Care Home: Greengates

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What the care home does well The home has a consistent staff team who are committed to the people who live at the home. Care staff have undertaken NVQ`s. Care staff identified on their completed surveys that they `work well as a team` and that they provide `support for the clients to access the local and wider community and experience new things`. Staff have a good understanding of the individual needs of the people who live at the home. The home provides an environment that is domestic in character with a homely, friendly atmosphere. The home has an ongoing program of maintenance and redecoration. What has improved since the last inspection? The home has met the four requirements made following the random inspection in March 2009. The responsible person was required to ensure that all care plans were reviewed and any examples of institutional care practices discontinued and people living at the home are actively encouraged to develop independence skills. This was required to ensure that people are safe and have their needs met in an appropriate way. Care plans viewed on this inspection indicated that care plans had been reviewed and no examples of institutional care practices were identified in those viewed. Information viewed would indicate that people are participating more in the home and community. The responsible person was also required to ensure that risk assessments and management plans are in place to address the behaviour issues and ensure the safety of the person, other people who live at the home, staff and visitors. This was required to ensure that risks were identified and managed to ensure the safety of people. During this inspection risk assessments were found to have been reviewed and additional risk assessments were in place to address risks posed by the behaviour of some of the people who live at the home. The responsible person was also required to ensure that people living at the home have the opportunity of a fulfilling lifestyle that provides social, leisure and opportunities to learn new skills and increase their independence. This was required so that people could fulfill their potential and enjoy their lives. Care plans contained home and community participation logs that evidenced that people are now participating more in the home and community. The fourth requirement was that the responsible person must ensure that that the home and garden are safe for people and that as one person uses a wheelchair that access is suitable and does not place the person or staff at risk. This was required to ensure the safety of people. The home now has suitable access for wheelchairs and has addressed other environmental issues that should ensure the home is safe for people with mobility needs. What the care home could do better: Four requirements are made following this key inspection. A care plan viewed identified that a person had lost weight however there was no information about the action that the home was taking and the person was not being regularly weighed. The responsible person must ensure that action is taken when there is an indication that a person has lost weight. This is required to ensure that people`s health needs are fully met and they are safe. Discussions with the manager and staff showed that they were unsure about the home`s policy in respect of how staff refreshments are paid for when on outings with service users. This meant that service users without the cognitive ability to make an informed decision are paying for staff refreshments. The lack of a clear policy places both service users at risk of abuse and staff at risk of allegations of financial abuse. The responsible person must ensure that the home has a policy relating to how staff refreshments are funded when on outings with people who live at the home. This is required to ensure the safety of the people who live at the home and staff. The home has only recruited one new staff member however records were not available at the time of the inspection visit to confirm that all pre-employment checks had been completed before the person commenced working in the home. The responsible person must ensure that they can demonstrate by way of records that all recruitment checks have been completed before staff commence working in the home. This is required to ensure the safety of people who live at the home. Although staff have undertaken most mandatory training there was no evidence that they had undertaken fire awareness or infection control training or training relevant to the specific needs of the people who live at the home such as Autism or Epilepsy. The responsible person must ensure that staff have undertaken all mandatory and service specific training relevant to the needs of the people who live at the home. This is required to ensure that staff have all the necessary skills to meet the needs of the people who live at the home. Other areas the home could improve are identified in the report in the relevant outcome group. These include removing historic and no longer relevant information from care plans to make then less bulky and more accessible as a care planning tool. There is also a need for a clear policy as to when risk assessments will be reviewed. Key inspection report Care homes for adults (18-65 years) Name: Address: Greengates 96 Monkton Street Ryde Isle Of Wight PO33 2DD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Greengates 96 Monkton Street Ryde Isle Of Wight PO33 2DD 01983564418 01983564418 mandy.minshull@islecare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Islecare Ltd 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 to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Greengates is a residential home providing care and accommodation for up to five adults with a learning disability. The home is a detached two-storey property situated in a residential area of Ryde, a short walk from local shops, beach and leisure facilities. Also close are Ryde town centre, bus station and the railway station. One person has their own self contained apartment on the ground floor with the remaining four service users having bedrooms on the first floor and communal rooms of a lounge and kitchen dining room on the ground floor. There is a good-sized garden that is laid mainly to lawn with patio and seating for use by the service users. Off road parking is limited but spaces can usually be found in the neighbouring streets. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 5 1 7 0 3 2 0 0 9 Brief description of the care home The registered provider is Islecare Ltd. At the time of the key inspection in November 2009 there was no registered manager. 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report details the results of an evaluation of the quality of the service provided at Greengates and brings together accumulated evidence of activity since the last key inspection in October 2007. The report includes reference to and information from a random inspection carried out in March 2009. The home also had an Annual Service Review (ASR) completed in July 2008. All core standards and some additional standards were assessed. Compliance with the four requirements made following the random inspection was also assessed. The visit to the home was undertaken by one inspector on the 15th January 2009 and lasted approximately five hours commencing at 1.00pm and being completed at just after 6pm. The inspector was able to spend time with the manager of the home and staff on duty Care Homes for Adults (18-65 years) Page 6 of 36 and was provided with free access to all communal areas of the home, documentation requested and people who live at the home. During the visit to the home the inspector was able to meet and speak with all the people who live at the home. The inspector observed interactions between staff and the people who live at the home. Prior to the inspection surveys were sent to the home to distribute. Seven were received from staff who work at the home, five from people who live at the home who had been helped to complete these by staff who work at the home. Surveys were also sent for external health and social care professionals however none were received. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? The home has met the four requirements made following the random inspection in March 2009. The responsible person was required to ensure that all care plans were reviewed and any examples of institutional care practices discontinued and people living at the home are actively encouraged to develop independence skills. This was required to ensure that people are safe and have their needs met in an appropriate way. Care plans viewed on this inspection indicated that care plans had been reviewed and no examples of institutional care practices were identified in those viewed. Information viewed would indicate that people are participating more in the home and community. The responsible person was also required to ensure that risk assessments and management plans are in place to address the behaviour issues and ensure the safety of the person, other people who live at the home, staff and visitors. This was required to ensure that risks were identified and managed to ensure the safety of people. During this inspection risk assessments were found to have been reviewed and additional risk assessments were in place to address risks posed by the behaviour of some of the people who live at the home. The responsible person was also required to ensure that people living at the home have the opportunity of a fulfilling lifestyle that provides social, leisure and opportunities to learn new skills and increase their independence. This was required so that people could fulfill their potential and enjoy their lives. Care plans contained home and community participation logs that evidenced that people are now participating more in the home and community. The fourth requirement was that the responsible person must ensure that that the home and garden are safe for people and that as one person uses a wheelchair that access is suitable and does not place the person or staff at risk. This was required to ensure the safety of people. The home now has suitable access for wheelchairs and has addressed other environmental issues that should ensure the home is safe for people with mobility needs. Care Homes for Adults (18-65 years) Page 8 of 36 What they could do better: 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. In the event of the home having a vacancy, the manager would ensure that prospective residents are fully assessed to ensure that their needs can be met at the home and have the opportunity to visit the home prior to admission. The home has a range of information available for new people and their representatives, some of which has also been produced in a format suitable for people who live at the home. Evidence: The inspector discussed the homes admission process with the manager and viewed information about the home that would be provided to new service users and their representatives. The manager has reviewed the information that is available to service users and their representatives. Most of this information is in typed format however some such as the complaints procedure is also available in a format more suitable for the people who live at the home. The information sets out clearly what services will be provided at the Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: home and other relevant information that people may require to help them decide if the home will meet their needs. The home has not had any vacancies and therefore no new admissions since before the previous inspection undertaken in October 2007. The manager identified the procedure that they would undertake should they be in the position of admitting a new person. This would include a thorough assessment, information from professionals involved with the person and their relatives, meeting the person and if they felt the home could meet the persons needs they would invite them to visit the home. With no new people admitted to the home recently or by the person currently managing the service it is difficult to ascertain how effective the home would manage an admission and meet the needs of a new person. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now uses a person centred care planning system. Care plan folders also contain historical information making them bulky and there is a risk that relevant information may be submerged by less relevant information. This places people at risk of not having all their needs met. It is not clear how frequently risk assessments are to be reviewed. People are more involved in general household activities and the local community. Evidence: Two care plans were viewed. Risk assessments and the ways in which risks should be managed were seen in care plans. The inspector spoke with staff about care plans and observed where they are stored. The inspector also discussed how decisions are made and observed how people who live at the home are encouraged and supported to be involved in some aspects of the day to day running of the home. The manager explained how peoples personal finances are managed and records relating to these were viewed. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: The home had a random inspection in March 2009. Following this requirements were made in relation to care plans and risk assessments. The responsible person was required to ensure that all care plans are reviewed, any examples of institutional care practices are discontinued and people are actively encouraged to develop independence skills. In relation to risk assessments the responsible person was required to ensure that risk assessments and management plans were in place to address behavior issues and ensure the safety of the person, other people who live at the home, staff and visitors. Two care plans were viewed. These were contained within large bulky files which are stored in a cupboard above the worktop in the homes kitchen. In addition to care plans and risk assessments the files also contained historical information and in one case information such as a property list relating to a service users relative who had been admitted to an older persons care home. The inclusion of historical and non relevant information in the care plans may mean that staff cannot easily find relevant and important information and this may be missed resulting in peoples needs not being met. There are also health and safety issues concerning staff removing and replacing the heavy files into the storage cupboard. There was no evidence of the institutional care practices that were present in care plans viewed in March 2009. Care plans covered all the activities that a person may undertake and provided individual information as to how their needs in each respect should be met. There was however some duplication within care plans with care files viewed containing two slightly different plans for how the person should be supported with getting up and going to bed routines. Care plans had been reviewed monthly by key workers. Included in care plans were forms stating my aspirations which records showed had been reviewed on a monthly basis. These appeared not to have been used since 2008. It may be that these are no longer in use however they did provide information as to how service users were being supported to develop independence skills and participate in the home and community. If these forms are no longer in use the home should determine how goals will be set with people to promote independence and participation. Care plans also contained risk assessments. These had all been