Care Home: Caldicott

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What the care home does well Staff showed good knowledge and understanding of the personal needs of the people living at Caldicott. This helps to make sure that people`s needs are met in the way they prefer. During our visit we saw staff talking to people who live at Caldicott in a polite manner and they showed a good rapport with people living there. The staff told us that they work well together to make sure that they can support the people who live at Caldicott. We have received four completed staff surveys which gave mixed comments overall. Everyone felt they knew the procedures of what to do if they had any concerns. Positive comments included: "We try our best to meet all requirements of service users and everyone in relation, all service users seem to be happy with the service"; "We have a very thorough handover"; "It provides a safe and comfortable environment for a service user to live in. We treat each service user with full respect and consideration of their feelings". What has improved since the last inspection? The support plans for the people living at the home were detailed and regularly reviewed. They gave enough information to show how people`s personal and social needs would be met and covered a diverse range of needs, eg what they want to do in the day, night times and at weekends. The staff had developed communication records to help people express their opinions and help to make their needs known. These records are a good example of the time taken by staff to produce documents that help everyone to have accurate information about each person`s likes, dislikes and choices, eg what they want to eat, what they want to do each day, how they want to be supported and reassured. Staff have also developed "anticipatory health calendars" which helped to show a planned approach to keeping people safe. This provides a good system for recording dates of health checks that also helps to make sure that each person living at the home was offered regular health examinations so they could stay healthy and safe. Great consideration is taken when somebody new is due to move into Caldicott so that everyone is in agreement about who moves there and staff and other people living at the home are able to get to know the new person. A number of new staff have been employed over the last few months, which has helped to build up a more stable staff team. It was evident during our visit that the staff had built good relationships and respect with the people living there and were able to interpret their needs and requests. We saw from our observations that the people living at Caldicott were relaxed and happy in the company of the staff. Each person living at the home is provided with a range of opportunities to help their personal development. They have a plan of activities that they would do during the week to help make sure they were active and had time to follow their interests. What the care home could do better: We noted some areas where action was needed to make improvements to the service. The information about how the home works and who it is for (the service user guide and statement of purpose), as well as the complaints procedure, need to be kept up to date so that people living at the home, their relatives, people who may be interested in moving in and others have up to date information in formats they can understand. Clear instructions need to be available in one person`s support plans to guide staff on how to support that person until the training they need is provided. This will help to make sure that staff support the person safely. All staff must be up to date with safeguarding policies and procedures so they know what to do to protect the people who live at the home. Staffing levels must be kept under review to make sure that they are appropriate to meet the needs of the people living at Caldicott. These reviews should include the opinions of staff and the people living there. In addition, adequate induction must be provided for any new staff working at the home to make sure they have the right information to support people safely at all times of the day and night. Accurate financial support plans and clear policies need to be available at the home to show that the finances of the people living there are safeguarded. Up to date evidence must always be available to show decisions about people`s finances are being made in their best interests if they do not have capacity to manage their finances personally. Clear information must be available about providing the equipment, adaptations and facilities to meet the needs of the people living at Caldicott. This will help show clearly who will provide any necessary equipment and help give staff clear guidance in obtaining necessary equipment on behalf of the people they support. Systems should be reviewed to make sure that the views of people living at the home and their advocates/representatives are obtained about the quality of the support and care being provided at Caldicott. Their views should be taken into account in developing the home to help make sure that it continues to run in the best interests of the people who live there. Key inspection report Care homes for adults (18-65 years) Name: Address: Caldicott 4 Caldicott Avenue Bromborough Wirral CH62 6DJ     The quality rating for this care home is:   two star good 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: Diane Sharrock     Date: 2 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Caldicott 4 Caldicott Avenue Bromborough Wirral CH62 6DJ 01513342122 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Alternative Futures Limited care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies 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: 3 Date of last inspection Brief description of the care home 4 Caldicott Avenue is registered to provide personal care for 3 adults with a learning disability. Alternative Futures Limited, a registered charity operating in the North West, operates the service. Alternative Housing Association owns the premises. 