment needs of the people who use the service are met in a flexible way. EVIDENCE: Little has changed since the previous inspection and the positive experiences people had with regard to leisure continue. Staff assist people who use the service to follow an individual weekly plan. The people who use the service attend a variety of day care services, such as college and day centres. They also attend clubs and go out to the local pub, cinema and shops. There was a trip out bowling on the afternoon of the inspection. The service has a seven seater car to ensure people who use the service can go out to activities or visit family and friends. Another people Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 16 carrier has recently been purchased and this enables people to go out in smaller groups or individually and have more choices. One person who uses the service told us that they continue to enjoy living in their home and staff helped them to do things they liked. At the last inspection they were swimming regularly and although they still enjoy going had reduced the frequency. Staff were working with the service user to maintain their fitness and continuing to encourage them to work towards their goal of losing weight. Staff continue to support them to return to their family home every fortnight which the person told us they liked. They told us that they sometimes found it difficult living with people who ‘didn’t talk’. The acting manager told us that this would be a consideration when someone new moved into the service. We observed people who use the service and staff assisted them to do activities that they enjoyed. Staff were helping people to complete jigsaws, watch television and use the sensory room. The rota is arranged so that people who use the service can attend college and daycare and ensuring necessary staff are available at ‘peak times’. The rota reflected this. There is an activity folder to reflect which activities people who use the service enjoy and also provides information on local leisure facilities. People who use the service go on holiday with their families – the acting deputy manager is planning for people to go away with staff support in the coming year as this has not occurred yet The service works closely with families. Most people who use the service return home on a regular basis, particularly over weekends and public holidays. One person who uses the service frequently returns home to his family as they live locally. This is not always planned and the staff have a protocol in place to manage the situation: this happens on a regular basis and staff have a god relationship with families. However, as stated earlier the advice from the multi disciplinary team has not yet been incorporated into the support plan. Menus are discussed with the people who use the service and are now available in a user friendly format. As occurred at the previous inspection people who use the service were served two hot meals (for lunch and dinner) – one person who uses the service chose to make a sandwich for lunch but others were not offered a choice. One of the people who use the service confirms that they regularly go food shopping twice a week with staff and this occurred during the inspection. The expert by experience spoke to people who use the service and staff and found the following: ‘I asked if Service Users could have T.V. in their room’. Service User One said “yes and I also have a Play Station”. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 17 The member of staff said that Service Users Two and Three had T.V. in their rooms. ‘I asked if Service User could have their friends in.’ Service User One said “yes friends can come in”. The member of staff said that Service Users Two and Three could have friends in if they wish. ‘I asked if Service Users got time on their own.’ Service User One said “yes I do”. The member of staff said that Service Users Two and Three did get to spend time on their own. ‘I asked if they went out to any clubs?’ Service User One said “yes I meet friends there, a member of staff drops me off and picks me up later” The member of staff said that Service User Two went to a leisure centre and Mencap. Service User Three went to College and Mencap. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 18 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): 18,19,20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of people who use the service could be better recorded and the medication system does not ensure the welfare of people who use the service. EVIDENCE: As discussed under the earlier heading of ‘Individual Needs and Choices’ further information is required to inform staff how to better meet the needs of people who use the service. Staff plan to attend workshops on devising Health Action Plans which will provide a consistent format for all people who use the service. Health Action Plans are still incomplete but there was evidence that people who use the service receive the necessary support form health and social care professionals. Staff confirmed they felt they had accessible support to ensure that they could meet changing needs. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 19 We inspected medication records of two people who use the service. A record of medication storage temperatures was kept to reflect that medication was safely stored. Copies of prescriptions are kept to reflect that the correct medication is received into the service. The Medication Administration Record sheets (MAR) were inspected and the code to reflect that ‘Social Leave’ had been taken was used. There was an improvement since the previous inspection in that records of the amounts of medication being checked out of the service were kept. However, there was no record of medication being checked back into the service or a record of administration whilst away from the service. This meant that it was not possible to see if medication amounts were correct. One medication still featured on the MAR sheet despite no longer being required. This could cause confusion and needs to be removed. There are no longer handwritten instructions which ensured instructions were legible. Some medication is beginning to stockpile as it is being ordered monthly despite being ‘as required’ and only needed occasionally. Shelving is needed in the medication cupboard to ensure medication is stored appropriately. The acting manager plans to order this in the near future. One person who uses the service has returned to self administering medication as staff had taken over this responsibility due to the lack of lockable space – an alternative has been purchased. There was a limited assessment conducted by the previous manager but this only reflected an agreement to self administer. There was no evidence to reflect that competency and ability to self medicate had been assessed by someone qualified to measure this. A more robust care plan would ensure clear guidelines for the staff to follow and ensure the service user’s well being. The service does not currently have a medication fridge but will investigate purchasing one although it is not currently required. There are no controlled drugs in use but the service has the appropriate facilities. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 20 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): 22,23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have an awareness of the company protocol to ensure that people who use the service are protected but this could be better evidenced. EVIDENCE: There were records to reflect that details of complaints are kept and the action that is taken. The acting manager plans to expand the current recording system to incorporate how concerns and compliments are responded to provide a more rounded picture of the service. The revision will also enable any staff member who records a concern to record the action taken. Service users confirmed that they felt that their concerns and anxieties were listened to and each person has an allocated keyworker that they can talk to. Monthly house meeting provide people who use the service with the opportunity to share their thoughts and feelings on issues that may escalate if they did not have a forum to share their concerns. There is also a link to an advocacy group and reviews with Social Services should a person who uses the service wish to talk to someone independent of the staff team. One person who uses the service told us if they were not happy that they would talk to their keyworker and that they knew how to make a complaint. Each person has Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 21 a user friendly complaints policy which informs them who to raise any concerns with. Staff have received company training to enable them to deal with aspects of abuse. All staff have signed to state that they are aware of the local authority’s procedure and a copy of the local safeguarding procedure is kept in the office. Staff have not yet completed any training regarding the Mental Capacity Act and are expecting this in the near future. Derivation of Liberty assessments will be necessary to demonstrate that the freedom of people who use the service is not unnecessarily limited by the fitting of window restrictors. One service user told us that they had been consulted about the window restrictors and understood the reason why they had been fitted. We checked two financial records for people who use the service and found them to be in good order. The service has two systems where individual’s personal allowance records are kept alongside the ‘main’ balance records. The acting manager will review this system to see if a more streamlined system can be introduced and be more affective. The expert by experience spoke to people who use the service and staff and found the following: ‘I asked if Service Users held house meetings to put their grumbles and ideas across?’ Service User One said “yes on Mondays when we choose the menu for the week” The member of staff said that all Service Users attend meetings every Monday to air their views. ‘I asked if Service User felt safe in the home?’ Service User One said “yes the staff are nice “. The member of staff said that all the Service Users were happy and felt safe in the home. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 22 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): 24,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service had a homely atmosphere and meets the needs of people who use the service. EVIDENCE: The service is close to Dunstable town centre and within walking distance to the local pub. Helpfully there is a zebra crossing outside the house to assist people who use the service in road safety. The service is in fairly good condition but some attention will be needed to decoration in the near future as some of the walls are scuffed and discoloured. This was noted at the previous inspection and there are hopes that a maintenance audit will occur once the new manager is in post. The Annual Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 23 Quality Assurance Assessment told us that there are plans to redecorate communal areas and service users’ bedrooms over the next twelve months. There are also threadbare areas on the back of steps on the stairs. This does not appear to pose a trip hazard and staff informed us it was wear from a previous tenant’s mobility aid. The dishwasher has been replaced since the previous inspection and staff no longer have to hand wash dishes. The television in the lounge has also been replaced as it had a lilac coloured picture and was distorted at the previous inspection. The laundry was in good working order and the washing machine has a sluice facility. This ensures that soiled linen can be properly and safely washed. The service also uses alginate bags which dissolve when washed. These are for using with soiled linen and reduce the amount of handling by staff of soiled items. The shower in a service user’s bedroom has been repaired since the previous inspection as it was delivering cool water. The house was clean and odour free when we visited. The front door has a keypad which releases in the event of a fire. One person we spoke to told us that they could leave the building independently. The padlock that was fitted on the back gates has been removed. As stated earlier the home has had window restrictors fitted on all but one window. This has been done in consultation with members of the multi disciplinary team to safeguard one service user. A risk assessment is in place and a key is carried to unlock the restrictors by the shift leader. The staff have also liaised with the fire officer and company health and safety adviser to ensure the safety of service users is observed in the fire plan. There are plans to review the garden and make it a more pleasant and accessible environment for the service users and involve them in this development. The expert by experience identified that the conservatory had no heating which meant that it could not be used on cold days especially in the winter months. The manager will look into this to provide a solution. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 24 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): 32,34,35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are able to meet the needs of people who use the service but permanent staff would enable this to occur consistently. EVIDENCE: During the two months that the service has been open it has seen several changes of staff. Half of the staff team are bank staff. Five positions are filled by bank members of staff who work full time hours. The acting manager is investigating why posts are not being permanently appointed. Staff we spoke to confirmed that they enjoyed working at the service and felt supported by the acting managers but wanted some stability. There are 3 staff on both early and late shifts (sometimes 4) during the week to ensure people who use the service can attend their daycentre or college. These numbers may be reduced at the weekend but some people who use the service generally return home for the weekend. At night there is 1 waking night staff and another staff Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 25 sleeping in. Service users told us that they felt supported by staff and they were able to participate in activities that they enjoyed. They told us ‘They’re a great team and they all work well together’. Records reflected that staff receive the necessary mandatory training to do their job and meet the needs of people who use the service. Staff complete some training online, known within the company as the ‘L box’ facility. This provides staff with flexibility to complete their training. The acting manager is aiming to enrol 2 staff on an NVQ course once they have completed the Learning Disability Qualification. 