Care Home: Denmark House

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What the care home does well People have access to a range of activities which they like and enjoy. One person said they do work experience and others like going to college. One person said they go to the pool for a swim regularly.Activities are provided at home such as aromatherapy, music sessions and access to a sensory room. One person said they liked `to chill out` in the sensory room. Each person has a room, some with en suite facilities which they decorate and personalise to reflect their interests and lifestyles. Staff have access to NVQ Awards and new staff complete the Learning Disability Qualification during their induction. What has improved since the last inspection? Two requirements were issued and both have been put in place.A full employment history was being requested for most of the new staff appointed.We have been informed about incidents affecting people`s well being. What the care home could do better: Each person must have a current assessment of needs and care plans must reflect their changing needs. A person centred approach should be put in place to enable people to express their wishes and aspirations.Any restrictions or limitations to freedom or choice must be recorded with the reason for these identified.Where `as necessary` medication is used, protocols and guidance must be in place.A quality assurance report must be produced to provide people with information about how their views shape improvements in the service.A manager must be registered with us. Key inspection report Care homes for adults (18-65 years) Name: Address: Denmark House 36 Denmark Road Gloucester Gloucestershire GL1 3JQ 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: Lynne Bennett Date: 1 5 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 37 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 37 Information about the care home Name of care home: Address: Denmark House 36 Denmark Road Gloucester Gloucestershire GL1 3JQ 01452383888 01452383888 nickyshaw@cathedralcarehomes.org.uk www.carehomes.co.uk Cathedral Care (Gloucestershire) Limited care home 9 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 9 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 9 The registered person may provide the following category of service only: Care home only - code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection 2 7 1 1 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home 36 Denmark House is a detached Victorian house within walking distance of Gloucester city centre. The home is owned by Cathedral Care (Gloucestershire) Ltd. The home provides accommodation for nine people with a learning disability who may also challenge the service. Some people have autistic spectrum disorders. All people living at the home have single rooms, some with en suite facilities. There are spacious communal areas, and large gardens to the rear of the house. The home has a car and a people carrier at its disposal. The Statement of Purpose had been reviewed and was not Care Homes for Adults (18-65 years) Page 5 of 37 accessible, copies are available upon request. Fees for the home range from 990 pounds and upwards per week. An additional charge is made for use of the homes vehicle. Care Homes for Adults (18-65 years) Page 6 of 37 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 Care Homes for Adults (18-65 years) Page 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home This inspection took place in October 2009 and involved two visits to the service by one inspector. The acting manager (who is the registered manager of the home next door) and deputy manager were present throughout. Surveys were returned to us prior to the inspection from people living in the home and staff. We spoke to visitors to the service. We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these 3 people. This is called case tracking. We also spent time observing interactions between staff and other people living in the home and observed people in their daily routines. We spoke to staff about the service they provide. Care Homes for Adults (18-65 years) Page 8 of 37 We examined a range of records including staff files, training records, quality assurance documents and health and safety systems. What the care home does well People have access to a range of activities which they like and enjoy. One person said they do work experience and others like going to college. One person said they go to the pool for a swim regularly. Care Homes for Adults (18-65 years) Page 9 of 37 Activities are provided at home such as aromatherapy, music sessions and access to a sensory room. One person said they liked to chill out in the sensory room. Each person has a room, some with en suite facilities which they decorate and personalise to reflect their interests and lifestyles. Staff have access to NVQ Awards and new staff complete the Learning Disability Qualification during their induction. What has got better from the last inspection Two requirements were issued and both have been put in place. Care Homes for Adults (18-65 years) Page 10 of 37 A full employment history was being requested for most of the new staff appointed. We have been informed about incidents affecting peoples well being. What the care home could do better Each person must have a current assessment of needs and care plans must reflect their changing needs. A person centred approach should be put in place to enable people to express their wishes and aspirations. Care Homes for Adults (18-65 years) Page 11 of 37 Any restrictions or limitations to freedom or choice must be recorded with the reason for these identified. Where as necessary medication is used, protocols and guidance must be in place. A quality assurance report must be produced to provide people with information about how their views