Care Home: Burncross Road

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What the care home does well There were no outcome areas that the home was currently doing well. What has improved since the last inspection? No improvements were founds since our last key inspection in June 2008. What the care home could do better: People needed to have their needs reassessed to ensure they were still living in a home which could meet their complex needs. People needed more support to make meaningful decisions about their lives as there was very little evidence that people play any meaningful part in planning their care and support. People`s care plans needed to be reviewed and updated to ensure their current needs were recorded so that staff know how best to support people. People`s risk assessments needed to be reviewed and updated to ensure that any risks associated with their care could be identified and adequate control measures put in place to protect people from avoidable risks. The staff needed to attend specialist training to ensure they had the necessary skills and knowledge to support people with complex needs. Staff training records showed that most staff did not have up to date medication, fire safety or moving and handling training. This placed people at risk and therefore requirements were made on the day for the service to address this. The manager needed to identify all staff who have not got up to date mandatory training in First Aid, Infection Control and Food hygiene and ensure they are trained in order that they can support people in a safe way. The manager will need to review the staffing levels at the home to ensure that people have access to meaningful day and leisure activities. People were not currently offered an accessible menu so they can could choose what they ate. This limited their independence and did not protect their rights. The medication systems needed to be regularly audited to ensure that medication was being stored, administered and recorded safely by the staff. This would help to protect people`s welfare. People needed to be better supported and empowered to access the complaints procedure and to voice their concerns. This would better protect people`s rights. The manager needed to continue working with the safeguarding adults team to ensure that safeguarding procedures were being robustly adhered to, which would help ensure people were safe from harm.The home needed to be deep cleaned as there were so many areas in need of cleaning and dusting. Walls and windows were dirty, some carpets were stained and some areas of the home needed refurbishing and redecorating in order to ensure people were living in a clean, homely and comfortable environment. A review of the staffing levels should be undertaken, to ensure there are sufficient staff to keep the home clean, well maintained and safe. The records in the home were not all accurate and up to date or available for inspection and action needed to be taken to ensure that all records were adequately maintained and that confidential information was stored securely at the home. The new manager of the service was an experiened Learning Disability nurse, however, she had only been in post for five weeks and she needed extra line management support from Dimensions senior management team, in order to ensure timely changes were made at the home to ensure any progress made is effective and sustained. The provider should ensure that regulation 26 reports are completed on a regular monthly basis and that when significant issues are highlighted in reports that action is taken to remedy the situation in a timely way. Key inspection report Care homes for adults (18-65 years) Name: Address: Burncross Road 209/211 Burncross Road Chapeltown Sheffield South Yorkshire S35 1RZ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Murphy     Date: 2 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Burncross Road 209/211 Burncross Road Chapeltown Sheffield South Yorkshire S35 1RZ 01142571763 F/P01142571763 debbie.johnson@new-dimensions.org.uk www.dimensions-uk.org Dimensions (UK) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Diane Sutherland Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Burncross Road is a care home providing personal care and accommodation for 12 people with Learning disabilities, nine of whom may have dditional physical disabilites. The home is owned by Dimensions UK and is situated at Chapeltown. The home is purpose built and consists of two properties adjacent to each other. All bedrooms are for single occupancy and one has an en-suite facility. There are garden areas accessible to people. The manager confirmed that peoples current fees ranged between £300 and £1000 per week. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 12 9 Brief description of the care home Information about the home is available to people in the form of a Statement of Purpose and the Service User Guide. These are available from the home. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means that people who use the service experience poor quality outcomes. Shelagh Murphy carried out this unannounced Key inspection of the service the total time spent on site was 7.5 hours. We had planned to do a short random inspection, because of information we recieved from Sheffield safeguarding adults team, due to concerns about peoples safety and the quality of support offered to people. However, we changed the inspection in to a key inspection when we found numerous areas of non compliance at the home, which placed people at immediate significant risk of harm. Therefore we needed to ensure all outcome areas were looked at. In the report we make reference to `us and `we. When we do this we are referring to Care Homes for Adults (18-65 years) Page 6 of 34 the inspector and the Care Quality Commission (CQC). We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. Some time was spent with the people who use the service. Three staff attended interviews with us, to give us their views of the service. We spent some time observing staff interactions with people. On the day of the site visit opportunity was taken to inspect a sample of care records, check records relating to the running of the home and to check some of the homes policies and procedures. We also made a partial check of the environment. The inspector checked all the key standards. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: People needed to have their needs reassessed to ensure they were still living in a home which could meet their complex needs. People needed more support to make meaningful decisions about their lives as there was very little evidence that people play any meaningful part in planning their care and support. Peoples care plans needed to be reviewed and updated to ensure their current needs were recorded so that staff know how best to support people. Peoples risk assessments needed to be reviewed and updated to ensure that any risks associated with their care could be identified and adequate control measures put in place to protect people from avoidable risks. The staff needed to attend specialist training to ensure they had the necessary skills and knowledge to support people with complex needs. Staff training records showed that most staff did not have up to date medication, fire safety or moving and handling training. This placed people at risk and therefore requirements were made on the day for the service to address this. The manager needed to identify all staff who have not got up to date mandatory training in First Aid, Infection Control and Food hygiene and ensure they are trained in order that they can support people in a safe way. The manager will need to review the staffing levels at the home to ensure that people have access to meaningful day and leisure activities. People were not currently offered an accessible menu so they can could choose what they ate. This limited their independence and did not protect their rights. The medication systems needed to be regularly audited to ensure that medication was being stored, administered and recorded safely by the staff. This would help to protect peoples welfare. People needed to be better supported and empowered to access the complaints procedure and to voice their concerns. This would better protect peoples rights. The manager needed to continue working with the safeguarding adults team to ensure that safeguarding procedures were being robustly adhered to, which would help ensure people were safe from harm. Care Homes for Adults (18-65 years) Page 8 of 34 The home needed to be deep cleaned as there were so many areas in need of cleaning and dusting. Walls and windows were dirty, some carpets were stained and some areas of the home needed refurbishing and redecorating in order to ensure people were living in a clean, homely and comfortable environment. A review of the staffing levels should be undertaken, to ensure there are sufficient staff to keep the home clean, well maintained and safe. The records in the home were not all accurate and up to date or available for inspection and action needed to be taken to ensure that all records were adequately maintained and that confidential information was stored securely at the home. The new manager of the service was an experiened Learning Disability nurse, however, she had only been in post for five weeks and she needed extra line management support from Dimensions senior management team, in order to ensure timely changes were made at the home to ensure any progress made is effective and sustained. The provider should ensure that regulation 26 reports are completed on a regular monthly basis and that when significant issues are highlighted in reports that action is taken to remedy the situation in a timely way. 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As most peoples full needs had not been reassessed for so long we could not be sure peoples complex needs were not being met at the home. Evidence: We asked for peoples needs assessments. This information was not available on the care plans we checked. The new manager said to her knowledge only one person had had their full needs reassessed since everyone had moved in to the home in 2003 and the documentation was not available, as it was still with the social worker who had recently carried out this assessment. Care Homes for Adults (18-65 years) Page 11 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not involved in making meaningful decisions. Most people did not play any meaningful part in planning the care and support they needed. Risk assessments did not not fully protect people from harm as they were not accurate or robust. Evidence: We checked two peoples care plan files and found that overall they contained adequate information for staff to support peoples basic needs. The manager told us that in the five weeks she had been at the service she had completely changed the support plan formats to make them more user friendly. This was an ongoing piece of work and not all of the care plans had been reviewed and adapted to the new format. The care plans we checked were devised using person centred principles. However, we found evidence that although these two care plans had been reviewed recently, they both contained information which was identified as incorrect and evidence that peoples needs had not been fully recorded. For example one person with diabetes Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: needed to have their bloods checked on a daily basis and we found evidence this had not been recorded on a daily basis. The staff said this had been recorded on the daily handover sheets but this had not been transferred over to the daily recording chart. On both of the care plans checked we found that peoples weight had not been regularly monitored. On one file we found a monthly weight chart which was started from January 2010 had only been filled in for January, May and June 2010 and there was no specific date the person had been weighed on. These issues had not been picked up before our visit and could have placed the persons health at risk. The manager of the service told us that of the other ten people who lived at the home, only six of the care plans had been fully updated recently. This did not ensure that peoples needs were fully recorded and may lead to peoples current needs not being met. We wanted to see whether people who lived at the home were supported to make decisions about their lives with assistance as needed. We were unable to seek peoples views on the day due to