Care Home: Dramsdon

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What the care home does well Clear admission policies and procedures are in place. People are protected through the risk assessment process. People are encouraged to make decisions and are part of the local community. People are supported to maintain important relationships. People are offered a good variety of home cooked food. People have access to a range of health care personnel in order to meet their health care needs. People have access to information such as the complaint procedure, within a `user friendly` format. People`s bedrooms are personalised and reflect their interests and personalities. The recruitment procedure ensures that all prospective members of staff are suitable to work with vulnerable people. Fire safety and accident monitoring are of a good standard. What has improved since the last inspection? Measures have been taken to stop an incident of institutional abuse. Staff have received training in adult protection and the Deprivation of Liberty Safeguards. The kitchen has been refurbished. Staff have received training in the safe handling of medicines and their competency to administer medicines safely has been assessed. What the care home could do better: A review of people`s support plans must be undertaken to ensure that they fully reflect the individual`s needs. Consideration should be given as to how support plans could be made more person centred. All out of date information should be archived. Epilepsy management plans should be in place for those people who have epilepsy. People should have a health action plan and protocols should be in place to manage conditions such as constipation. Staff must ensure that they sign the medicine administration record when they have administered medicines to people. Staff should ensure that they countersign any handwritten medicine administration instructions in order to minimise the risk of error. All staff must undertake up to date training in mandatory topics such as first aid, manual handling and epilepsy awareness. Key inspection report Care homes for adults (18-65 years) Name: Address: Dramsdon Rivar Road Shalbourne Marlborough Wiltshire SN8 3QE     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: Alison Duffy     Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Dramsdon Rivar Road Shalbourne Marlborough Wiltshire SN8 3QE 01672870565 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): White Horse Care Trust Name of registered manager (if applicable) Mrs Christine Mary Ann Messenger Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care use on admssion to the home are within the following category: Learning disability- Code LD Date of last inspection Brief description of the care home Dramsdon provides care and single room accommodation for five people under the age of 65 who have a learning disability. The service is one of a number of services, run by the White Horse Care Trust. The registered manager is Ms Christine Messenger. Dramsdon is a spacious bungalow set in secluded gardens. It is located in a small village on the Wiltshire/Berkshire border. Within the village there is a public house and Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 5 Brief description of the care home a shop. Staffing levels are generally maintained at two or three support staff on duty during the waking day when people are at home. At night, a member of staff provides sleeping in provision. There is an additional on call management system in place at all times. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place on the 21st April 2010 between 9.40am and 4.50pm. On arrival at the service, there was one staff member on duty. Another staff member later returned from supporting a person with a leisure activity. The registered manager was not on duty. Staff members assisted us with the information we required. We spoke with the registered manager on the telephone after the inspection to give feedback on our findings. Before visiting the service, we sent the registered manager an Annual Quality Assurance Assessment (known as the AQAA). This was the services own assessment of how they were performing. It told us about what had happened during the last year and about their plans for the future. During our visit, we toured the accommodation and met with people who use the service. We spoke to staff members on duty and observed how they interacted with people. We saw people having lunch. We looked at care-planning information and staff training records. We also looked at documentation in relation to health and safety. Care Homes for Adults (18-65 years) Page 6 of 36 The last inspection of this service took place on the 28th June 2007. All key standards were assessed on this inspection. Observation, discussions and viewing of documentation gave evidence, which showed whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: A review of peoples support plans must be undertaken to ensure that they fully reflect the individuals needs. Consideration should be given as to how support plans could be made more person centred. All out of date information should be archived. Epilepsy management plans should be in place for those people who have epilepsy. People should have a health action plan and protocols should be in place to manage conditions such as constipation. Care Homes for Adults (18-65 years) Page 8 of 36 Staff must ensure that they sign the medicine administration record when they have administered medicines to people. Staff should ensure that they countersign any handwritten medicine administration instructions in order to minimise the risk of error. All staff must undertake up to date training in mandatory topics such as first aid, manual handling and epilepsy awareness. 