Care Home: Conway House

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What the care home does well People are supported to keep in touch with family and friends so they maintain relationships that are important to them. Visitors are made welcome and can visit at a time that suits them. As idenfied at previous inspections people living at the home have access to a range of specialist community services should they require them. These include general practitioners, opticians, chiropodists, speech and language therapists and dieticians What has improved since the last inspection? Improvements to the environment have occured in a number of areas in the home these include: the bathrooms being refurbished, new conservatory windows and roof, a newly fitted kitchen and appliances, the dining room being refurished and decorated, along with the redecoration and new flooring being laid in the lounge, entrance hall, office and stairs. Staffing levels for night time have been reviewed and now include two waking night staff, which promotes the safety and well being of people living in the home. Medication management has improved but further work is required to ensure the safety and well being of people living at the home. What the care home could do better: Systems should be developed so that people`s views on the running of the home are sought and acted upon. Individual fire risk assessments should be completed for people indicating the support they require in the event of a fire. Risk assessments must be in place for staff commencing work on only a Protection of Vulnerable Adults first checks whilst awaiting a Criminal Record Bureau check being obtained. (Since October 2009 the Protection of Vulnerable Adults first check has changed its name to the Independent Safeguarding Authority (ISA) so people employed after this date will be referred to this body prior to commencing work in care homes ) There needs to be a review of the training provided to ensure that staff have the skills and knowledge to meet the needs of people living in the home. Activities need to be reviewed to ensure these are what people living at the home want and need so they can lead a stimulating and fulfilling lifestyle. The dining experience for people living at the home should be reviewed to ensure people are actively encouraged and offered a choose of food and drink. Reasons for the high turnover of staff need to be explored and action taken to reduce this, so that people living at the home have consistency of care delivered to them by staff they are familiar with.Documentation such as care plans and complaints procedures need to be in accessible formats for people living at the home, so they are empowered to direct their care and raise concerns if necessary. Key inspection report Care homes for adults (18-65 years) Name: Address: Conway House 44 George Road Oldbury West Midlands B68 9LH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Thompson     Date: 2 0 1 1 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: Conway House 44 George Road Oldbury West Midlands B68 9LH 01215521882 F/P01215521882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Peter Birks,Mrs Julie Birks care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 8, Physical disability (PD) 8 Date of last inspection Brief description of the care home Conway House is a large bungalow, which was originally built in 1954. It was converted and extended in 1994 to provide residential care for eight people with learning and physical disabilities. The Home is situated on a suburban road, opposite a small row of shops and a nearby public house. Access to the front of the Home is via a small parking area and a concrete ramp. There is a large garden to the side of the property and a sensory room situated to the rear of the house. There are eight single bedrooms, some of which have sliding doors, which lead onto the patio and give a pleasant view of the garden. The decoration and personal belongings reflect the individuality of the people living at the home. There is a lounge area, dining room and Care Homes for Adults (18-65 years) Page 4 of 34 8 8 Over 65 0 0 Brief description of the care home kitchen with a separate laundry. There are two large bathrooms with toilets. One bathroom has a bath with a jacuzzi. There is an in-house day care provision for some service users. The Home provides a range of activities for service users. The current scale of charges for the home range from £1200 to £1900 per week. For up to date fee information the public are advised to contact 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector carried out this inspection visit over two days. We were assisted on the first day by an expert by experience and their supporter. An expert by experience is a person who, because of their shared experience of using the services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The home did not know we were going to visit. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Eight people were living at the home all of whom had a learning disability. We case tracked two peoples care which involves establishing individuals experience of living in the care hoome by meeting or observing them, discussing their care with staff, Care Homes for Adults (18-65 years) Page 6 of 34 looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The manager and assistant manager were on duty during the first day of the inspection. We were assisted on the second day of the inspection by the assistant manager and owner. We spoke to staff on duty on both days of our visit. We looked around some parts of the home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home March 2009. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the Home must tell us about. 