Care Home: Evimiz

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What the care home does well Before people are admitted to the service they are thoroughly assessed by the manager and this minimises the risk of a person being admitted whose needs can not be met. The care plans in place are well written and provide staff with a good level of information to enable them to meet peoples needs consistently. People lead active lifestyles and the staff team provide them with support to do this as required. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 The manager makes good use of other professionals to meet peoples needs appropriately. The home has a complaints procedure that has been produced in an easy read format to help people with communication difficulties to make a complaint. Neither of the people in the home manages their own finances and records of income and expenditure are present for each person. Medication administration is managed effectively on the whole and once the shortfalls identified in this report have been addressed potential risks will be minimised. People live in a home that is decorated to a high standard throughout which is homely, comfortable and meets their current needs. Records for staff recruitment show that the regulations are followed and this minimises potential risks to people in the home. Health and safety risks are minimised through staff training, policies, procedures and regular checks being completed by the staff team. What has improved since the last inspection? A number of points identified above are improvements since the previous inspection was completed, either as a result of requirements in the previous inspection report, or from ongoing developments by the manager. What the care home could do better: The manager must ensure that they fulfil their responsibility to identify potential risks, assess them and develop strategies to minimise them. Topical creams and ointments must be labelled with the date they are opened. The manager must ensure there are accurate care plans/guidelines in place to enable staff to meet peoples needs consistently and not put them at risk. All staff must be trained in behaviour management by an appropriately qualified trainer to ensure that people in the home and staff are not put at unnecessary risk.EvimizDS0000068544.V377231.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Evimiz 155 Fairview Road Cheltenham Gloucestershire GL52 2EX Lead Inspector Mr Paul Chapman Key Unannounced Inspection 5th August 2009 09:30 Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 1 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. 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 home adults 18-65 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. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 2 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 Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Evimiz Address 155 Fairview Road Cheltenham Gloucestershire GL52 2EX 01242 701779 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) david@evimizcare.comEvimizcare.com Evimiz Care Ltd Mr David Paul Dodwell Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - (Code PC) to male service users whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 3. Date of last inspection 8th September 2008 Brief Description of the Service: Evimiz is a converted domestic dwelling in the centre of the Fairview area of Cheltenham. It is a terraced house that provides residential accommodation for up to three male adults with Learning Disabilities/Autistic Spectrum Disorder from eighteen to sixty-five. The house has accommodation on the ground and first floor. There are three single bedrooms with use of a communal bathroom with bath, hand basin, and toilet and shower cubicle. There are no en-suite facilities in the home. On the ground floor there is a communal lounge, dining room and kitchen. Off the kitchen is the laundry area, a toilet and access to the courtyard garden. The Manager/Staff office/sleep-in room is located in the basement. All the accommodation has been registered to meet current environmental standards. To the front of the property is the pavement and on-road parking. The courtyard garden is to the rear of the property and is screened by a fence with access from the street via a locked gate, all of which is well maintained at the present time. The fee range for the home is dependent on a person’s assessed needs. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Before completing the inspection site visit to this service we (the CQC) sent the registered manager questionnaires to distribute to people living in the home, staff and other professionals to complete. In addition to questionnaires the registered manager also completed an Annual Quality Assurance Assessment (AQAA). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). This inspection site visit was completed over a period of 5.5 hours; the responsible individual and the registered manager were present throughout the site visit. The responsible individual supported us to complete a tour of the premises whilst the manager was in a meeting. After the meeting the manager joined us and we discussed the care of one individual in depth whilst examining the care package created by the manager and his team. In addition to assessing the care package we also examined procedures and documentation for staffing, health and safety, complaints, quality assurance, and the day to day running of the home. Whilst we were at the service we spoke to the parent of a person living in the home and a member of staff. One of the people living in the home was offered the chance to speak with us but declined. The other person was attending day services. What the service does well: Before people are admitted to the service they are thoroughly assessed by the manager and this minimises the risk of a person being admitted whose needs can not be met. The care plans in place are well written and provide staff with a good level of information to enable them to meet peoples needs consistently. People lead active lifestyles and the staff team provide them with support to do this as required. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 6 The manager makes good use of other professionals to meet peoples needs appropriately. The home has a complaints procedure that has been produced in an easy read format to help people with communication difficulties to make a complaint. Neither of the people in the home manages their own finances and records of income and expenditure are present for each person. Medication administration is managed effectively on the whole and once the shortfalls identified in this report have been addressed potential risks will be minimised. People live in a home that is decorated to a high standard throughout which is homely, comfortable and meets their current needs. Records for staff recruitment show that the regulations are followed and this minimises potential risks to people in the home. Health and safety risks are minimised through staff training, policies, procedures and regular checks being completed by the staff team. What has improved since the last inspection? What they could do better: The manager must ensure that they fulfil their responsibility to identify potential risks, assess them and develop strategies to minimise them. Topical creams and ointments must be labelled with the date they are opened. The manager must ensure there are accurate care plans/guidelines in place to enable staff to meet peoples needs consistently and not put them at risk. All staff must be trained in behaviour management by an appropriately qualified trainer to ensure that people in the home and staff are not put at unnecessary risk. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 7 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. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential admissions to the service are able to obtain information in an easy read format if required. The Service User’s Guide enables potential admissions to the service to make an informed choice about the service provided in the home. EVIDENCE: Since the previous inspection was completed there have been no new admissions to the service. The service has an admissions policy and the AQAA completed by the manager shows that this policy was reviewed in August 2008. The previous inspection report made a requirement for the Service User’s Guide and Statement of Purpose to be reviewed and created in a format that people living in the home can understand. We examined both documents during this site visit and this showed that the manager has now created both of these documents supported by symbols (this includes a complaints procedure). We recommend that these documents are dated. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans accurately reflect the needs of people in the home and provide the staff with sufficient detail to enable them to meet peoples needs consistently. People are able to make choices about their day to day lives and staff support them appropriately. People are being put at unnecessary risks due to risk assessments not being implemented as required. EVIDENCE: At the time of this site visit 2 people were living in the home. As a result of this we examined the care of 1 person in detail. Records showed when the person was admitted to the service an assessment of their needs was completed by the manager. As part of that assessment they Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 11 also obtained a copy of the person’s community care assessment provided by the funding authority. From the completed assessment the manager has created a number of care plans, examples of these included; eating and drinking, personal care, foot care, dental care, clothing, household management, behavioural management and communication. The samples we examined provided a good level of detail to the reader about the person’s needs and the actions staff should take to support them. All of the care plans we examined had been reviewed by the manager at regular intervals (this had been a requirement of the previous inspection report). Unfortunately the previous update required as a result of a review had not been printed off from the computer. The manager did this once we had brought it to their attention. They must be mindful in the future that all updates are printed and added to the person’s file. This becomes a recommendation of this inspection report. From speaking to a member of staff and the information supplied in the AQAA it is clear that choices are identified with people on a 1 to 1 basis. House meetings do not take place regularly, but the manager has identified this as an area he wishes to improve in the future. From examining records and speaking to staff it is clear that people are empowered to make choices about the activities they wish to take part in and the food they eat. The manager highlighted that they will be attending training in DOLS (Deprivation of Liberty Safeguarding) training in the autumn. The previous inspection report made a requirement that risk assessments relating to peoples behaviour should be placed with the behaviour recording charts enabling staff to know what they should do. Examining risk assessments we found a limited number in place. Of those we read there was no evidence of review. The manager stated that they had read them but not recorded these reviews. The manager must ensure that they record when they have completed a review. In respect of the person whose care we were examining we were extremely concerned. From speaking to the manager and owner, and from notifications to the CQC more detailed risks assessments should have been implemented without delay after recent incidents. This was discussed with the manager and we stressed the importance of these risk assessments being implemented. It becomes a requirement of this inspection report that the manager fulfils their responsibility to ensure that potential risks to people in the home and staff are identified and strategies are in place to minimise them. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, 17 People using the 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 supported to take part in a range of activities supported by the staff team. People’s families are welcome to visit at anytime and staff support people to maintain relationships where required. EVIDENCE: We spoke to staff about Activities; they stated that people go out a lot and gave examples of people going out for meals in Cheltenham, using local shops, visiting parks, using libraries, attending day services and completing chores around the home. Supporting what staff told us was a daily diary which detailed peoples activities. Looking at the daily diary we noted some of the language used in the recording was poor, we brought this to the attention of the manager who explained that they had spoken to staff about their recording Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 13 and would again. When speaking to a member of staff they explained that they had just passed their driving test and would be able to take people on trips outside Cheltenham in the future. At the time of our site visit the parents of 1 person were at the home and 1 of them spoke to us about the care of their son. They explained that they can visit the home at anytime and feel that the home does a good job. On the day of the site visit they were taking their son out for the afternoon. Each day staff record what people eat. Records we saw showed evidence of people being given a choice about what to eat. Speaking with the proprietor of the service they commented that some of the staff need training in cooking and they are trying to address this at the moment. 1 staff member comes in regularly and helps people make cakes. The AQAA states an area where the home could do better is encouraging and supporting people to socialise with friends, find out about local groups/clubs and college courses that people may be interested in. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place that provide staff with a good level of detail to meet peoples personal care needs consistently. The home makes good use of other health professionals to meet people’s needs. Generally the medication administration minimises potential risks to people in the home but unnecessary risks are still present and need to be addressed. EVIDENCE: Examining care plans relating to personal care showed that detailed plans were in place that enabled staff to meet the person’s needs consistently. These plans had been reviewed at regular intervals. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 15 Records for appointments with other health professionals were seen in the person’s daily diary. Notes we read were appropriately detailed providing the required amount of information. We recommend that for ease of access to medical notes/appointments they should all be kept in 1 place. The previous inspection report made a number of requirements against the medication procedures in the home; • Records of medication ‘into’ and ‘out’ of the home are maintained. • Records within the home are accurately maintained. • People’s allergies must be identified on medication sheets. • Staff specimen signatures must be made available with charts. • Photos should be available with medication charts. • Medication training should be arranged for all staff. • The manager must implement a regular medication audit and implement a policy for the management of medication when people are away from the service for a period of time. We assessed each of these areas which showed that the manager has now addressed them appropriately. Examining the home’s medication administration showed that on the whole it is well-managed and safeguards the people in the home. 2 shortfalls were identified; topical creams were not dated when they were opened and whilst completing a tour of the premises we found a topical ointment being stored in the home’s fridge. This was brought to the attention of the manager and owner and we explained that if they needed to store medication in the home’s fridge it should stored in a lockable container. The AQAA states that a planned improvement for the next 12 months is the creation of a policy to manage a death in home, and to implement plans in case of a severe illness or severe change of capacity in line with Mental Capacity Act(2005). Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 service has a complaints procedure that has been produced in easy read format to help people with communication difficulties to understand it. Failure to provide guidelines on managing behaviour and training to staff is putting people and staff at unnecessary risks. EVIDENCE: A requirement of the previous inspection report was that the complaints procedure must be developed and available in a format that is completely accessible to the people living in the home. As a result of this requirement the manager has reviewed the complaints procedure and it is now available in an easy read format. When speaking to a parent of a gentleman living in the home they said they knew that the home had a complaints procedure. No complaints about the service have been received by the CQC. The AQAA states that there have been 2 complaints made to the manager since the previous inspection. Both complaints were addressed within 28 days and have been concluded. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 17 We examined plans in place for behavioural management. Current plans provide a good level of information about supporting the person inside the home, from day-to-day. From speaking to the manager and from a notification received by the CQC it is clear that the potential risks have increased when supporting this person in the community over the past 2 months. Unfortunately there were no care plans/guidelines in place to reflect these risks and instruct staff on the actions they should take. Speaking with the manager and owner of the service we stressed that care plans/guidelines and risk assessments should already be in place. The manager explained that they have been working with other health professionals to address the person’s needs and it was planned that they would be writing some guidelines with a psychologist to address these issues in the future. Current practices are putting both the person and staff at unnecessary risks when they are out in the community. It becomes a requirement of this inspection report that guidelines are created without delay to minimise the risks to the person and the staff supporting them. A requirement of the previous inspection report was that all staff should complete behaviour management training (this was a repeated requirement from the previous inspection report in September 2007). The AQAA completed by the manager states, “3 staff