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 36 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 36 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. A clear admission process enables people to be assured that their needs will be met within the home. Evidence: People had lived at the service for many years. There was one vacancy at the time of our visit. Staff told us that they were not aware of any recent referrals to the service. They said an assessment of a prospective person would be undertaken to ensure that their needs could be met within the home. Staff said that management would ensure that the person was compatible with the other people using the service. They said there would be a clear transition plan in place to help the person get used to the home. Following our site visit, Ms Messenger told us that the organisation had clear admission policies and procedures in place. She said that these would be adhered to in the event of a new person being referred to the service. Ms Messenger said that as part of the assessment process, information would be gained from the persons care manager, their family and any other involved social/health care professionals. The Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: person would be encouraged to visit the service and stay for a meal or over night. This would give the person more information about whether the home was suitable for them. In relation to what the service did well, the AQAA stated we have a generic service users guide in place, which describes the home and facilities on offer for possible new clients. Pre arranged visits to the home, and the trust has an admission policy. Individuals have their own contracts. The AQAA stated that implementing the service user guide in a user friendly format was something that would be improved upon over the next twelve months. The admission criterion was clearly stated within the Statement of Purpose. Care Homes for Adults (18-65 years) Page 12 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To ensure their needs are met, people would benefit from more person centred, up to date information within their support plans. People are encouraged to make decisions about their every day lives. People are safeguarded through the risk management systems in place. Evidence: The AQAA stated we provide care and support based on person centered philosophy of care. Care planning, person centered plans, risk assessments, health action plans, staff training on PCP [person centred planning] and making it real, were things the AQAA stated the home did well. We looked at the support plans of two people who used the service. We saw that the plans varied in content. Ms Messenger told us that she had started reviewing all information so some plans were more up to date and relevant than others. Ms Messenger told us that she was aware that the plans would benefit from being more person centred. We saw that the first page of one support plan gave information about Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: inappropriate attention seeking behaviour. We said this should be reviewed, as it portrayed negativity and labelled the person. It was not clear whether some information within the support plans remained relevant. For example, there were guidelines in place in relation to the support a person needed at mealtimes. The guidelines were dated 2008. We saw that the person would refuse food and drink when they were not well. The information stated that staff needed to be very insistent with the person at these times. To ensure there was no misinterpretation of the intervention required, we recommended that the terminology used, was clarified. Information which showed the support a person needed with dressing and undressing was dated 2007. A communication profile was dated 2003. The information had been reviewed annually with no change recorded. We recommended that staff added additional information as they became more familiar with the persons way of communicating. Later within the file, there was more detailed information about how the person expressed their needs. This included when I am I pain I will... when I need help I will... Another plan stated to help me communicate, you need to observe my body language. We advised that details of this should be stipulated within the plan. As good practice, staff had signed to show that they had read the persons updated support plan. At our last inspection, we recommended that peoples personal records were slimmed down by archiving non-current information. We said that the most important basic information should be readily available at the front of each persons record. There was little evidence that this had been addressed. We saw that staff had used some subjective language within written documentation. For example, it was recorded is usually cooperative and was full of mischief. We said that staff should only record factual information. Ms Messenger told us that she had noted this and was planning to work with staff to improve the standard of record keeping. There was good information about the persons likes and dislikes within their support plan. We saw that people were encouraged to make decisions about their lives in relation to their ability. One person indicated that they wanted a drink. A staff member asked if they wanted tea or coffee. The person was shown both items in order to indicate their choice. We saw that the person regularly gave staff a CD to show when they wanted their choice of music changed. Another person indicated that they were cold by leading us to their wardrobe. They pointed to a jumper to Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: demonstrate that they wanted additional clothing. We saw that staff prepared lunch as detailed on the menu. One person had an alternative due to their individual health care condition. As a means of developing decision making opportunities, we recommended that people should choose what they wanted to eat, rather than staff preparing what was on the menu. A staff member told us that the menus were devised according to peoples individual preferences. Following our site visit, Ms Messenger confirmed that more involvement in choosing meals would be considered. Within the AQAA, it