shape improvements in the service. A manager must be registered with us. Care Homes for Adults (18-65 years) Page 12 of 37 If you want to read the full report of our inspection please ask the person in charge of the care home. If you want to speak to the inspector please contact Lynne Bennett CQC South West Citygate, Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 Enquiries.southwest@cqc.org.uk 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 set out 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 13 of 37 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 14 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide need to be accessible to people so that they can acquire information about the service they will receive. Satisfactory admission arrangements are in place that include an assessment of peoples needs. Ongoing reassessment of people will ensure that the service is continuing to meet their changing needs. Evidence: A copy of the current Statement of Purpose could not be found during our visits. The acting manager confirmed that it had recently been reviewed and amended to reflect changes to the service. A copy of the Statement of Purpose must be displayed in the home. The acting manager confirmed that she would be giving a copy to each person. She stated that the Service User Guide had been changed to include information about a contribution from each person towards the costs of transport. Each person had a copy of their terms and conditions in place, although their personal details had not been completed. The home had two vacancies at the time of our visits. They had not had any new admissions since our last inspection. The homes admission policy and procedure includes Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: completing an assessment of need and obtaining a current assessment and care plan from the placing authority. Care Homes for Adults (18-65 years) Page 16 of 37 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. Greater consistency in care planning will ensure that the assessed and changing needs of people are recorded and they are safeguarded from possible harm. A person centred approach to care planning will make sure that people are involved in developing their care plans that reflect their aspirations and needs. Evidence: We case tracked three people living in the home, two of whom had changing needs and another person who needed specialist support. Each person had a care plan in place which had been developed from an assessment of needs. Some of the assessments were considerably out of date - 2003 and 2005. One person had a copy of the most recent assessment of need and care plan supplied by their placing authority this year. Another person did not have this information but there was evidence of regular reviews during 2009 with a multi disciplinary team to support them through life changes. For another person the last review records were for 2003 but the management team stated that a review including representation from the placing authority had been arranged for the following week. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: Each person had a copy of a document titled, Main Care Objectives 2009. This document had not been personalised to each individuals particular needs and provided a statement of what the service would provide. The quality of care plans was inconsistent. One person who had considerable information on their file about having received a diagnosis of early onset dementia had no care plans which referred to this condition or the support they would be receiving. Another person who had been involved in a Deprivation of Liberty assessment and authorisation had risk assessments which described what had been put in place as a result but care plans had not been amended to reflect this. Staff were observed following conditions listed in this authorisation, such as moving the persons position. There was evidence of regular meetings to monitor this person in relation to the authorisation and their changing needs. A best interests meeting was held during our visits. Care plans provided some information about peoples personal care needs, communication and eating and drinking support as well as activities and mobility. The deputy manager stated that she would be introducing a person centred approach to care planning and shared with us the format which would be followed. This would provide a more holistic approach ensuring that peoples physical, emotional, social and intellectual needs are met. Key workers were producing a monthly review of each person which contained an overview of what had happened during the previous month including appointments, incidents, outcomes for them, concerns and a summary of their needs. This was an excellent document. Daily records were also being kept and we sampled these for two weeks in September. There was some cross referencing to other records such as incident records which is good practice. Monitoring records were also being used. There were a significant number of daily records being used which could be confusing to the reader. The deputy manager had already identified this and was producing a new format for files to simplify the homes current record management systems. Communication care plans indicated how people would like to be supported and whether they used verbal expression, sign language or a total communication approach. One person had been referred to a Speech and Language Therapist and Psychiatrist due to their changing needs and concerns about how to support them when anxious or upset. It was recommended that the staff use photographs as a memory prompt for example which staff would be on duty. Staff spoken with said this had not yet been developed for this person but they had used this system with another person in the past. They said they had put photographs of the persons family in a memory box and were developing a Life Book containing historical information important to the person. The use of restrictions and restraints was recorded for some people such as the use of a lap belt and access to a wardrobe but records providing the rationale for the use of a listening device and a key pad on the kitchen door were not seen. Records must be in place for any restrictions or restraints to peoples freedoms or ability to make choices with evidence provided of the rationale for these. Where necessary these should be done in a multi disciplinary forum. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: A range of risk assessments were in place most of which had been reviewed. It was evident that where there were changes or incidents had occurred risk assessments had been reviewed and amended to reflect this. A missing persons policy and procedure was in place and there was a proforma on each persons file with a copy of a current photograph. Care Homes for Adults (18-65 years) Page 19 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of leisure interests which reflect their lifestyle choices. People are offered a varied and balanced diet appropriate to their needs, promoting their health and wellbeing. Evidence: Each person had an activity schedule in place describing the range of social, recreational and leisure activities which were planned for them each week. In addition to this they had an activities record of what they had actually completed which confirmed that for the two weeks sampled most people had followed these schedules. The deputy manager was in the process of introducing an activity session plan describing the activity, the rationale for it and any other information staff would need to ensure continuity. Alongside this she was introducing an activity record to be completed by staff indicating whether people had chosen to do the activity and their participation. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: People told us they liked going to social clubs to meet with friends, to do work experience at a nurseries (gardening and artwork) and to go to the pub. Another person said they were looking forward to going swimming and had enjoyed a massage by an external therapist during our visit. People were observed choosing what to do during our visits, whether going to buy a newspaper, going for a drive, doing puzzles or games. People said they went to college and a variety of day centres. Daily records indicated people were supported to go to church regularly. Care plans for some people indicated their chosen spiritual or religious beliefs but this had not been identified for everyone. Surveys indicated that clients have structure and base where they can do various activities from, and the activity programme is very good. Surveys also indicated that people have their own independence. During our visits we spent time in the dining room observing people and also having lunch with them. Some people helped themselves to drinks and breakfast. One person helped prepare the lunch and set the tables. Daily records indicated that people had regular contact with family and friends. People were supported to visit family or have visitors to the home. Various compliments were noted on file from parents saying how happy they were with the home and the service being provided. Staff were observed preparing an evening meal and lunch both were prepared using fresh ingredients. Fresh vegetables, salad and fruit were available. A dietician had been consulted about the nutrition of some people and this information was accessible to staff. One person was observed being supported with their meal, following guidelines in their care plan. This was done at their pace and with patience and sensitivity. Menus were displayed in the kitchen and daily records indicated whether people had a main meal. Staff said alternatives would be provided and they were heard discussing with one person an alternative choice to the lunch menu. This would be noted on daily records. Additional records including a food diary were being kept for people for whom there were concerns about their diet. We joined people for lunch and meals were delivered by staff fully plated to the table. This included salad cream which had been added to the salad. People were also poured a drink and the jug was removed to the kitchen. This is institutionalised practice and the home should consider putting drinks, condiments and putting vegetables or salads in serving dishes so that people can help themselves. Care Homes for Adults (18-65 years) Page 21 of 37 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. Peoples health and wellbeing are being met helping them to stay well. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. Evidence: There was evidence that peoples likes and dislikes had been identified and were being respected by staff. Each person also had a care plan indicating how they wished to be supported with their personal and health care needs. Plans were quite basic and did not provide a great deal of information about each individuals preferences such as whether they wished to be supported by male or female carers. Surveys stated, they (people) are treated with respect and dignity. During our visits staff were observed supporting people sensitively and discreetly. Robust records were in place detailing peoples appointments with a range of health care professionals including their General Practitioner (GP), Dentist, Optician and outpatient appointments. Each appointment was recorded in a spreadsheet providing easy access to information which was supported by individual records of each appointment with a summary of the outcome and any changes in their circumstances. There was also evidence of close working with the local Community Learning Disability Team (CLDT) and staff spoke about the support provided