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: Systems should be developed so that peoples views on the running of the home are sought and acted upon. Individual fire risk assessments should be completed for people indicating the support they require in the event of a fire. Risk assessments must be in place for staff commencing work on only a Protection of Vulnerable Adults first checks whilst awaiting a Criminal Record Bureau check being obtained. (Since October 2009 the Protection of Vulnerable Adults first check has changed its name to the Independent Safeguarding Authority (ISA) so people employed after this date will be referred to this body prior to commencing work in care homes ) There needs to be a review of the training provided to ensure that staff have the skills and knowledge to meet the needs of people living in the home. Activities need to be reviewed to ensure these are what people living at the home want and need so they can lead a stimulating and fulfilling lifestyle. The dining experience for people living at the home should be reviewed to ensure people are actively encouraged and offered a choose of food and drink. Reasons for the high turnover of staff need to be explored and action taken to reduce this, so that people living at the home have consistency of care delivered to them by staff they are familiar with. Care Homes for Adults (18-65 years) Page 8 of 34 Documentation such as care plans and complaints procedures need to be in accessible formats for people living at the home, so they are empowered to direct their care and raise concerns if necessary. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been no new admissions to the home so we were unable to make a judgement in this area. Evidence: There have been no new admissions to this home since the last key inspection of May 2008. This standard was not assessed as there have been no new admissions to the home. The files of two people living at the home we did look at, however contained needs assessments either completed by the home or the relevant placing authority. The homes own assessment covers all subjects listed in Standard 2.1 of the National Minimum Standards for Younger Adults. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and observation of practice demonstrate that people living in the home are not always actively encouraged to participate fully in making decisions about their care. Evidence: We looked at two care plans. Care plans explain what each persons needs are and the care and support they require to make sure these needs are met. These plans included risk assessments. There were plans for personal care, medication, communication, socialising and other identified needs. Plans included details of strengths and needs, skills promotion, short and long term goals and how these would be achieved, by whom and when. We found some of the plans had not been signed or dated. We found that assessments were not being carried out frequently but only on an annual basis. We spoke to five members of care staff and we also observed people being supported by staff. The staff demonstrated knowledge of peoples individual needs which was Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: consistent with the information on peoples files. We found no written evidence to confirm that people living in the home and or their representatives had been involved in drawing up the care plans. Our previous inspection report made a recommendation that alternative formats for care planning should be explored in order for the individuals wishes to be taken into account. This has not taken place. Our expert by experience observation about the care plans was his file was enormous, and full of information which I could not understand. There was nothing in easy read or pictures. It was extremely evident that this person had no involvement in their care planning.... people should be involved in the care they recieve. The care records did not demonstrate that people are encouraged to make choices or decisions about their daily lives. Staff did say they would offer a choice when choosing clothes of a morning. Our expert by experience observations confirmed that in all instances choice is not being actively promoted. Their report stated: I was interested to talk about residents meetings, but the home does not have them, I could not understand then how people are able to contribute their views or have any control over their lives. This is very disappointing to see and was not at all person centred. As with care planning we found risk assessments to be in place for identified needs but some have not been reviewed to reflect changes. We left an immediate requirement for the home to re assess the use of bedrails. They informed us post inspection that they had re risk assessed everyone using bedrails and had contacted the occupational theraphist to carry out re assessment of there use. Care Homes for Adults (18-65 years) Page 13 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 adequate 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 do not experience a meaningful lifestyle that promotes their independence or reflect their individual choices, needs or personal interests. Evidence: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to five staff members and observed care and support on the days we visited. All of the people who live at this home have differing communication needs. Our expert by experience observed: I asked how people are encouraged to make choices if they were unable to verbally. The manager responded by saying that staff knew the residents well and that they could determine what choices they were making, by eye contact and sounds. This worried me a great deal as people should be included in making all their own choices, and it was evident that there was no reliable system Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: other than a staff members interpretation. .....The manager responded that they had tried various system of supporting people to communicate without words, but failed to provide me with any examples. Later on after speaking to a few of the staff, I