stated the service balances risk against our duty of care and provides comprehensive risk assessments which are reviewed regularly. We keep up to date with all local and government policy which affect the persons life. We asked staff about individual risk assessments as we did not see any within peoples support plans. The risk assessments could not be located. Ms Messenger told us after our visit that all risk assessments were kept in a separate file. She said that up to date risk assessments covering aspects such as eating and drinking, accessing the community and bathing were in place. We advised that they should be easily accessible so that staff were aware of their content. Care Homes for Adults (18-65 years) Page 15 of 36 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 are involved in social activity and are supported to maintain important relationships. People have a varied nutritional diet, which is based on fresh ingredients. Evidence: In relation to what the service did well, the AQAA stated provide a range of activities which are individual and recognises individual likes/dislikes. All individuals are supported to maintain relationships with family and friends. Clients are supported to access local shops, hairdressers and social venues. Staff members told us that people attended day services, social clubs and leisure activities on a regular basis. They said that peoples families were always welcome within the home. One staff member told us we try to get people out as much as possible as they seem to enjoy being outside rather than being indoors. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: When we arrived at the service, three people were at home with one staff member. One person was listening to music in their bedroom. Other people were walking around the home. One person spent some time in the garden. There was no organised social activity taking place. One staff member told us that people did not have any particular interests when at home. They said that people liked to spend time outside in the garden. The staff member told us that two people in particular liked to walk, especially in open spaces. During our visit, one person went swimming with a member of staff. In the afternoon, three people went out for a walk with two staff members. The person who had gone swimming in the morning, remained in the home. They watched television and then went out into the garden. Staff told us that this was because they had already gone out in the morning. Increasing the variety of social activities was something the AQAA said the home could do better. From observing people at the start of our visit and looking at written evidence of social activity, we agreed that people could be offered more individualised activity. For example, one record showed that the activities the person had undertaken over a period of time were walking around garden, relaxing in the lounge, listening to music and a social drive. There were no other external activities documented. From the activity plan, we saw that the majority of external activities took place as a group. Ms Messenger told us that both group and individualised activity took place. She said that staff were very good at spontaneously supporting people to go out. At our last inspection, we recommended that the evaluation of activity goals should demonstrate how people had been approached and what aspects had been successful or difficult to achieve. There was no evidence within support plans to show that this had been addressed. In relation to listening to people and acting on what they said, the AQAA stated the team has been providing alternative day services for the clients at Dramsdon to increase more activities within the community. This is still on going and we hold regular reviews and make changes to reflect the individuals preference. Opportunities are sourced to provide a variety to the peoples day provision. The team are being trained in the WHCT paperwork so that each key worker can work closely with the residents to ascertain how they display their likes/dislikes etc. WHCT has provided the tools and training. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: In relation to equality and diversity, the AQAA stated develop individual PCP and support plans. Organisational polices in place which address the above issues. We would support individuals to access personal religious preferences if required, but at present no interest is shown even though encouraged. Also we would accommodate cultural dietary needs if required. Staff told us that a formal rotating menu was in place. This contained a range of traditional, home cooked foods. Staff told us that they believed the standard of food to be good. They said the meals were based on peoples preferences. One staff member told us that a person would be given an alternative if they did not get on with what they were eating. We saw a range of fresh fruit and vegetables in the kitchen. Staff told us that the majority of meals were cooked from scratch. Recipe cards were in place to help staff with the preparation and cooking of meals. A record of meals was maintained. We saw that people were supported appropriately at lunch time. Staff sat with people and encouraged individuals to eat safely. People had equipment to enable them to eat independently. There was general discussion about the days events. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of health care services to ensure their health care needs are met. Improvements to the medicine administration systems would minimise the risk of error. Evidence: Staff told us that people needed varying support with maintaining their personal care routines. Peoples preferred routines of getting up and going to bed were stated within support plans. We saw within daily records that one person did not sleep well. Staff had recorded was reluctant to go to bed and was out a few times. S/he finally settled and went to bed at 11pm and didnt settle till 10.30pm. Following our site visit, we discussed this with Ms Messenger. We agreed that supporting the person to go to bed later, may encourage them to be more settled. Ms Messenger told us that she would discuss this with the staff team. In relation to what the service did well, the AQAA stated all residents have access to additional specialist care, referrals are made through the community nurse team. Good relationship with local GP. Clients special aids such as wheelchairs, mobility aids eating equipment are determined by professional assessments. Risk assessments in Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: place. We saw that people had good access to their GP and other health care professionals. This included the chiropodist, dentist and psychiatrist. One person had attended an Epilepsy clinic. Information about the persons epilepsy was dated 2003. We said that this needed to be updated with an epilepsy management plan in place. After our visit, Ms Messenger told us that this was being addressed. Staff told us about the persons epilepsy and the support they needed if they had a seizure. There was information about a person having a hearing test and a continence assessment in 1996. We advised that this information be archived with new appointments made as required. There were various care charts in place to monitor aspects such as bowel management and menstruation. Staff had sought medical advice about one persons constipation. We advised that a protocol in relation to this, be developed. We saw that health action plans were in place but not all had been completed. The AQAA confirmed that this was something the service could do better. Ms Messenger told us that she had started working with the community nurse in developing health action plans for each person. Within one persons support plan, there was written documentation about their health care condition. This had been taken from the Internet for staff reference. A record of each persons weight was maintained. We saw that staff recorded any marks or bruises noted on a person within a body map. We advised that the information was specific and included details such as the size and colour of the identified area. This would assist with monitoring the healing process. Since our last inspection, there had been three errors with peoples medicines. Two errors occurred in June 2009 and one occurred in March 2010. Ms Messenger told us that additional training had been arranged for staff. We saw that each staff members competency with the safe handling of medicines had been regularly assessed. A GP had recently reviewed peoples medicines. They had also signed to authorise that staff could administer some peoples medicines covertly in food or drink. We saw that staff had recorded prescribed medicine instructions within the medicine administration record. We recommended that the instructions be countersigned in order to minimise the risk of error. Staff had signed the record to show that they had applied a topical cream. There were a number of gaps within the record in relation to the administration of prescribed medicines. It was not clear whether the gaps were an administrative error or whether the person had not been given their medicines. Ms Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: Messenger told us that she would talk to staff about ensuring they signed the medicine record after each medicine administration. A staff member told us that there were no controlled drugs currently held within the home. They said the medicines cupboard had been updated to ensure it complied with current legislation. Care Homes for Adults (18-65 years) Page 21 of 36 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 or their representatives to raise a concern. Intervention following an allegation of institutional abuse has enabled people to be protected from further occurrences. Evidence: Staff told us that they would inform Ms Messenger if they received a formal complaint. They said alternatively, they would provide the complainant with contact details of a senior manager within the organisation. Staff said the complainant would then have the opportunity of raising their complaint directly with them. The AQAA stated that accessible complaints procedure and video, WHCT policies, procedures concerning intimidation and bullying, yearly staff abuse training, yearly questionnaires sent to relatives and other professionals, records of all financial transactions, 2 monthly care and finance visits by the trust and secret squirrel visits were things the service did well. Placing the complaints procedure on to DVD and continuing to develop ways to empower people were things the AQAA said the service could do better. Ms Messenger told us that there had not been any recent complaints. We asked two staff about the procedures to follow if they were informed of a suspicion or allegation of abuse. They said they would immediately inform Ms Messenger or a Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: senior manager within the organisation. They said management would then deal with the situation. We asked the staff about the local safeguarding procedures in Wiltshire and Swindon. They showed us a copy of the document No Secrets, which was located on the notice board in the office. Since our last inspection, there had been one safeguarding referral. This involved institutional abuse. The allegation was substantiated. As a result, the organisation initiated disciplinary proceedings and a programme of staff secondment to other services was devised. All staff undertook refresher training in adult protection and the Deprivation of Liberties safeguards. We saw within a support plan that one person wore night wear, which they needed staff support to remove. The record stated wears a sleep suit at night as they would remove ordinary clothes and may become hypothermic. We talked to Ms Messenger about this, as the clothing appeared restrictive and not age related. Ms Messenger told us that the clothing was a necessity in order to ensure the persons dignity and their