their high support needs, however, from our observations of staff interactions with people, from speaking to staff and the manager we found that the majority of people had very little input and influence over the way their home was managed. When we observed staff interactions with people they were kind, but did not seem to have any ideas or enthusiasm about how to meaningfully communicate with, occupy or support people. People were not empowered and staff seemed to have lost direction in how to support peoples basic needs. When we spoke to staff they had very limited ideas about how people could be empowered to make decisions about even basic everyday choices. This did not protect peoples rights or their dignity. We checked two peoples risk assessments and found that overall, people had did have risk assessments. These covered risks associated with people being moved in hoists, risks within their environment, managing behaviour and outings from the home for people who used wheelchairs. Several needed updating. We looked in detail at a risk assessment dated 22.6.10 which, referred to risks associated with a radiator in a persons bedroom. The information in the risk assessment was brought to the managers attention as we were concerned about the quality of it. The manager advised us that the information was wholly incorrect and did not include adequate control measures. This did not protect people from harm. This made us question the validity and safety of the other risk assessments and asked the manager to look at these as a priority. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: We would also question the training staff had received in order to devise the risk assessments as they were generally of a poor quality and lacked understanding of the risk assessment process. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home did not always have their social and personal care needs met in a way which respected their dignity. Evidence: Some people had opportunities to access appropriate activities. One person who had 1 to 1 staff support had gone out for the day and we saw another person going off to a day centre. However, for the other people who remained at the home we did not see any organised outings or activities. It was a very sunny day and we observed throughout the day staff sat outside writing in files or sat in the house writing in files and people sat in wheelchairs inside, with the T.V. on. Of the people who lived at the home who did venture outside to see staff, there were no activities for them and it appeared to us as if people were just being contained at the home. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: When we spoke to the staff they told us they did not have the ability to take people out as much as they would like. They said this was because they did not have enough staff on duty as they had to do all the cooking, cleaning and laundry as well as support people with personal care needs and complete records. They told us this was one of the reasons that people were not adequately occupied and supported during the day. We then checked peoples activity records and found the following recordings for one person:- 7.6.10, X has been playing with his ball, 8.6.10 been to Burton Street, 9.6.10 X has had a bath and played with his ball, 10.6.10 X has been playing with his ball. This same level of activity was recorded for the majority of entries over the four week period we checked. This did not meet the persons social or leisure needs or offer them any meaningful activity whilst at the home. We discussed our observations of the lack of opportunities for people living at the home and the lack of staff interactions with people and fed back the staff concerns to the manager who advised us that she was aware that people who live at the home were not currently having their social needs met. We advised that as a priority this area must be addressed to ensure people were leading meaningful lifestyles. Staff and the manager told us that people were supported to maintain relationships with their family and that people could have visitors at any time. We wanted to see if people were offered a healthy diet and enjoyed the mealtimes. There were no planned menus available for people to make choices from. Staff told us they knew peoples likes and dislikes and would provide foods which people enjoyed. We discussed with the manager the ways that menuss could be made accessible to people using photographs etc and enabling people to make choices. The staff told us that everyones daily meals were recorded in their care plans, in order for staff to be able to monitor peoples appetites and we saw evidence of this. We spoke to staff about how they prepared soft, mashed and pureed food for people with swallowing assessments. One member of staff told us the meals, many of which, were pureed did not look appetising and they would not wish to eat the food in this way. It would appear that some staff were pureeing the whole meal together rather than preparing the food individually. This practice did not protect peoples dignity and must be changed as a priority. Care Homes for Adults (18-65 years) Page 16 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who lived at the home did not have their health and social care needs fully met. The medication practices at the home did not protect peoples health and welfare. Evidence: There was evidence that people were being supported with personal care from their daily records, held in their care plans. Some people were observed to be wearing age appropriate clothing and appeared well dressed and groomed, however, other people we spoke to had dirty hands and nails, had food spillages on their clothing and needed more support to meet their personal hygiene needs. There was also evidence that the personal records had not been completed accurately. One care note we saw had a date in the future, other notes we saw indicated peoples dental care plan was over a year out of date and other records were not accurate. For example, some menu charts had gaps where the staff had not recorded what people had eaten. These practices did not protect peoples dignity or ensure their health and welfare was fully protected. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: We wanted to check whether people were supported by appropriately trained staff in relation to moving and handling people safely. Many of the people who lived at the home required a high level of staff support to transfer safely from wheelchair to baths and other seating areas. We checked the staff training matrix and found that only 7 of the 23 staff had up to date training in moving and handling techniques. This practice could place people at significant risk of harm. Therefore we issued an immediate requirement for the registered person to ensure that the service had adequately trained members staff on duty at all times to safely carry out moving and handling tasks. We asked whether people had health action plans (HAP). These are records of peoples health needs and are recommended as good practice documents to be devised for all people with learning disabilities in conjunction with their GPs. We were advised that all of the people who lived at the home had these plans, although we did not see any that had been agreed with the local GP. We checked two HAPs. One was blank as it was due to be completed imminently and the other was last reviewed on 18.7.2006. These practices do not protect peoples health needs. It was difficult to gauge whether peoples physical and emotional needs were being met as peoples complex needs meant that verbal communication was limited. However, from our observations we saw some people aimlessly wandering about the house, with no staff attention. Other people were screaming out and people who were sat in wheelchairs with very limited physical abilities were left in a room to watch T.V. for the majority of the time we were at the service. From these observations and our earlier discussions with the staff and manager we found that overall, most peoples needs in this area were not being met. We wanted to see whether the homes procedures for dealing with medication were safe. We asked to check the staff training matrix and found that only 7 of the 23 care staff had up to date medication training. This practice did not ensure that at all times there were adequately trained staff on duty to administer medication safely. Therefore we issued an immediate requirement for the registered person to ensure that they covered the service with an adequately trained member staff at all times to administer medication. We also found other errors in the Medication Administration Records or MAR sheets. On one persons MAR sheet there were numerous gaps where staff had not signed to say a prescribed drink thickener had been given. The manager thought that this had been given to the person but had not been signed for. We also saw evidence where staff had signed the MAR sheet and recorded that they had given a person double the Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: dosage of a medication they were prescribed, (Sodium Valporate 200mg x 2 daily). The manager checked this and found this was an error on the MAR sheet and the person had not been given a double dose of the medication but staff had not picked the error up on the MAR sheet and had just signed it. We also found in the pharmacy returns box which was stored outside the locked drug cabinet, two tegretol tablets, which had not been administered or signed for. These practices placed people at risk of harm. Care Homes for Adults (18-65 years) Page 19 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was no evidence that concerns or complaints were listened to or acted upon. Because we have no outcome for the most recent safeguarding incidents we cannot be satisfied that people were fully protected by the systems in place at the service. Evidence: Complaints procedures were available in pictorial formats, however, there were no records of any complaints that had ever been made at the service. We were shown complaints books that had just been devised by the manager. This indicated to us that people were not being supported to air their concerns and complaints and we could not be satisfied that any future complaints would be managed well by the service. All of the staff we spoke to said they were aware of the adult safeguarding procedures and they had completed training on this subject over the last month. The manager confirmed this. They also advised that a copy of the new local area safeguarding adults procedure was in the staff office for everyone to access as required. We then checked the staff training matrix and found that 17 of the 23 staff had completed this training on 17 and 25 June 2010. This training was provided by Dimenisons training team. When we spoke to staff about their understanding of the principles of safeguarding people, they had some understanding. However, we could not be sure that they fully understood the concept of neglecting a persons needs. One conversation we had with Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: a staff member indicated they thought that the lifestyle they expected to lead was different to that, which a person with a learning disability could expect to lead. This concerned us greatly and was fedback to the management team to indicate a poor staff culture at the home. From our records we knew that 4 adult safeguarding referrals had been made over the last year. These included three medication errors where people had been given double doses of medication in error. The most recent referral was an allegation of neglect of a person who lived at the home. These referrals led on to safeguarding investigations and three were closed and one was ongoing. The investigation into the latest safeguarding incident has led to the service being placed into Serious Incident Procedures with Sheffield City Councils safeguarding adults team. Information from this key inspection will be fed back to the safeguarding case conference. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not currently living in a clean and homely environment and this does not protect their welfare or dignity. Evidence: Peoples bedrooms were personalised and comfortable and the lounges were homely. However, they were dusty and looked as if they had not been adequately cleaned for some time. The overall impression we took from the home was that people were living in a home which, did not present as clean or homely. The entrance hall looked dirty, the furniture was stained and dusty, the walls and doors were stained with food debris and dirty finger marks. There were areas of the walls where pictures had been taken down but not replaced leaving dirty marks. Bathrooms checked were dark and institutional, there were very few homely touches. There were several carpets stained with food and spillages. The door ways were scuffed and paintwork was chipped by the wheelchairs. The kitchen was not adequately clean, the walls looked greasy, the tiles, work surfaces, cabinet doors were cracked and damaged and did not provide surfaces which could be adequately cleaned. The exterior of the home was not well maintaned, clean, tidy or inviting. Gardens were overgrown, there were pots with dead plants in Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: and there was an impression that the home was not cared for at all. Staff attitudes to the up keep of the home can be summed up by a member of staff spilling a drink on a carpet and being asked if they were going to clean it up, by saying, `Its okay itll just sink in. This did not protect peoples dignity and again demonstrated a poor staff culture to caring for people whose home they worked in. From the records checked it was clear that the majority of the staff team need to have infection control training updates. This could place peoples health and safety at risk. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people were not being supported by an adequately staffed team. And the staff were not appropriately trained or skilled to meet peoples complex needs. Evidence: The staff rotas for May 2010 showed that the staffing levels in each house caring for 6 people there were generally 2 carers on each shift during the day, on 10 out of 28 shift this rose to three carers in one house. We asked for the night rota for the last four weeks and this was not available. From our observations and from speaking to staff it was clear that the home was not always adequately staffed to ensure that peoples basic care needs could be met, that people could be meaningfully occupied, to access the community or for staff to keep on top of the domestic duties. Therefore we are going to require that the management of the service reviews the current staffing levels to ensure that peoples personal social needs can be met at all times and that domestic duties are effectively carried out to ensure the home is kept to an acceptable standard of cleanliness. We did not check the staff recruitment files during this inspection as these were kept at the Registered head office. These will be checked on our next inspection to the home. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: There was plenty of evidence that the staff team had not been offered all of the up to date mandatory and specialist training required for them to have the necessary skills to support people safely. The staff training matrix showed gaps in up to date training for most staff in medication, moving and handling, fire safety, first aid and health and safety. The only training which most staff had completed recently was the adult safeguarding training completed over the last two weeks. Three members of staff told us, they had not received regular training from the service over the last two years. Two members of staff told us, they had not been offered frequent supervision until the new manager had had taken up their post. However, all three staff told us that they did feel able to take any concerns or problems they had to the new manager, who they described as, `approachable and `fair. Staff also told us they had not had regular staff meetings until recently when the new manager had introduced these to the service. From our observations we did not see a lot of good staff practice. For example, staff were not very clear of peoples communication styles and did not appear to understand how to offer meaningful support to people with very complex needs in an empathetic manner. Care Homes for Adults (18-65 years) Page 25 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not benefiting from the way the service was run. There were so many systemic problems that the current manager will require alot of extra support and resources to make the improvements required at this home. Evidence: The manager of the home was not registered with CQC. She had only been in post for five weeks but advised us that she was in the process of applying to become the registered manager. The manager had a nursing qualification in Learning Disability and had previous experience as a registered manager of a service. The staff reported that the manager was supportive and listened to them. Throughout our site visit we found that records required by the Care Homes Regulations 2001 had not been adequatley kept up to date or accurate. For example peoples daily records, care plans, risk assessments, health needs, medication administration records and complaints records all provided us with evidence that record keeping at the unit was not robust and accurate. We also saw evidence that confidential information about people was not routinely stored in a secure location. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: This did not protect peoples dignity and could place peoples welfare at risk. The health and safety policies and procedures in place, did not fully ensure peoples safety and welfare. The staff had not completed all of the mandatory training required to ensure they had the skills to support people safely. Some details of this had been reported on in previous outcome areas of this report. We found evidence in the staff training matrix that some staff had not completed fire safety training or taken part in a fire drill over the last year. Some staff had not completed this training or a fire drill since 2005. Only 2 of the staff team had current fire drills and fire safety training in place. This placed peoples safety at risk therefore we issued the manager with an immediate requirement. This was to ensure that at all times there were adequately trained staff on duty to ensure people could be adequately supported by staff who knew what action to take in the event of a fire. We checked to see if Regulation 26 visit reports, (these are visits carried out by the provider to