4 Caldicott Avenue is a detached dormer bungalow, situated in a quiet residential road. On the ground floor there are two single bedrooms. There is a large lounge and a separate dining room. There is a domestic style kitchen, a separate laundry area and an office. A walk in shower room/WC is also available on the ground floor. On the first floor there is a single bedroom and a further bathroom /WC with a whirlpool bath. To the rear of the service is a garden, which can be accessed by a wheelchair. There is car parking at the front of the home. The service is located close to shops and supermarkets and Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 3 Brief description of the care home there is access to public transport. The service provides a minibus, which gives people the opportunity to go out together. The weekly cost for the service is 1366.62. pounds, Items not covered by this fee includes chiropody, television licence (if television in own bedroom), haircuts, presents, toiletries and confectionary and some activities. A service user guide and a statement of purpose, which describe the services offered at Caldicott, are available for potential people, their relatives and social workers to refer to. An inspection report can be made available to anyone who wants to have access to it. 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: two star good 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 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit was carried out on 29 June 2009 and took 6 hours in total. It was done by one inspector. The report will refer to we and us as it is written on behalf of the Care Quality Commission. We gathered information for this visit in a number of different ways. We looked at the care and support that people living at Caldicott receive. We call this case tracking and it involves looking at peoples care records, talking with them where possible and talking with the staff who provide their support. This gives us a picture of what the persons care and support needs are and what staff do to meet those needs. At this visit, we looked at the care provided for two people who live at the home. Care Homes for Adults (18-65 years) Page 6 of 34 We spent time meeting with the people living at Caldicott and with the staff who were on duty at the time of our visit. Questionnaires (surveys) were sent to people living at the home, their relatives and staff to find out what they thought about the home. We received four completed surveys from staff and information from the surveys are included in this report. We looked at the action taken at the home to make sure that peoples diverse needs are considered and we have commented on this in the report. We also looked at other records sent to us by the manager before our visit. This included a completed questionnaire that we call an annual quality assurance assessment (AQAA). This questionnaire gives us information of progress being made at the home to maintain and improve the quality of the service. We have used the information in this survey to plan our visit to the home and in writing this report. 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: Care Homes for Adults (18-65 years) Page 8 of 34 We noted some areas where action was needed to make improvements to the service. The information about how the home works and who it is for (the service user guide and statement of purpose), as well as the complaints procedure, need to be kept up to date so that people living at the home, their relatives, people who may be interested in moving in and others have up to date information in formats they can understand. Clear instructions need to be available in one persons support plans to guide staff on how to support that person until the training they need is provided. This will help to make sure that staff support the person safely. All staff must be up to date with safeguarding policies and procedures so they know what to do to protect the people who live at the home. Staffing levels must be kept under review to make sure that they are appropriate to meet the needs of the people living at Caldicott. These reviews should include the opinions of staff and the people living there. In addition, adequate induction must be provided for any new staff working at the home to make sure they have the right information to support people safely at all times of the day and night. Accurate financial support plans and clear policies need to be available at the home to show that the finances of the people living there are safeguarded. Up to date evidence must always be available to show decisions about peoples finances are being made in their best interests if they do not have capacity to manage their finances personally. Clear information must be available about providing the equipment, adaptations and facilities to meet the needs of the people living at Caldicott. This will help show clearly who will provide any necessary equipment and help give staff clear guidance in obtaining necessary equipment on behalf of the people they support. Systems should be reviewed to make sure that the views of people living at the home and their advocates/representatives are obtained about the quality of the support and care being provided at Caldicott. Their views should be taken into account in developing the home to help make sure that it continues to run in the best interests of the people who live there. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is given to anyone thinking about moving into Caldicott. This makes sure that the service is the right place for a person to live in and that their needs can be met. Evidence: The information we were sent about Caldicott before our visit told us there is a detailed procedure to be followed when new people wish to move to the home. This includes making sure that a check is done about the person and their needs to make sure these can be met at the home. Nobody new has moved to Caldicott since our last inspection although there is one vacancy at the home. Staff explained that they have a compatibility assessment to make sure that anybody new will be able to live alongside the other people already living at the home. They told us that a few people had been considered to move into Caldicott; however, for various reasons they felt they would not be suitable. They explained they are still in the process of reviewing assessments and looking at