general well being. We advised that the night wear should be discussed and agreed with the persons care manager. The agreement should then be documented within the persons support plan. We saw that there was a physical intervention/restraint policy in place. The policy was dated 2006 and therefore in need of review. Care Homes for Adults (18-65 years) Page 23 of 36 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 benefit from a clean and comfortable environment. Peoples bedrooms are personalised and reflect their individuality. Evidence: We toured the accommodation and saw that each person had a single room which was individually decorated and furnished. All rooms were homely, comfortable and well maintained. There was a spacious lounge, a separate dining room and assisted bathrooms. There were pleasant, well maintained, secured gardens surrounding the bungalow. The garden contained various seating areas including patio furniture and a swing seat. In relation to what the service did well, the AQAA stated the home is comfortable, bright and airy. Each persons room is decorated to their personal taste. The home has a cleaning rota which meets the legal requirement for environmental health. WHCT policies on infection control, health and safety are in place. The house and individuals inventories are in place. There are monthly health and safety audits. The home has a trained fire officer and a health and safety representative. At our last inspection, we recommended that the kitchen was refurbished so that it could be cleaned to a satisfactory standard. This had been addressed. Staff told us Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: that there had not been any other changes to the accommodation since our last inspection. Following our visit, Ms Messenger told us that a planned programme of redecoration was being devised. The AQAA stated that replacing the lounge curtains as soon as possible was something the service could do better. We saw that one person had difficulty getting up from the sofa in the lounge. We advised that consideration be given to alternative seating arrangements for this person. We saw that two people had drinks which they placed precariously on the sofa where they were sitting. There were no coffee tables on which drinks could be safely placed. Staff told us that people generally had all drinks and food in the dining room. Ms Messenger told us that she would look into purchasing small tables, so that people were not at risk of spilling drinks over themselves. We saw that the kitchen, dining room and one persons bedroom had stable doors fitted. This meant that the bottom section of the door restricted peoples access into the room, while the top of the door, enabled people to look into the room. Staff told us that the doors had been assessed within the risk assessment process and in relation to the deprivation of liberty safeguards. They said that the doors were in place to minimise the risk of people coming to any harm. They said that one person would eat the food in the kitchen and would pick up debris from the dining room floor. We talked to Ms Messenger about the need to regularly review the situation and to ensure that the reasons for the restrictions were sound. Ms Messenger told us that people were at risk of harm if the safeguards were not in place. As part of the safeguarding investigation, all locks had been removed from bedroom doors. The AQAA confirmed that people were not able to use the locks, so they did not need to be in place. We saw within the AQAA that over the next twelve months, the environment would continue to be monitored with improvements made where necessary. We saw that the home was clean and odour free. We advised that the waste bin in the bathroom be replaced with one that was foot operated. There were pump action soap dispensers and bars of soap in the bathrooms and toilets. We recommended that the bars of soap be removed in order to minimise the risk of cross infection. All cleaning substances were stored in a cupboard which displayed a sign, keep locked. We saw that the key had been left in the lock so the cupboard was not secured. Ms Messenger said she would address this with the staff team. Care Homes for Adults (18-65 years) Page 25 of 36 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. Staffing levels and the recent secondment of staff to other services has impacted upon the service. Staff training could be improved upon in order to ensure that staff are up to date with their knowledge and skills to meet peoples needs effectively. People are protected by a robust recruitment procedure. Evidence: Staff told us that there were generally two or more staff on duty when people were at home during the waking day. However, as stated earlier in this report, when we arrived at the home, one member of staff was on duty with three people using the service. Another staff member had taken a person swimming. Ms Messenger told us that there were generally two or more staff on duty during the waking day yet at times of annual leave or sickness, managing the staffing allocation could be a challenge. Staff told us that at night, one member of staff undertook a sleeping in role so they were available, if required. They said there were varying occasions when they needed to support people during the night. Staff told us that they then worked the next day, which was sometimes difficult. One staff member told us that Ms Messenger was aware of this and was trying to resolve the situation. Ms Messenger confirmed that the morning shifts had been changed so that staff could go off duty earlier in the day if Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: they had been disturbed during the night. As stated earlier in this report, staff engagement and opportunities for people to be involved in individualised social activity was limited during the morning of our visit. We saw that there had been occasions whereby staffing shortages had affected peoples opportunities to do things they wanted to