learnt that a lot of them had only worked at the home for a few weeks or months and therefore could not possibly know the residents well. We were told that some people living at the home are helped, assisted and encouraged to tidy their bedrooms, so they can maintain and develop life skills and promote their independence. We spoke to staff and examined care records in order to ascertain how peoples social needs and activities are met. Evidence indicated that there are a range of activities undertaken such as visiting the cinema, watching DVDs, visiting shops and the pubic house. Our expert by experience report stated I was interested to learn more about peoples holidays, and how people chose their holidays. The manager said they went to Brean Sands, and had done for years. The residents were divided into 2 groups, the first group went in August and the 2nd group in September. .... There was no evidence to support that the residents had been involved in the planning or deciding the destination. Holidays are an important part of peoples lives and people should choose where they go and more importantly whom they go with. The home has a sensory room. The expert by experience was invited to look at the sensory room. Their observations were: was outside in a converted shed. It was undergoing a re-paint, so I could not picture what it looked like, but I thought it was an odd location, and meant that people would have to go outside to access it, which is not practical in the winter. We spoke to one family member who was visiting the home on the first day of our visit. At present the home has no meetings taking place for people living at the home or their relatives or representatives. We were told that the home had recently had a Halloween/Bonfire night where family members were invited. We were told that people are offered a choice of two main meals at lunch time. There are no pictorial menus in the home but we were told by the management team that people living at the home are shown two meals and were able to chose from either one. We looked at records that indicated that on a significant number of occassions people living at the home were having the same meal. We also looked at individuals food diaries and found these records to contain gaps. Food diaries/records are used to monitor peoples nutritional intake for those identified at nutritional risk and are important. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Our expert by experience was invited to lunch and their observations were: I was invited to lunch and joined everyone in the dining room. There was a choice of 2 meals, which the staff showed people and then encouraged them, to choose. Some residents chose, but one member of staff showed a female resident and said she had never offered her a choice and did not know if she could choose. The resident did indicate her choice, but it was obvious that if I had not been there this lady would have not been given a choice, when clearly she is able to choose. .....people should always be offered a choice. The expert by experience also observed that people living in the home were wearing bibs whilst being fed by staff, they found this upsetting and could not understand the reason for the bib. They questioned whether this was necessary if the staff member was feeding them with sufficient care. They also observed: There was only 1 choice of drink offered so again I observed people had little opportunity to make choices within their own home. As a visitor I was offered more choices. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The sytems in place do not always ensure that peoples health care and dignity needs are properly monitored or maintained which may lead to health care needs not being met. Evidence: There is a mixed group of people living in the home in respect of age, gender and ability. Each has a key worker, who is responsible for ensuring needs are met. Care plans provided some information about the support people required with personal care and they were dressed appropriately for their age, culture, gender and for the weather. Observations made during the inspection confirmed that peoples privacy and dignity is not consistently respected. The expert by experience observed I rang the door bell......there was a resident in the hallway, who I immediately said hello to and introduced myself to and my supporter. A...member of staff cut into my conversation and immediately said that the resident was deaf. Even though ...was deaf, I still felt it important to introduce myself as I was entering ...home . The expert by experience also observed on being shown around the home that the member of staff: knocked Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: on each bedroom door before entering I did not agree with this, as all residents whose rooms ...showed us were out at days services, and therefore had not been asked if we could go in. Peoples bedrooms are private and their personal space should be respected. I would not like anyone going into my bedroom without my permission. Care plans and assessments looked at contained comprehensive guidelines for staff regarding individuals personal preferences about how they are guided, supported, moved and transferred. The home had not implemented the requirement to ensure that personal care delivered during the night by male carers is with consent and agreement of females living in the home. There was no policy or procedure in the home in relation to cross gender care. There was also no policy or procedure for the acceptable boundaries on hugging and kissing, which will be discussed further in concerns, complaints and safeguarding section of the report. Both these policies and procedures need to be in place so that staff have clear guidance on what is expected practice to protect both people living at the home and staff from any mis understanding and that peoples rights are not compromised. As at the previous inspections it was