the compatibility of new people. Great consideration is taken in someone new moving in so that everyone is in Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: agreement to who moves there and is able to get to know the new person. The staff explained that the bedroom would be decorated for anybody new coming into Caldicott so they can choose their own colour scheme. Good information is given to anybody who is interested in moving into the home, including the option of having a trial visit to the service. This makes sure the service is the right place for the person to live in and and that their needs can be met at the home. An information brochure about the service is available to tell people about Caldicott and about the support they can expect. This had been produced in large print with pictures to help some people understand the information more easily. This helps people to decide if Caldicott is the right place for them and if their needs and choices can be met there. This brochure is called a statement of purpose. Some parts of it need to be updated so that people have accurate information about how to contact the commission. Care Homes for Adults (18-65 years) Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of the people living at Caldicott are identified so that staff can support them to meet those needs and personal choices. Evidence: Detailed individual support plans were available for each person living at Caldicott. We looked at two of them to see what the peoples care needs were and how they were being met. We also met those two people and talked with the staff on duty. This helped us to see how care and support was being provided in the home. The plans were detailed and regularly reviewed to make sure they were up to date. They gave enough information to show how peoples personal and social needs would be met and covered a diverse range of needs, eg what they want to do in the day, night times and at weekends. These plans provided staff with clear guidance about what they needed to do and gave appropriate instructions as to the support each person required, in a range of environments and situations, to enhance their life. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: One plan that we looked at was very individualised and specific to what the person wanted to do each day. For example, it was very detailed about what time they wanted to get up. The plan had been regularly reviewed to make sure it was accurate and met the persons changing needs. The staff had developed records for communication needs. These records had been developed over time by staff who had got to know each persons needs, choices and non verbal ways of communicating. These documents are vital for people who use non verbal signs and rely on staff to interpret their behaviours to know what they want. The records are a good example of the time taken by staff to produce documents that help everyone to understand each persons likes, dislikes and choices, eg what they want to eat, what they want to do each day, how they want to be supported and reassured. When we spoke to staff, they could clearly discuss the needs of the people they helped support and had got to know them very well and had built up a good rapport with them. We could see that staff had built up good relationships and respect with the people living at Caldicott and were able to interpret their needs and requests. Following our visit we received 4 comment cards sent back to us from the homes staff telling us that the people living there were not able to tell us what they thought about the home and that they did not have contact with their next of kin. We found that the home did not have any evidence that steps had been taken to find out the views of people living there about the service they received. We only saw minutes for one house meeting from 6/1/09; the agenda covered various topics such as mobile phones, laundry, night cleaning rota, routines, time owing, continuity and team work. We noticed there was a note on file saying....May, June, July, August, Sept, Oct, Nov, Dec, meetings cancelled due to illness and staff vacancies. The information we had been sent before our visit stated, they....... have customer feedback which they regularly review; however, during our visit, we did not see any records relating to feedback about the quality of the service provided. We looked at a sample of financial records kept at the home about peoples personal allowances. The support plans we saw had a section covering the management of the persons finances and gave some details of how staff support each person with their finances. However the staff explained to us that various monies and accounts were stored and managed at head office; this information was not included in writing in any of the records held at the home. Staff told us that each person living at the home had three bank accounts and they thought two of these were held at head office. Staff did not know Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: why each person had three accounts and were unsure where two accounts were stored. We saw a recent bank statement for monies stored at head office which stated the money was being transferred to the persons bank account. However the bank statement gave a different amount transferred into it. Staff explained that the monies may have been transfered to the other two savings accounts held at head office. We found that the audit trail of paperwork was not clear or accurate enough to show that this persons money was being properly managed in their best interests. There was no rationale or record of the various accounts in peoples support plans. There was no information to say who was acting as each persons appointee and there was no information to say which account was used to receive benefits and funds. Some records gave two different amounts of the benefits received with two different weekly amounts. Staff said they had only recently been able to set up individual bank accounts in each persons name. There was no evidence of whether assessments had been carried out to establish whether people had the capacity to make their own decisions about these matters. The organisation that runs the home had developed financial licenses, which had been