to them. It appeared that recommendations from Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: CLDT were being implemented by staff team. Surveys stated, the home liaises with key professionals fro advice and support. Health Action Plans were being put in place for people. Part of this document was already in use when people were being admitted to hospital. The deputy manager was in the process of completing the full document for people. The local surgery had contacted the home to make appointments for annual health checks. The needs of two people being case tracked were changing due to age and it was evident that the home were working closely with a range of health care professionals to make sure that they were receiving the appropriate support from staff during this difficult time. Records as mentioned need to reflect these changes. Staff were being provided with training in Dementia and BiPolar Disorder from the CLDT. Staff confirmed that they had completed training in the safe handling of medication and that they also had access to an open learning pack. Some staff had completed this training some time ago and needed refresher training. The home did not have any systems in place to audit the competency of experienced staff. They had systems in place to shadow staff who were going through their medication training and we examined a record confirming this observation. The acting manager said that the home had a copy of the most recent British National Formula although we could not find this copy during our visit. Systems for administering medication were mostly satisfactory. Most handwritten entries had been countersigned and the medication administration record confirmed that a stock control system was in place. A bound book was being used to monitor the stock levels of as necessary medication. A number of liquids and creams had not been labelled with the date of opening. Some homely remedies were being used for which there was no evidence of authorisation from the GP or Pharmacist. The use of homely remedies had been approved for one person by their GP. A protocol was in place for the use of one as necessary medication but was not in place for another. The acting manager said this latter medication was now being given regularly and was no longer an as necessary medication. However she must make sure that where people are being given as necessary medication clear guidelines are in place describing the rationale for their use and the maximum dose which can be given. Care Homes for Adults (18-65 years) Page 23 of 37 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. Systems are in place to enable people to express their concerns and they are confident that they will be listened to. People are safeguarded from possible harm or abuse. Evidence: The home has a complaints system in place and a copy of the complaints procedure was displayed in the entrance hall. Each person also had a copy in their personal files. (These need to be amended to reflect our new contact details.) The deputy manager said that she would be producing the complaints procedure in a more accessible format using symbols or pictures. People indicated in their surveys that they were confident in the complaints procedure and if they had any concerns they would talk to staff. Staff surveys said, they (people living in the home) can talk to any member of staff about anything, at any time, because there is a good procedure in place for that. A complaints and compliments file was in place. We had received two complaints about the home which we had asked them to investigate. They supplied us with a satisfactory outcome to each complaint. Copies of these complaints were not in their file. There were copies of compliments from parents. One parent had also written to the local newspaper who printed their letter expressing their appreciation of the home. Most staff had completed training in the safeguarding of adults and a Regulation 26 report confirmed that refresher training was being arranged with the local County Council. Those spoken with were confident that the management would challenge poor practice and would take the necessary action. Staff had completed training in MORE (Management of Response to Emotion) although the acting manager thought that they Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: would be accessing training from another provider. Refresher training was due for some staff. A protocol was in place for one person identifying triggers and distractors. It stated that physical intervention as per Studio 111 training should be followed rather than referring to MORE. Incident records were being kept for some people and they indicated a decline in the number of episodes of anxiety or aggression. These were being monitored by the CLDT. As mentioned there were a number of restrictions and limitations to freedoms which need to be recorded with the rationale for these identified. The management team had worked closely with other professionals to apply for and obtain a Standard Authorisation for a Deprivation of Liberty (DOLS). This was being reviewed and monitored by all concerned and was put in place in the best interests of the person to safeguard them from potential harm. Financial records were examined for the people being case tracked. A new proforma had been put in place providing evidence that regular checks were taking place. Expenditure could be cross referenced with receipts. Each person had a bank account which they were able to access and for which monthly accounts were produced. The deputy manager confirmed that spot checks were in place to monitor peoples personal finances and that an independent accountant also audited peoples accounts. Finances for three people were managed by their placing authority. Care Homes for Adults (18-65 years) Page 25 of 37 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. Planned