ensure they are monitoring the service on a monthly basis), had been carried out on a regular basis and found evidence that no reports were available from October to March 2010. There was evidence that they had been carried out on the following dates, 1 and 28 April, 25 May and 7 June 2010. However, our concerns were why these visits had not identified and then rectified all of the issues we found during our inspection. One example was the regulation 26 report carried out on 1 April 2010 stated that only 15 of the staff team had up to date moving and handling training and this would be out of date in May 2010. This was not addressed as an urgent issue at the time and remedial steps taken to ensure peoples health and safety. This demonstrated that the systems in place to monitor the quality and safety of the service were inadequate and left people at risk of harm. We checked a sample of health and safety certificates and records at the home and found the following information, Hoist checks had been carried out on 20.5.10, 3.6.10, 9.6.10. Specialist baths had been checked on 16.11.09, and 1.6.10. The gas certificate was dated 17.6.10 and electrical circuits check was completed on 9.4.08. Legionella checks 26.11.09. Water temperature checks had been carried out on a regular basis over the last month. Fire equipment checks had been carried out in May 2010. These checks helped to ensure peoples health and safety was protected. Care Homes for Adults (18-65 years) Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 28 of 34 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 1 20 13 The registered person must 30/06/2010 ensure that at all times there are adequately trained staff on duty who have up to date moving and handling training. To ensure staff know how to support people safely. 2 20 13 The registered person must 30/06/2010 ensure that at all times there are adequately trained staff on duty to administer medication to people. To protect peoples health and welfare. 3 43 13 The registered person must 30/06/2010 ensure that at all times there are adequately trained staff on duty with up to date fire safety training. To ensure that staff can safely support people in the event of a fire. 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 6 15 Peoples needs assessments, 30/08/2010 care plans and risk assessments must be reviewed and updated to Page 29 of 34 Care Homes for Adults (18-65 years) 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 reflect their current needs and wants. To ensure peoples needs can be identified and met safely. 2 12 18 The home must be adequately staffed. To ensure that people have appropriate support to meet their needs. 3 17 16 People who require pureed meals due to swallowing needs, must be offered food which has been prepared appropriately. To protect their dignity. 4 20 13 Medication audits must be carried out on a regular basis to ensure that any medication errors are identified quickly and addressed. All staff who are required to administer medication must have adequate training. To protect peoples health and welfare. 30/07/2010 15/07/2010 30/08/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 5 22 22 People should be supported to access the complaints procedures in a meaningful way and empowered to be able to voice their concerns. To protect peoples rights. 30/08/2010 6 23 13 The service must continue to 30/08/2010 work with the safeguarding adults team to ensure people are protected from harm. To protect peoples welfare. 7 24 23 The home must be deep cleaned to ensure that people are living in a clean and safe environment. To protect peoples health, dignity and welfare. 31/07/2010 8 32 18 The staffing levels must be 30/08/2010 reviewed to ensure that there are adequate numbers of staff on duty to ensure that domestic tasks are completed adequately. To ensure the home can be adequately cleaned to an acceptable level for the people who live there. Care Homes for Adults (18-65 years) Page 31 of 34 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 9 35 18 The staff training records 30/08/2010 must be checked and all staff who have not had up to date mandatory training must be offered this. To ensure the staff have the correct skills to support people safely. 10 41 17 All records required by the 30/08/2010 regulations, for example care plans, risk assessments and staff training records, must be kept up to date and confidential information must be stored securely. To protect peroples safety and welfare. 11 42 26 All regulation 26 reports must be sent in to CQC on a monthly basis for the forseeable future. To ensure that we can monitor the stanards of the findings and actions taken to ensure peoples welfare. 31/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 All of the people who live at the home should have their full needs reassessed. To ensure they are appropriately placed at the home. Care Homes for Adults (18-65 years) Page 32 of 34 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 2 7 People should be supported to make decisions about their daily lives with assistance from staff as required. To empower people and protect their dignity. People should be offered adequate opportunities to meet their social, developmental and leisure needs. To ensure people are leading meaningful lives. Menus should be made in accessible formats to enable people to make choices about the food they wish to eat. People need more staff support to ensure their personal care needs are fully met. To protect their dignity. The environment within the home and externally should be checked to identify which areas need to be redecorated and refurbished to ensure people are living in a homely and comfortable environment to protect their dignity. The regulation 26 system should be reviewed to ensure that all identified risks are actioned and records are updated to reflect this. To prevent people from unnecessary risks to their health and welfare. The current manager should be offered more line management support to make the necessary changes the service requires. To ensure that quality and safety standards are improved to safeguard peoples welfare. 3 12 4 5 6 17 18 24 7 39 8 43 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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