evident that people living at this home have access to a range of specialist community services should they require them. These include general practitioners, opticians, chiropodists, speech and language theraphits and psychologists. Health care plans were seen to be in place for identified needs such as diabetes and epilepsy. Care plans for epilepsy contained maximum timescales that a seizure should last and at what point medical intervention should be sought. Whilst this is an improvement in care planning staff have not received training in management of epilespy. Staff need training in specialist conditions which people have at the home so they are looked after appropriately and not placed at risk of harm. We looked at the arrangements in place for medication management. Not all staff dispensing medication have attended an accredited medication management course. Staff dispensing medication should have this training to ensure they have the skills, knowledge and the home can demonstrate that they are competent to perform this task so as not to place people living at the home at risk. Medication is stored in a separate locked wall-mounted medication cabinet and trolley in the dining room. The Medication Adminstration Record (MARS) looked at was signed indicating medication had been given as required. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. Medication is being adminstered by Percutaneous Endoscopic Gastrostomy (PEG) lines when it has not been licenced to be adminstered via this route. PEG routes are make by an surgerical procedure which are put into the abdomen a line so that some one who is having difficulty swallowing can be receive nutrition via this route. We discussed with the Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: management team how to reduce the risk of complications and risk to people who have medication adminstered by this route. Care plans also need to contain details of how to administer medicines via this route. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for dealing with complaints and safeguarding but urther work is required to ensure the people living at the home are supported to raise concerns and the staff have the knowledge and skills to deal with them. Evidence: A complaints procedure was seen in everyones bedroom. People living at the home do not have the complaints procedure in a format that is accessible to them and so it is not meaningful. The expert by experience report stated that current complaints procedure was worthless. The AQAA sent to us in March 2009 identified the complaints procedure needed to be produced in an individual format appropriate to each individual. The home needs to set a time by which they will have achieved this. The complaints folder contained complaints and compliments. The complaints could be split into two sections: those received by the home and those made by the home to external agencies/services. The complaints folder was disorganised and information was not easy to retrieve. The complaints folder demonstrated that they were being logged and responded to. Following this inspection a safeguarding referral was made, the outcome of this is not known. Since our previous key inspection the Commission has referred two concerns raised with us onto safeguarding to investigate. The home has notified us of the outcome of one of these safeguarding referrals. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Staff we spoke to demonstrated a general understanding of their duty to safeguard people and how to report their concerns to senior managers. We spoke to staff and looked at training records to determine that training in safeguarding vulnerable adults had been provided. It was difficult to ascertain from the training matrix which staff had received safeguarding training. Some staff had received training from their previous employer and not their current employer. Staff spoken to had not received training in Mental Capacity Act or Deprivation of Liberty. The home needs a Code of Conduct policy and procedure for staff so they are aware of what behaviour is deemed acceptable when caring for vulnerable adults. We saw inventories of peoples belongings on their case files. This ensures that peoples personal items are protected. We saw records for management of peoples personal finances. Details of peoples personal expenditure and running balances were seen. We did not examine these in detail but it is recommended that when taxi rides are shared that copies of the receipt are kept on each individuals files. 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. People live in a clean, safe and comfortable home, which promotes their well being. Evidence: The home provides domestic accomodation and care in an ordinary environment. The home looked no different to others in the area and is not distinguishable as a care home. Areas of the home have been refurished and redecorated since the last inspection these include the bathrooms, bedrooms, kitchen, dining room, conservatory, new flooring has been laid in the lounge, entrance hall, stairs and office upstairs. We looked around the home with a member of staff escorting us. Since the last inspection a number of bedrooms have been redecorated. The expert by experience observations were bedrooms were particularly nice. They were well maintained, very personal, colourful and appeared clean. .....In the corner in the corridor I noticed that there were lockers, which belonged to the staff. I did not think these needed to be downstairs, as they looked awful and not something you would find in your own home. I thought they would be better off upstairs in the managers office. ........I was invited into the garden, which was nice, with a spacious lawn, and was very accessible to everyone that lived there. I was told that the residents grow their own vegetables and have all planted the garden themselves. This was great to hear as people should be Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: able to tend to their own gardens. The home has two bathrooms, both of which are located near to peoples bedrooms. One has an assisted bath and the other a spa bath. The bathrooms have been refurbished and decorated since the last inspection. All areas of the home were clean and hygienic indicating good cleaning routines. There is a separate laundry room, which was clean and organised. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not receiving a good range of training, so people are supported appropriatley. The recruitment procedure is not robust and places people at risk of harm. Evidence: The AQAA received stated that 80 percent of staff had a National Vocational Qualification (NVQ) level 2 or above in care. We looked at the training matrix and it was colour coded in relation to dates of training. Not all staff have received mandatory training such as manual handling and food hygiene which is vital to their current role. Some staff had received mandatory and specialist training from their previous employer and there had been no update or refresher in these subjects by the home. Further work needs to be undertaken with regard to specialist training which is vital to meeting the needs of people living at the home and these include; communication, diabetes, continence management, epilepsy, LDF (Learning Disability Framework) and person centred approaches to care and support to ensure staff have the sufficient knowledge to support people living in the home. At our previous inspection this was identified as an issue and it is concerning that this remains outstanding. We spoke to five members of staff during this visit who were all enthusiastic about their work and keen to learn and develop their skills. Staff told us they had an Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: induction course to the work place when they first started. We were shown a blank format of the current induction package. The induction package does not cover the Common Inductin Standards as recommended by Skills for Care. The current induction and training package for staff is poor and does not provided them with the skills and competences to enable them to undertake their roles confidently. We were informed that fifteen members of staff have left the home in the past twelve months. For a small home this is a high turnover of staff and will ultimately impact on the care of people living at the home, who need consistency in the care provided. On the second day of our inspection visit the management team were in the process of recruiting new staff. We viewed staff rotas and these show that between four and five staff are on duty during the day. One carer however is allocated to provide one to one care for one of the people living at the home between the hours of 7am and 10am and 5pm and 10pm. Staff also have cleaning and cooking duties. We were informed that the manager does provide care to people living in the home if staffing numbers drop however this is not indicated on the rota. The current staffing arrangements on certain days restrict peoples opportunities. The staffing arrangements must be kept under review so that there are adequate staff on duty at all times to meet peoples assessed needs. At night there are two members of staff on duty. We could see from the rota that the registered manager was available five days a week between 9 am and 5pm. We meet the assistant manager on both days of the inspection but they are not identified on the rota. The rotas stated two members of staff were on duty for the night shift. We looked at staff recruitment records for four staff members. Of those files seen all of them contained an application form and suitable references. Staff were commencing employment at the home with references and Protection of Vulnerable Adults checks (POVA firsts) whilst awaiting the full Criminal Records Bureau check (CRB). The Protection of Vulneralbe Adults since October 2009 has changed its name to Independent Safeguarding Authority (ISA). Staff who commence work whilst awaiting a full CRB should have a practical risk assessment completed that demonstrates the person working in the home was not left to on their own with anyone living at the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being run in order to meet the best interests of people living in the home. Evidence: The Registered Manager has many years experience of working in the care home sector and has completed the Registered Managers award. Prior to the inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were brief in parts and gave minimal information about the service provided to people living at the home. We have highlighted earlier in the report that some work is required in relation to risk assessments so that people are supported and safe. We were told by the provider that the Quality Assurance system consisted of the owner visiting on a regularly basis and carrying out regulation 26 visits, monitoring complaints and talking to staff. The quality assurance system would benefit from being Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: developed further to include meetings with people living at the home and their representatives, audits of practice within the home. The Mental Capacity Act 2005 and the deprivation of libery safeguards are poorly understood. There are no clear policies and procedures in place for staff to follow. Staff do not know about the Mental Capacity Act and the deprviation of liberty safeguards. The recruitment practices do no adequately protect peopel living in the home. Staff do not have sufficient or recent training to provide them with the skills, knowledge and competences to meet all of the needs of people living in the home. The home has had an external organisation carry out a health and safety audit. Servicing of hoists had taken place in April 2009 demonstrating that equipment was being checked regularly to comply with current legislation. It is recommended that fire risk assessments are completed for each person living in the home and should include any specific requirements such as hearing, vision or mobility difficulties that may impact on individuals responding to the fire alarm. Staff spoken to and records confirmed that training in, fire safety, manual handling, health and safety, first aid and food hygiene was not happening for all staff. This does not ensure a safe environment is provided for people living at the home. 