do. For example, within documentation, it was stated XXs behaviour has seemed slightly worse this quarter possibly due to XX death or not being out a lot due to staffing. Another record stated continues to be very vocal at times especially if s/he can not go out due to staffing levels or weather. Following the safeguarding investigation previously identified, it was agreed that staff would work temporarily in other care homes within the organisation. A staff member told us that a programme of staff secondment had been arranged. Some staff members had been transferred to other services and had since returned to Dramsdon. Other staff members were either on or waiting for their secondment. Two staff from other care services had been seconded to Dramsdon. Staff told us that these changes had put additional pressure on the staffing roster. Ms Messenger confirmed this and said that the incident had impacted on the ability of the service to move forward. The AQAA stated due to half the staff team being seconded and the removal of the deputy during the investigation and disciplinary process, the work we were hoping to get done at the home had to be put on hold. Staff told us that the opportunities for staff training were good. One staff member told us that they had recently completed a number of courses. These had included adult protection and first aid. Another staff member told us that they had completed abuse training. They said they had completed something else yet could not remember what it was. Later within our visit, they told us it was training in the Deprivation of Liberty Safeguards. Staff told us that Ms Messenger had organised a series of training sessions. These included physical intervention and quality and diversity. The dates and details of the training were displayed on the notice board in the office. Staff told us that they were able to put their names down for any training available. They said they could also ask for specific training in relation to peoples needs, as required. We looked at the staff training matrix. We saw that not all staff had undertaken up to date training in manual handling, food hygiene, health and safety, epilepsy awareness or communication. We saw that four staff members needed refresher training in first aid although the first aid risk assessment stated that all staff would receive refreshers when required. The training matrix showed that all of the staff team except one had a Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: National Vocational Qualification (NVQ.) It was stated within the Statement of Purpose that all staff had a minimum of five days training a year. From documentation available, this information was not accurate. Ms Messenger told us that she was aware that added focus needed to be given to this area. She said she was beginning to organise courses in relation to priority. We saw within the AQAA that over the next twelve months, individual training files for staff would be developed. In relation to what the service did well, the AQAA stated Good equal opportunities, recruitment polices and practices. Training programme tailored to individual homes needs, including legislative requirements. Local advertising. All new staff complete an induction programme and LDQ award. Comprehensive mandatory training for all staff. Opportunity to gain qualification in NVQ 2, 3 and managers to complete NVQ4 and RMA if needed. 2 monthly supervisions and yearly IPRs. As Ms Messenger was not on duty, we were not able to look at staff recruitment files. Staff told us that the most recent staff member had been recruited from another care service within the organisation. There was currently a vacancy for a deputy manager. Following our visit, Ms Messenger told us that the service always adhered to a robust recruitment procedure. This included the completion of an application form, a formal interview and the receipt of two written references. Ms Messenger told us that checks had been undertaken to ensure that each member of staff was suitable to work with vulnerable people. Following our discussion, Ms Messenger confirmed in writing that robust recruitment policies and procedures were in place. The AQAA stated that all staff had satisfactory employment checks before they started work at the home. In relation to equality and diversity, the AQAA stated continue to look at practices and use the legal guidelines to improve the promotion of equality and diversity of people. Staff will be undertaking Equality and Diversity workbooks as part of their ongoing training. Care Homes for Adults (18-65 years) Page 28 of 36 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. People benefit from a manager who has a sound value base and is committed to developing the service. Systems are in place to safeguard peoples health, safety and general wellbeing. Evidence: We approved Ms Messengers application to become the registered manager in November 2009. Ms Messenger was also the registered manager for another care service within the local area. She said she aimed to split her time equally between the two services. Staff confirmed this. They said Chris [Messenger] is usually here two days a week. She has two days at the other service and is then involved in meetings and other Trust things. We always know where she is, so we can contact her at any time, even if she is at the other service. If she is on annual leave, we would contact another manager if we needed to. There is good on call support. Ms Messenger had a nursing qualification and also the Registered Managers Award. She had worked within the organisation for approximately twelve years. Within discussion, it was apparent that Ms Messenger had recognised the areas within the Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: service which were in need of development. She said she had started to target those areas with greatest priority. She said that other areas of development would then follow. Ms Messenger told us that she aimed to be approachable and have an open door