improvements to the home will make sure that people live in a home which is pleasantly decorated and comfortable. Evidence: At the time of our visits the communal areas were in need of attention. The Responsible Individual and the management team stated there were plans to address this shortly after our inspection. A colour scheme had been chosen for redecoration of the dining room, lounge and hallway. New fixtures and fittings were being bought. In addition to this some carpets in communal areas had been replaced since our last inspection and there were plans to replace others. Day to day repairs were being identified and logged. There was evidence that these were being dealt with in a timely fashion. People had an inventory for their personal possessions and fixtures and fittings. Their rooms reflected their interests and lifestyles, some had en suites. They had access to a sensory room and a sun house both of which were being redecorated. The gardens to the rear of the home were well kept. The laundry was small and compact and tidy at the time of our visits. Laundry baskets were used for each persons individual clothing. Infection control measures were observed to be in place. Hazardous products were kept securely. Liquid soap and paper towels were supplied in communal toilets and hand wash basins. Care Homes for Adults (18-65 years) Page 26 of 37 Care Homes for Adults (18-65 years) Page 27 of 37 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. Peoples needs are met by a competent staff team, who have access to a mainly satisfactory training programme that needs to ensure staff knowledge is kept up to date. Recruitment and selection procedures should safeguard people from possible harm. Evidence: A number of staff had recently left the home for which interviews were being held during our visits. Staff said that they were covering any spare shifts and although there may be occasional shortages, management often covered these shifts. A survey indicated that at times there are shortages of staff and people said that occasionally activities might be cancelled because there were not enough staff. The weeks we sampled indicated that there were at least 3 staff on shift sometimes rising to 4. The current rota also indicated at least 3 staff were being scheduled to work each shift. The acting manager was aware that if staffing levels fell below 3 this was notifiable to us under Regulation 37. Surveys also indicated that as peoples needs were changing so did the level of support they required. The acting manager said that she was re-negotiating a contract for one person with their placing authority. The acting manager said that new staff were being registered to start a National Vocational Qualification (NVQ) in Health and Social Care. They had a visit from their assessor during one of our visits. New staff were also completing an induction at the home followed by the Learning Disability Qualification (LDQ). Copies of certificates were Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: on their files. The training matrix for the home indicated that over 50 per cent of the staff team had a NVQ. Since the last inspection three staff had been appointed. Their files indicated that each had completed an application form and where there were gaps in employment history these had been explored with one person and evidence provided to give a full employment history. For another person gaps had not been explored. The acting manager thought that this information had been obtained at interview but had not been evidenced. She stated that she had clarified gaps in employment history at interviews held during our visits. A list of dates and employment details were seen. New staff were being appointed after a satisfactory Criminal Records Bureau (CRB) check had been obtained as well as two references. Copies of CRBs were being kept on peoples files. The acting manager was advised that to comply with Data Protection recommendations these need to be kept separately. People living in the home were not being involved in the interview process although the deputy manager said she wanted to explore how people could be involved. Proof of identity and a current photograph were on each file. A training matrix was in place although it needed updating to reflect changes to the staff team. Individual training profiles were being put in place for each member of staff. Copies of certificates were being kept on this file. Regulation 26 reports indicated that monitoring of training needs was taking place. The acting manager confirmed that open learning packs had been purchased for staff to complete some mandatory training refreshers as well as specialist courses in areas such as Dementia. She had also researched a range of external training providers and was beginning to access training through them. Some training was also being provided for staff by the CLDT. Training in the protection of adults was being booked, as confirmed by notes in the Regulation 26 reports. Staff should also have an understanding about the Mental Capacity Act and DOLS. Care Homes for Adults (18-65 years) Page 29 of 37 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. The service will benefit from having a period of consistent management providing leadership and direction to the staff team which should promote improved better outcomes for people living in the home. People need to be informed about the outcome of the quality assurance system so they can see how their views shape the service. Health and safety systems should protect people from possible harm. Evidence: The home currently does not have a registered manager. The registered manager of Denmark Lodge which is next door has been overseeing the home since January this year. A deputy manager had been appointed with a view to becoming the manager of the home. She has