attended a challenging behaviour course (though 2 of these subsequently left shortly after)”. Speaking with the manager they stated that 3 staff had completed behaviour management training with previous employers, but not since being employed at Evimiz. The manager stated they had purchased a training pack from a recognised training organisation and had started going through it with staff. This is a concern to us that after the original requirement being made in September 2007 that all staff have still not completed behavioural management training. It becomes a requirement of this inspection report that all staff receive behavioural management training from a qualified trainer, from a recognised and approved training organisation. The manager gave their assurance that they would start to organise this in the days following this site visit. The manager has created a Traffic light system to identify different levels of behaviour that may be displayed. We examined a sample of these which gave a good insight into behaviours that may be displayed in the home. Unfortunately the document was not dated; the manager assured us that it was an up-to-date document. It becomes a recommendation of this report that future documents are dated. Staff complete ABC charts after an incident has occurred. The manager explained that the format of these charts has changed recently to a full page document to encourage staff to record greater detail. From examining the recent records it was clear this approach had been successful with a greater level of detail being recorded. We spoke to the manager about this and Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 18 recommend to enable them to update the Traffic Light system they need to create an audit trail with the ABC charts. We examined the records for income and expenditure of people in the home. Neither of the people in the home is able to manage their own monies and their appointees are family members. Records showed that monies are received form appointees for each person regularly. Staff sign confirming all expenditure and receipts are kept to evidence this where possible. These were seen to be correct at the time of this site visit. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, homely and well-maintained environment that meets their current needs. EVIDENCE: We completed a tour of the premises with the owner; they explained that the outside of the property was repainted a year ago. To the rear of the property is a traditional yard with garden furniture. The owner said that this is used by the people in the house when the weather is good. The outside of the property is well maintained. We did not see either of the bedrooms inhabited at the time of this site visit as 1 person was out and another was in a meeting and then going out. The Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 20 communal areas of the home were decorated to a high standard throughout; the home has a separate lounge, dining room and kitchen. We saw all of the bathrooms and toilets which on the whole were well maintained. The blind in the bathroom was damaged and the manager said they would replace this. At the time of this site visit the home was clean and tidy with no offensive odours. The AQAA highlights that since the previous inspection was completed new wooden floors have been fitted in 1 bedroom and in the hallway. Also, a new window has been fitted in 1 of the bedrooms. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures minimise potential risks to people living in the home. Training records are well organised and provide evidence that staff have completed a range of training to meet the needs of people in the home. EVIDENCE: We examined the training records for the current staff team. This showed that new staff complete a recognised external induction course when they are employed. Training records for the staff team are well organised in their personal files. We saw a range of training certificates providing evidence of staff completing training in Safeguarding Vulnerable Adults, Food Hygiene, Infection control, Moving and Handling, First Aid, Safe handling of Medication and Autism. We spoke to a member of the staff team about the training available in the home. They confirmed they had completed the training we saw in the records and stated that they could access training as required. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 22 As identified earlier in this report the only major training shortfall we found was relating to the management of behaviour. The AQAA states that 3 members of staff have completed NVQ’s (National Vocational Qualification) to a minimum of level 2 in care. This means that 50 of the staff team have achieved NVQ’s and therefore the home meets the recommended number for this standard. Staff without these qualifications are working towards achieving them. The previous inspection report made a requirement that the manager must ensure that the recruitment of staff meets the criteria set out in the regulations. We examined the recruitment records for a member of staff employed since the previous inspection was completed and this showed that all of the documents required by the regulations were present. Another requirement of the previous inspection was that the manager ensures that staff receive supervision 6 times a year. Examining records of staff supervision and speaking to the manager it was clear the frequency of supervision has increased. The manager also explained that a number of supervisions are “ad-hoc” and should be recorded. It is recommended that the manager ensures that all staff receive supervisions at regular intervals and these are recorded. Since the previous inspection there has been a small amount of staff turnover with 2 people leaving. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 People using the 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 manager is appropriately qualified and experienced to manage this service and has continued to develop it since the previous inspection was completed. The service has a quality assurance procedure that seeks the opinions of a range of people involved in the service. There are a range of health and safety measures in place that minimise potential risks to people living in the home. EVIDENCE: Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 24 The manager is qualified in managing health and social care and has completed their NVQ level 4 in health and social care. The manager has substantial experience in working with this client group and this is evidenced in the care plans they have written to meet people’s needs. The manager continues his personal development and is booked to complete DOLS training in September. As identified earlier in this report there is major concern about the management of people’s behaviour and the strategies in place to support them, speaking to the manager we were assured that this will be addressed without delay. Considering all of the information gathered during this inspection process it is clear that the manager has made significant progress in developing the service and meeting the requirements of the previous inspection report. This in turn has raised the quality of the service being provided in the home. Speaking with the manager and owner of the service they explained that they will be applying to de-register the service as a care home and intend applying to provide a domiciliary care service. We received 1 completed questionnaire from a health professional involved with the service. When asked what the service does well they commented, “They are always concerned and appear to want to do the right thing”. Comments from the parent we spoke with supported this. A requirement of the previous inspection was for the manager to produce an annual quality assurance report. We discussed the home’s quality assurance procedures with the manager and owner. They explained that they have sent questionnaires to parents and other professionals involved with people in the home and are awaiting their responses. The manager plans to develop quality assurance procedures further and explained that they plan to complete the annual review earlier so it does not coincide with the our inspection and the results will be available for us to examine. This will be examined at the next inspection site visit. The home has a range of policies and procedures and the AQAA states that all staff are expected to read the policies and sign to confirm they have read and understood them. A requirement of the previous inspection report was we must be informed of incidents that come under Regulation 37. The manager is now doing this as identified earlier in this report. Staff are recording incidents thoroughly in the ABC charts where appropriate. There are a number of strategies in place to minimise risks to people’s health and safety around the home. These include staff training, a health and safety policy and a number of checks completed around the service. We saw evidence of the following: - Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 25 • • • • • • Fire safety – There was a fire risk assessment in place dated August 2008 and 2 evacuations had been completed. The fire alarm had been tested as required up until May 2009 but we were unable to find records of any tests after this date. Fire equipment was inspected by a qualified engineer in April 2009. We found a fire extinguisher in the basement of the property that had been missed by the engineer; the owner said that this would be rectified. Fridge and freezer temperatures are recorded daily. Cleaning chemicals are stored securely and the manager has created risk assessments that identified potential risks. We did not find any data sheets to support the risk assessments and it is recommended that the manager contacts the suppliers to obtain these. The health and safety, and infection control policies were reviewed in August 2008. Portable Appliance Testing (PAT) is completed regularly. Hot water outlets are monitored regularly. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 3 X 2 X Version 5.2 Page 27 Evimiz DS0000068544.V377231.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4b, c) Requirement The manager must ensure that they fulfil their responsibility to identify potential risks, assess them and develop strategies to minimise them. Failure to do this will continue to put people and staff at unnecessary risk. 2. YA20 13(2, 4c) Topical creams and ointments must be labelled with the date they are opened. Failure to do this may lead to people being treated with medication that has past its expiry date. 3. YA23 15, 13(4b, c) The manager must ensure there are accurate care plans/guidelines in place to enable staff to meet peoples needs consistently and not put them at risk. Failure to implement plans to meet peoples needs in the area puts both staff and the person at an unacceptable risk. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 28 Timescale for action 18/09/09 18/09/09 18/09/09 4. YA23 18(1c) All staff must be trained in behaviour management by an appropriately qualified trainer. The manager must provide the CQC with evidence that all staff have completed this training by the date of “Timescale for action”. Failure to provide the staff team with this training puts people living in the home and staff at unnecessary risks. This requirement is repeated from the inspection report dated 8th September 2008. 16/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The manager should date the Service User’s Guide to show the reader when it was created. The manager should ensure that when they update a care plan to reflect a person’s needs that a copy is printed and added to their file. Peoples medical/health notes should be kept in one place to enable staff to access them easily. Traffic light documents should be dated to show the reader when it was created. There should be a clear audit trail between the traffic light documents and the ABC charts completed by staff. The manager should ensure they record all staff supervisions. DS0000068544.V377231.R01.S.doc Version 5.2 Page 29 3. 4. 5. 6. Evimiz YA19 YA23 YA23 YA36 7. 8. YA42 YA42 The manager needs to ensure that the fire alarm is tested regularly and the results are recorded. The manager should contact the manufacturers of the cleaning chemicals used in the home and ask them to supply the data sheets. Evimiz DS0000068544.V377231.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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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