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 9 13 Bedrails risk assessments need to be carried out for peopel living in the home to assess establish whether they are needed and appropriate for that individual. This will ensure that peoples rights and risks are managed appropriately. 23/11/2009 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 12 Where bedrails are fitted and used there must be risk assessments that determines that this is the best option and ensrue that they are fitted, covered and maintained. This is to make sure everyone is kept safe. 29/01/2010 2 19 12 Staff should receive training in care of people with epilespy. This is to ensure that staff have skills and competencies to meet the 29/01/2010 Care Homes for Adults (18-65 years) Page 29 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 needs of someone with epilespy. 3 20 13 Staff dispensing medication must undertake an accredited training course for the administration of medication. To ensure they have the skills and competences to dispense medication safely. 4 33 17 The duty rota should be a record of all people working at the home. This will ensure records can demonstrate who was available in the home to deliver care. 5 34 19 The manager must ensure that a practical risk assessment is carried whilst awaiting a full Criminal Records Bureau check to ascertain and minimise any risk. To protect people living at the home from risk of harm. 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 29/01/2010 29/01/2010 29/01/2010 1 6 The evaluation process should be reviewed to provide an overview of events and the effectiveness of the current Page 30 of 34 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 care arrangements in place. . 2 6 To produce care plans in suitable formats in order that individual care be involved in decisions relating to their care. To ensure care plans are signed and dated in order to monitor who completed and when last reviewed. To under take formal reviews of care plans at least six monthly in order that any changes in needs are identified and met. (Recommendation first made May 2008) 3 9 Risk assessments should be reviewed as and when changes occur to ensure any risks to people living at the home are appropriately managed. (Recommendation first made May 2008) 4 11 Systems need to be explored to activity supported and promote people living in the home with chose in areas such as meals and activities Arrangements should be in place to review and evaluate activities so people are supported to do things they like and enjoy. People living at the home and or their representatives should be invited to attend house meetings so that their views about the running of home are sort. A policy and procedure should be in place for cross gender care so that people living in the home are supported by staff in a manner appropriate to their needs and wishes. The home should with obtain the NEWT Guidelines ISBN 0-9552515-0-8 or ISBN 978-0-9552515-0-4 or contact the drug manufactures medical information department and ascertain what medications can be administered via PEG routes. The home complaints procedure should be reviewed to ensure that it is in an appropriate formate for people living at the home. This will ensure that they have the information to make a complaint. The home should ensure all staff have Code of Conduct Page 31 of 34 5 14 6 16 7 18 8 20 9 22 10 23 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 guidance given to them so they are aware of what is expected of them in regards to them looking after vulnerable adults. 11 23 That staff undertake safeguarding training every three years to ensure their knowledge is kept up to date with any changes in legislation. (Recommendation first made May 2008) 12 23 It is recommended that the home obtain a copy of the Department of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training, so that staff are aware of their responsibilities and peoples rights are protected. The home should ensure that money held for individuals contains a copy of the receipt for all money spent on their behalf. The staff lockers are moved away from the main living area. Staff should received communication, diabetes, continence management, epilepsy, LDQ and person centred approaches to care training, to ensure they have sufficient knowledge to support people living at the home. # (Recommendation first made May 2008) 16 33 The home should carry out exit interviews of those staff leaving the home to ascertain why there is a high turnover of staff and take appropriate action to reduce the high number of staff leaving the home. This will ensure that people living at the home receive care from staff who know their needs well. Staff should receive an induction that enables them to under take their roles confidently. (Recommendation first made May 2008) 18 39 It is recommended that the quality assurance system be developed further, so that continuous improvement can be achieved. It is recommended that individual risk assessments be undertaken for people living at the home to ensure their safety in the event of a fire. Page 32 of 34 13 23 14 15 24 32 17 35 19 42 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 20 42 All staff working at the home should receive training in health and safety, fire, manual handling, first aid and food hygiene. 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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