considerable experience in the field of learning disability and has a DIPSW (Diploma in Social Work). She has registered for the Leadership and Management for Care Services Award. Since becoming the deputy manager she had identified a number of areas for improvement and had started to look at records management. She was planning to introduce a more person centred approach to care and had developed an action plan to improve other systems within the home. Management had received training in the Mental Capacity Act and Deprivation of Liberty Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: Safeguards and there was information for this in the home. As mentioned there was evidence the necessary assessments and records were being completed by the home in respect of the Deprivation of Liberty Safeguards (DOLS). At the time of our inspection one person living at the home was subject to a DOLS standard authorisation. There was evidence that the Regulation 26 visits to the home required by us were taking place each month. Records of these visits were in place for January to September this year. People living in the home were part of this process. People had taken part in a survey this year responding to set questions about the service they receive. A number of individual audits were in place monitoring finances and medication. An external contractor had also conducted a health and safety audit providing some recommendations which were being implemented. The management team need to draw together this information to produce a report and action plan to provide people with evidence of the improvements planned for the home. Health and safety systems were in place making sure that records were maintained at appropriate intervals for fridges, freezers, hot food temperatures and water outlets around the home. Food in fridges was labelled with the date of opening or production. Fire records indicated that regular checks and testing were in place for fire equipment and that drills were taking place. The deputy manager confirmed that night time fire checks would be planned. A new format had been provided by an external contractor for the fire risk assessment to replace the present version due for revision in 2011. The management team confirmed this would be completed as soon as possible. Portable appliance testing had been completed and servicing of other equipment and utilities was in place. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 37 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 Description 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 Description Timescale for action 1 1 4 The registered person must 30/11/2009 make sure that a copy of the Statement of Purpose is accessible to people who might require a copy. This is so that people can have access to information about the service they are to receive. 2 6 15 The registered person must ensure that care plans are kept up to date and reflect peoples current needs. 30/11/2009 This is so that peoples changing needs can be met. 3 7 17 The registered person must 30/11/2009 make sure that any restrictions or limitations to choice or freedom are agreed with people and recorded. Care Homes for Adults (18-65 years) Page 33 of 37 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 Description Timescale for action This is to safeguard people from possible harm or abuse. 4 20 13 The registered person must 19/11/2009 make sure that where as necessary medication is used, there is clear guidance in place about its use. This is to safeguard people from possible harm. 5 37 8 The registered person must 26/02/2010 appoint a manager to run the home who must become registered with us. This is to make sure the home is managed by a person assessed by us as competent and fit to do so. 6 39 24 The registered person must produce a quality assurance report summarising the quality assurance system which is in place. 30/11/2009 This is to make sure people living in the home have access to information about planned improvements. 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. Care Homes for Adults (18-65 years) Page 34 of 37 No Refer to Standard Good Practice Recommendations 1 2 3 5 6 7 Terms and conditions should be completed with personal details. Assessment of each persons needs should be reviewed at least annually. The use of photographs should be implemented as an aide memoir for a person who has dementia - to include for instance photographs of staff, other people in the home, activities and meals. There should be a record of peoples chosen spiritual or religious beliefs. Promote peoples independence by putting drink, condiments and vegetables or salad in bowls so that people can help themselves. Personal care plans should indicate peoples preferences for the gender of care staff supporting them with their personal care needs. Liquids and creams should be labelled with the date of opening. The use of homely remedies should be authorised by the GP or Pharmacist. The British National Formula should be accessible in the home. Refresher training in the administration of medication should be provided for experienced staff. Competency audits should also be in place. The complaints procedure should have our new contact details. Copies of complaints and their outcomes should be kept on the complaints folder. Staff should have access to refresher training in the management of challenging behaviour and use of physical intervention. Protocols describing how to support people when they are challenging the service should reflect the training provided to staff eg MORE. Staff should have an understanding about the Mental Capacity Act and DOLS. The training matrix should be updated. Page 35 of 37 4 5 11 17 6 18 7 8 9 10 19 19 19 19 11 12 13 22 22 23 14 23 15 16 35 35 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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