policy. She felt this would enable staff and peoples relatives to be honest and raise any concerns they might have. This was confirmed within the AQAA in relation to what the service did well. The AQAA stated the new style of management is now well underway, thus removing/reducing barriers. As Ms Messenger was not on duty during our visit, we were not able to look at the services quality assurance processes. After our visit, Ms Messenger told us that a quality assurance system, which was used across all services within the organisation, was in place. Surveys were sent to peoples relatives and involved health social/care professionals in order to gain their views about service provision. Ms Messenger told us that the organisation collated the information received. As a means to improve the service, Ms Messenger told us that she was intending to devise action plans, which were specific to Dramsdon. In relation to listening to people, the AQAA stated the views of the service user are paramount in decisions concerning the service, through regular contact discussions with relatives and friends. Staff receive training in PCP and making it real which concentrate on promoting the ways to support individuals to promote their views. Staff told us that they had delegated areas of responsibility in relation to health and safety. They said this involved areas such as fire safety, the control of substances hazardous to health and risk management. We saw that there were a number of environmental risk assessments in place. Some had been completed in 2005. They had been reviewed annually with no change written against the date. We advised that the assessments be re-written at the next review. Some of the risk assessments gave control measures which were not accurate. For example, within the assessment which assessed staff hanging out the washing, it stated all staff have been trained in manual handling. This was not accurate, as manual handling refresher courses had not been recently completed. Entries within the accident book were well recorded. Ms Messenger had completed an audit of all accidents. The information had been coordinated and had been forwarded to the organisation for information and monitoring. We looked at the fire log book and saw that fire safety was of a good standard. All checks of the fire safety equipment were consistently undertaken. There were clear records in place to demonstrate all fire drills and staff fire instruction. There was a fire Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: wallet which had up to date information about peoples needs which would be needed in the event of an emergency. This information was also stored in the homes vehicle so it was accessible in the event of an accident. On a tour of the accommodation, we found that the temperature of the hot water from three hand washbasins was above the recommended level. Following our visit, Ms Messenger told us that she had requested a plumber in order to check all hot water was of a safe temperature. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 All support plans must be kept up to date and fully reflect peoples individual needs. So that staff have the required information to meet peoples needs effectively. 30/07/2010 2 19 12 Protocols must be in place in 30/06/2010 relation to peoples health care needs. This includes the management of constipation. So that peoples well being is maintained and their health care needs are met. 3 19 12 Epilepsy management plans must be in place for those people with epilepsy. So that staff have the information to support people effectively and safely during and after a seizure. 30/06/2010 Care Homes for Adults (18-65 years) Page 33 of 36 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 4 20 12 Staff must ensure that they sign the medicine administration record after supporting a person with their medicines. So that people have their medicines as prescribed and the risk of error is minimised. 30/05/2010 5 35 18 Staff must undertake up to date training in mandatory subjects such as manual handling, food hygiene, first aid, the safe handling of medicines and epilepsy awareness. 30/06/2010 So that the staff have the knowledge and skills to effectively meet peoples needs. 6 42 13 The hot water must be regularly tested to ensure it is of a safe temperature. So that people are not at risk of scalding themselves. 31/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Staff should ensure that they only record clear, factual information within peoples support plans and daily records. Care Homes for Adults (18-65 years) Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 6 Information which staff learn from people, such as the development of peoples communication skills should be identified within the persons support plan. Consideration should be given as to how each persons support plan could be more person centred. People should have a completed Health Action plan in place. Another member of staff should ensure that they countersign to witness any handwritten medicine instruction on the medicine administration record. Discussion about the identified persons nightwear should be discussed with their care manager and documented within their support plan. Consideration should be given to enabling the identified person to have more appropriate seating. Consideration should be given to the supply of coffee tables so that people are not at risk of spilling their drinks over themselves. The decision to restrict peoples access to areas of the home should be regularly reviewed. In order to minimise the risk of cross infection, a foot operated bin should replace the one currently in the bathroom and all tablets of soap should be removed. Environmental risk assessments currently in place should be rewritten so that they are up to date and accurate. 3 4 5 6 19 20 6 23 7 8 24 24 9 10 24 30 11 42 Care Homes for Adults (18-65 years) Page 35 of 36 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). 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