signed by a senior manager in the April 09. However these records had not been fully completed and did not have any details regarding what was included or covered in the weekly fees paid. We noticed that one person had been charged for buying equipment that was necessary for their care. Staff thought that people had to buy their own equipment. Recently each person had to buy bed rail covers costing over 100 pounds and one person had bought a specialised electric bed. There was no financial assessment or written explanation to show what rationale or decision had been made by the organisation to access each persons funds to buy equipment necessary for their care. There was no information in the statement of purpose for the home or the contracts advising people they would be expected to buy their own equipment. We could not find a financial policy explaining this process and the information we received was given to us by staff, of their understanding of what the arrangements were. It was not clear in looking at each persons records as to whether their mobility benefits were used towards the costs of the communal vehicle or how agreement had been reach regarding its management and use. Staff thought that each person living at Caldicott contributed to the funding of the communal minibus and each person did have a transport and travelling assessment . The ones we looked at had not been fully completed; there were gaps in the forms so it was unclear whether people were charged for the use of the minibus. For example, there was a question on the transport assessment forms, can he fund the cost of transport independently ........ . The answer part of this section was blank and had not been signed. Following our visit Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: to the service we have met with senior management from the organisation and they were fully co-operative in discussing the issues raised during our visit to the home. They explained the new processes for managing peoples finances so it is clear what people are charged for. They clarified that people living at the home are not charged for the management of the minibus and that the costs of this are covered by the organisation. They had also arranged for an internal audit of the finances of people who live at the home and agreed to let us have information about the findings, although this had not arrived at the time this report was completed. They also told us that the financial management of peoples monies had been recently reviewed and revised and that staff were going through a lot of training with the new procedures. They also told us about the new procedures regarding how finances are managed and how people are assessed and supported with the managing of their money. Following our visit to the home, we also shared information about the management of peoples money at the home with Wirral social services and the primary care trust responsible for the contract and placement of people living at the home. At the time of completing this report, we were awaiting further information from both authorities. The organisation had contacted the authorities to help with the review of peoples finances. Care Homes for Adults (18-65 years) Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff provide good support so that the people living at Caldicott can take part in a range of activities to meet their social needs. Evidence: We met everyone living at the service during our visit, including the staff on duty. We observed that people living at the home were relaxed and happy in the company of the staff. This showed us that staff had built up good relationships with the people living at Caldicott. In discussions with the staff and in looking at records, we could see that the people living at Caldicott receive the support they need to get out and about regularly in their local community. Each person is provided with a range of opportunities to help their personal development and they have a plan of activities that they would do during the week. These included shopping , lunch out, visit to dentist, relaxing, spending time with staff, going for a drive, a picnic, listening to music, tidying their room, a disco, walk, tea out, visit to the local sensory room, trip Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: to the pub, having a lie in and watching the television. The records showed a variety of activities that each person is involved in to enhance their enjoyment and quality of life. Each persons file showed that staff try to plan social events and activities and also carry out risk assessments to help make activities as safe as possible. Some of the plans we saw showed important information to help staff support people safely with, for example, diet, trips out and holidays, health and communication. Staff told us there is a communal minibus for the home that they try to regularly use but at times were restricted by just a few members of staff being able to drive the bus. They felt it was a good facility to have as it enabled people to get out and about far more than they would be able to do otherwise. Staff told us about the recent holiday to Spain that had arranged, which they all enjoyed. Staff had developed financial forms for costs of the planned trip to Spain. These help to show how decisions are made in managing a persons funds, especially showing value for money and that their funds are being managed in their best interests. The forms could be clearer in giving a breakdown of the overall costs incurred for the holiday so that it is clear what the overall amount was spent on, including staff costs. The kitchen was equipped with domestic style appliances and staff helped provide meals based on the daily choices offered. Records of food served at the home showed that a variety of meals are served in order to offer people as much choice as possible. The dining room was well maintained offering a homely environment for people to enjoy meals in. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given support to maintain their health. Evidence: Detailed support plans were available for each person we looked at two of them as part of our checks to see what care and support was being provided to meet peoples needs. The plans had recently been updated and revised; they gave enough information to show how peoples personal care and support would be met. The plans provided staff with guidance about what support each person needed with their health care. They showed that people are supported in accessing health and social care services if needed, especially the doctor, optician, and care managers. The information the manager sent us before our visit to the home told us, The anticipatory health calendars have been a good development to closely monitor peoples health care needs; service users all have up to date health passports to record all health care information......have provided improvements in health monitoring and links in effectively working with other documentation relating to health care and support. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: The introduction of these documents provided a good system for recording health checks and also helped to make sure that each person was offered regular health examinations so they could stay healthy and safe. We looked at the storage and procedures of managing medications at the home and found them to be well organised. The medications records overall were detailed and helped provide a good system of supporting people with the administration and storage of their medications. Staff have developed an easy read workbook for each person living at Caldicott called, My medications. The workbooks were a good example of what staff had done to try and explain to people how they support them with their medication. Staff told us that one drug had been prescribed by the doctor in September 2008, to be given in particular circumstances that might arise. However, they were unable to give the drug as they had still not received training on how to administer it safely. They explained that they had been trying to arrange the training and had only just identified a suitable trainer. They were awaiting permission from head office to release funds for this training. The situation we found at our visit meant that one person was potentially unable to have their prescribed medication if needed due to staff not having the necessary training. Staff told us that that the advice given to them was to call an ambulance if required and arrange admission to hospital, as they were unable to give the prescribed medication. The persons support plan did not give information regarding this situation, which means that staff did not have written guidance about managing it to make sure that the person received the medical help they might need. Following our visit we have had regular communication with the manager and senior representatives from the company. They have confirmed a training date for this necessary training but had been unable to get a date before September 2009. The support plan has a handwritten entry guiding staff to call the emergency services if they are were worried. This support plan needs to be a lot clearer and specific to provide the guidance staff need to manage the situation, should the medication be needed, and should include the doctors advice on what to do until the training has been completed and staff can give the medication themselves. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure for the home that is being developed to help people to understand it more easily. Staff have received training on safeguarding adults and there is guidance for them to follow so they know how to protect the people living at Caldicott from harm. Evidence: Information about how to raise a concern or complaint is made available to the people living at Caldicott. The policy was quite detailed and formal and staff advised they had developed a pictorial form which they had submitted to head office to await approval before being able to use it. The use of adapted formats is good practice as they help people using the service to have a better understanding of the ways in which they can raise concerns. We looked at a sample of staff training records which described various training that they had attended including safeguarding and abuse awareness. Staff described the various training they had received and everyone was able to explain what they would do and what policies they would follow if they ever had concerns. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Caldicott is maintained well so that it provides people with a safe and comfortable place to live in. Evidence: We were shown around the home and looked at a number of rooms and shared spaces. Each person living at Caldicott has their own bedroom where they are encouraged to have personal belongings and to individualise the room the way they want. The information we were sent from the home before our visit there told us, people are involved in the redecoration of the service, theres a cyclical internal decoration programme, new lounge carpet recently fitted. We did not see this programme but staff explained what decoration had taken place since our last visit to the home. During our visit we noticed the washing machine was broken and staff had been waiting for its repair for over two weeks. They felt it was taking a long time and were worried about getting the washing done, which they felt was necessary to do each day to make sure there was enough clean bedding and linen. Staff also told us that the chair lift to the first floor was out of order. They confirmed it Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: was no longer used and were unsure whether it was going to be replaced or removed. There is a lounge overlooking the garden which offers an attractive view from the lounge area. There is a homely dining room next to the kitchen which offers a quiet area for people who live at the home to relax in. The kitchen is a domestic style facility that is accessible to everyone living at the home. Caldicott was decorated to a good standard and provided a homely environment for people to live in. We looked at a sample of the certificates showing that services in the home such as gas and electricity were being serviced and maintained safely. The necessary checks were up to date to show that the home is safe for people to live and work in. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home are well trained and enthusiastic; they work hard to make sure that the people living at Caldicott are supported with their individual needs. Evidence: We were unable to look at staff personnel files as the manager of the home was on holiday but staff were able to tell us about the recruitment and selection procedures that they had gone through. One staff member had a copy of their criminal record bureau check and said that all staff have them in place before they can start work at the home. These checks are important in helping to make sure that staff are suitable to work with the people who live at Caldicott. Staff felt they now had a full staff team after taking on approximately four new staff over the last six months. They felt they were building up a good team and were using fewer agency staff members to cover for absences and vacancies. In speaking to staff and in looking at staff training files we found some staff had been provided with mandatory training. Staff felt they had been provided with a lot of support and training over the years and felt the training offered was very good. Just one staff member felt they had last had safeguarding training over 2 years ago and was due to have an update but had no date for this as yet. All staff need updated Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: training to help keep them up to date in their practices and help to appropriately support people, in eg, safeguarding and the administration of specialist medications. Staff were very positive and felt they were being provided with the right training and skills to help them do their job and to help them to support the people living at the service in the right way. It was evident during our visit that the staff team had built up good relationships and respect with the people living at Caldicott and were able to interpret their needs and requests. Staff were very motivated and enthusiastic and told us about a number of initiatives that they would like to get involved in. Staff said they would like to develop more records to meet peoples needs and would like more staff to be able to be qualified to drive the minibus. We received various positive comments from staff including comments contained in the four completed comment cards that were sent back to us. Comments included, We try our best to meet all the requirements of service users and everyone in relation. All service users seem to be quite happy with the service, We have a very thorough handover, It provides a safe and comfortable environment for a service user to live in, we treat each service user with full respect and consideration of their feelings. We also received comments and concerns regarding the use of agency and bank staff who had never met the people living at the service before and had no knowledge of their needs. One person made a comment stating, I feel concerned that bank staff who have never met the service users are able to work a night shift, when quite obviously they are not prepared with basic knowledge of the service users. Recent staff rotas we saw showed us that other staff had been brought in to help cover staff absences. Staff generally were concerned that some people would be on duty on their own especially at night, unsupervised, with no experience or training in supporting the people living at Caldicott with their specific needs. The rotas for June 2009 showed this had happened. There was no structured induction or guidance booklet for new staff to access but staff advised that they went through everything with new staff, including agency staff, when they handed over to them. Following our visit both the manager and senior representatives of the company have reviewed this issue. They have told us of the action they have taken to resolve the problem. They have revised their staffing requirements so that only agency staff with the right qualifications and experience will be sent to support the people living at Caldicott. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: The four completed staff surveys we received gave mixed comments and views about staffing at the service. One person felt they never have enough staff, one person felt they usually did and two people felt they, always had enough staff on duty. Systems need to be established to enable staff to express their views about how the service is running so that their concerns can be resolved. Care Homes for Adults (18-65 years) Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Caldicott is well managed so that it is a safe place for people to live. Evidence: The manager has worked at the home for many years and offers good stability for the people who live and work there. He is appropriately experienced and qualified and is able to show that he effectively manages the service in the best interest of everyone living there. The information we were sent before our visit told us that, the manager has an NVQ(national care qualification ) 4 in care and the registered managers award, also has a mental health certificate from Manchester university and a certificate in managing medications, with effective management resulting in a low overall staff turnover....... ...........The audit system has been developed with an associated audit calendar to further monitor all matters relating to managing the running of the home. This system will link in with the service development team who are able to provide analysis and feedback and therefore action plan accordingly. Has positive staff feedback as reflected in the last report summary as a result of staff questionnaires, Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: also positive feedback from community teams and input from a health facilitator from pct in Wirral, also they have published feedback from customer satisfaction surveys following analysis by the service development team. .......... We did not see any of the auditing tools used by the service or any of the feedback questionnaires. These tools would be useful to develop with staff at the home so they are knowledgeable and included in the developments about the service and are aware of ways to give regular feedback to develop Caldicott. We felt that during our visit and through the staff comment cards we received that staff were very committed, enthusiastic and motivated to develop the service and gave lots of comments and suggestions. The home is visited on a regular basis by a representative of the organisation. These visits, which are required by the care homes regulations, are part of the quality assurance process and help to make sure that senior managers are aware of how the home is running. A report has to be produced to show evidence of these checks. We could not find any recent reports during our visit but they have since been sent to us, following our visit. Staff working at the home should have access to these reports so they know what improvements might be needed. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking the electrical installation, fire safety equipment and the gas supply. These checks help to make sure that the home is a safe place to live and work in. We looked at a sample of accident records which indicated appropriate information had been recorded and appropriate action had been taken. We noticed there had been three incidents around the management of medication and the manager had taken good actions after each incident to help improve peoples practice and prevent further errors occurring. The manager arranges house meetings which help to make sure that everyone is up to date and included with the developments of their service. However we were only able to see the minutes for a meeting organised in January as the manager made it clear in this file that the monthly meetings had been cancelled due to sickness and staff absences. These meetings are necessary to help show good feedback and inclusion of everyone at the service in the developments of Caldicott. Care Homes for Adults (18-65 years) Page 28 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 29 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 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 23 There should be clear 18/09/2009 guidance and information on the companys commitment to provide the equipment, adaptations and facilities necessary to meet peoples needs. This will help show what equipment the organisation is responsible for providing and help give staff clear guidance for obtaining necessary equipment on behalf of the people they support. 2 7 20 Records of peoples finances 18/09/2009 must be accurate and up to date and show clearly how each persons money is being managed. Information about this should also be kept in their support plans. This is to make sure there are clear and transparent records to show that each 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 persons money is managed and safeguarded in their best interests. 3 20 15 Support plans should be reviewed to make sure they contain all the information needed including up to date information about the administration of peoples prescribed medication. This will help to make sure that staff know what to do to keep each person safe and to make sure they receive the medicines as prescribed. 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 18/09/2009 1 1 The information about the home (the statement of purpose) should be updated to provide the new contact details for the Care Quality Commission so that people will know how to contact the commission if they need to. The manager should have clear updated procedures and records to show how each persons finances are managed on their behalf, especially where people are unable to make their own decisions. There should also be information that provides people with the name of their appointee and summaries of all of their financial procedures. These records must be clear and accessible to everyone living at Caldicott and their representatives. This will help to show that peoples money is being managed in their best interests. Regular auditing will help to give clear accurate records. 2 7 Care Homes for Adults (18-65 years) Page 31 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 3 8 Effective systems should be set up to regularly find out the views of the people who live at Caldicott about the service they receive so that their opinions can be taken into account in how the service is developed. Staff should always have the necessary training to be able to safely support people with their medications. The organisation should consider using a picture version or easy to read version of the complaints procedure to help people living at Caldicott understand it more easily so they can be supported to make their concerns known. People who live at Caldicott and the staff should be made aware of the ongoing redecoration and refurbishment programme so they are kept informed about developments at the home. The procedures for ordering repairs for essential items of equipment should be reviewed to make sure that the washing machine can be repaired quickly to enable staff to ensure that necessary clean linen is available. There should be updated individual training and development plans for each member of staff to make sure they have received the training they need to help them with their job roles, including specific timescales for medications and safeguarding training where this is needed. A system to enable staff to express their views should be established so that these can be taken into account in developing the service and their concerns can be resolved. Consideration should be given to providing guidance/induction books for new staff, especially agency staff to help them be informed about necessary information to manage their shift at Caldicott effectively. The reports of the monthly visits made to the home by representatives of the organisation that runs it, to check on how it is running, should be made available in the home so that people know about the developments and comments made about their home. The ways in which people are currently informed about and included in the developments of the home should be reviewed. For example, the house meetings should be run more regularly so that people can share all of their comments and opinions as to how they want to develop Page 32 of 34 4 5 20 22 6 24 7 32 8 36 9 39 10 39 Care Homes for Adults (18-65 years) 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 Caldicott. 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. 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. 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