6 additional staff are working towards their learning disability qualification. The deputy manager told us that two member of staff have NVQ level 2. The acting manager is aware of the low level of NVQ qualifications within the staff team and plans to address this. We inspected three staff records. Head office conduct recruitment checks and a copy of checks are kept in the home. Records were in good order and had improved since the previous inspection where references had not been from the most recent employer and senior colleagues, not the manager of their previous workplace cited with no evidence of this being explored Clear photographs were not present in recruitment files which are required to ensure the identity of the employee but there are photographs of staff displayed on a board to notify service users who is on shift. This was not up to date on our arrival but was updated during the inspection. The expert by experience spoke to people who use the service and staff and found the following: ‘I asked if they did not want help from staff could they do things for themselves.’ Service User One said “yes I am able to”. The member of staff said that Service User Two and Three could but with limitations, due to their disabilities. ‘I asked if both male and female staff attend to them.’ Service User One said “I am independent, I do things for myself “ The member of staff said that Service User Two would only let female staff attend to her. Service User Three would let either male or female staff attends to them but preferred a male member of staff. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 26 ‘I asked do you know the staff and what they do.’ Service User One said “yes they are here to help and support us” The member of staff said that the Service Users do know the staff. ‘I asked do you have a key worker?’ Service User One said “yes I have two” The member of staff said that Service Users Two and Three Do have key workers. These were the questions that the expert by experience asked the member of staff. I asked the member of staff if the Service Users had a personal profile? They told me “yes they are kept in the office” I asked the member of staff how do you communicate with Service Users that are non verbal? They told me that they used signs, picture format and looked at body language. I asked the member of staff what activities do Service Users participate in? They told me that the Service Users participate in Horse Riding , Basketball, Swimming, and go for trips out to the shops, pubs and market fairs in the Care Homes own mini bus. The activities inside the home were jigsaw puzzles, board games, table soccer, building blocks and music in the Sensory room. I was told by the member of staff that there were ten staff, nine were female and one was male. There were four staff on morning shift and four staff on afternoon shift. At night time there was one sleep-in member of staff and one wake in member of staff. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 27 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): 37,39,42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A registered manager must be appointed to ensure the consistent running of the home. EVIDENCE: During the two years months that the service has been open it has seen five managers – only one of these staff was registered with the Commission. The manager who was in post at the previous inspection has left and there have been two acting management arrangements since. A manager has been recruited for Bullpond Lane and the company is currently undertaking recruitment checks. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 28 Staff we spoke to confirmed that they enjoyed working at the service and felt supported by the acting managers. However they felt that the service would benefit from a period of stability to enable the service to settle down. There was evidence that the service has started to move forward and the current acting managers are reviewing documentation and reviewing paperwork to ensure that records are up to date and reflect the current management arrangements. The registration certificate displayed reflected out of date details and the acting manager will request an up to date certificate from the Commission. People who use the service are asked their views during reviews and house meetings. Staff have maintained meetings for people who use the service despite fluid management arrangements. Monthly reports are completed by a member of the company’s senior management team to assess the quality of the care being delivered, the environment and the conduct of staff. We noted that there had been frequent visits from the operational manager to offer support to the acting managers and staff team. The company also issues quality assurance questionnaires on an annual basis to people who use the service, their relatives and professionals involved in their care. Staff are also asked to take part. Once feedback is received it is published in a report and made available to those ho completed the questionnaires. There are plans to launch a local magazine to mirror the success of the regional publication. Health and safety records reflected that the necessary checks to ensure the safety of people who use the service and staff are carried out. Fire drills are conducted and take place at various times to include the night staff; emergency lighting checks take place monthly and hot water temperature checks are recorded. As discussed earlier there are risk assessments to reflect the introduction of locked window restrictors. One service user told us that the implementation of locked restrictors had been discussed with them. Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 29 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 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 2 3 X 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Version 5.3 Page 30 Bullpond Lane DS0000070212.V378407.R01.S.doc Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA19 Regulation 15 (1)(2) 12(1)(a) Requirement Identified needs must have a comprehensive care plan to enable staff to meet the needs of the people who use the service. Examples of this are management of complex needs, management of health needs. This requirement has been partially met since the last inspection. Identified risks must have a risk assessment in place to demonstrate how the risk is monitored, managed and met e.g. people leaving the premises and placing themselves at risk. This requirement has been partially met since the last inspection. The medication system must ensure the safety of people who use the service. Accurate records of amounts of medication must be kept to ensure amounts can be checked. If medication leaves or enters the service accurate DS0000070212.V378407.R01.S.doc Timescale for action 31/01/10 2. YA9 15(2) 31/01/10 3. YA20 13 (2) 31/01/10 Bullpond Lane Version 5.3 Page 31 records must be kept and the reason recorded on Medication Administration Record Sheets. (This has been partially met since the previous inspection) Medication that is no longer required must not feature on the Medication Administration Sheet. This could cause confusion As required medication must be ordered responsibly as it is beginning to stockpile. A manager of the service must be registered with the Commission for Social Care Inspection. An up to date registration certificate must be displayed in the service. 7. YA37 8, 9 31/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bullpond Lane DS0000070212.V378407.R01.S.doc Version 5.3 Page 32 Care Quality Commission Eastern Region 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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