updated in June 2009, however there was no indication as to how often risk assessments would be updated and when a review was due. The manager was asked about reviews of risk assessments and was unclear as to how often or when these would be reviewed. Additional risk assessments had been added to the care plans since the random inspection in March 2009 to include the risk of injury from other service users. These were also dated June 09 and as with other risk assessments there was no indication as Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: to how often these would be reviewed. It was not clear from care plans or risk assessments the extent to which the person whose plan it was had been involved in making the care plan or risk assessments, or their level of involvement in the monthly reviews. Due to the level of cognitive and communication needs of the people who live at Greengates it was not possible to have an indepth discussion with them. The inspector spoke with one person who stated they were happy and that they could do what they wanted. Another person informed the inspector that they wanted to move to live nearer their relative. Discussions with staff indicated that meetings had been held with the persons care manager in respect to their stated wish. Care plans contained information about peoples individual likes and dislikes and discussions with staff demonstrated that they were aware of peoples likes and dislikes. There was limited information in care plans concerning peoples capacity to make decisions however there were records showing that people who had indicated by their behaviour that they had not wanted routine flu immunizations had not been forced to have these. Discussions with care staff and the homes training matrix showed that staff have not had deprivation of liberties or mental capacity act training and were not aware of the legal issues that result from this legislation. During the inspection the inspector observed some instances and care plans stated how the people who live at the home would be supported to participate in the running of the home on a day to day basis. This included a person being asked if they wanted to lay the table for dinner and care plans stating that people should be encouraged to bring their laundry to the laundry room and the assistance they would then require to set the machines. Service users were observed being asked if they wanted to go to the supermarket to help with the homes food shopping. It was not clear how peoples views would be included in other decisions about the home. Some communal areas of the home had been redecorated however there was no indication that the people who live at the home had been included in the choice of colours. People do not have the cognitive ability to manage their own finances and all appointee-ships except one have now been transfered to the court of protection or relatives. The manager confirmed that the process is now commencing to transfer the final person to the court of protection. There was evidence that personal money is spent on things that people like and enjoy. Bedrooms were personalised reflecting their occupants interests. The support people receive in relation to their personal finances is recorded in care plans. The inspector viewed the arrangements in respect Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: of personal finances and the procedures and records are appropriate and well maintained. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence indicates that people living at the home are participating more in the home and community. People are supported to maintain contact with their families and most have enjoyed a holiday this year. People are offered meals they enjoy cooked by staff. The home must clarify the arrangements whereby service user pay for staff refreshments whilst on outings in the community to protect people from the risk of financial abuse. The home must ensure that they can show how additional individual time is being provided to ensure that peoples needs are being met. Evidence: Information from care plans, discussions with care staff and observations during the inspection visit are considered. The random inspection undertaken in March 2009 identified that there was limited evidence that people were doing many activities either in the home or in the Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: community. A requirement was made that the responsible person must ensure that people have the opportunity of a fulfilling lifestyle that provides social, leisure and opportunities to learn new skills and increase their independence. The home has a house lease car. The manager explained that people living at the home each pay for this monthly and then the fuel costs are divided dependent on the amount of use each person had made of the car. Records indicated that each person uses the house car and costs are divided according to usage. Care plans contained weekly plans for regular activities such as day services and visits to family members. Within their bedrooms people have a variety of home entertainment equipment and relaxation equipment. During the inspection visit people were noted to be able to spend their time as they wished. Care plans contained records of activities people had undertaken both in the home and in the community. These indicated that people are now participating more in the home and in the community. Staff are recording when people are offered activities and outings but refuse and there was information about places one person who is reluctant to go out particularly enjoys visiting. The home is located within easy walking distance of Ryde seafront and Ryde town centre. Also close by are a number of cafes and pubs. One person has an individual staff member and at all other times two staff are also available for the remaining four people who live at the home. There should therefore be adequate staff on duty to support people to attend community events and participate in the running of the home. One person receives eight hours of additional individual time per week funded by the local social services department however it was not clear from the duty rotas or care plans how these individual hours are used. The manager appeared unsure about the individual hours and was unable to provide information as to how these are provided above that which other people receive. People are involved in assisting care staff with food shopping in the local shops and use local health facilities. Care staff stated that they have time for activities and outings. Four of the five people who live at the home had a holiday this year. One person visited their sister and three people had a holiday at a holiday centre in the New Forest. the fifth person declined a holiday. The requirement in respect of activites has therefore been met although there is a need to esnure that this is sustained and embeded in practice. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: Whilst viewing financial records the inspector saw evidence of money spent on outings and refreshments. The inspector asked how staff refreshments are funded and the manager was unclear about the homes policy concerning this. Staff stated that they just have a small cheap item such as a bowl of chips and a soft drink however this is paid for by service users. Staff were unsure about the exact policy in respect of refreshments or if there is a limit on what they can spend from service users personal money. There was no information in the service users guide concerning the use of service users personal money for staff refreshments whilst on outings. A requirement is made that the home must have a clear policy relating to the use of service users personal money for staff refreshments whilst on outings. The person responsible for the service users financial affairs must be made aware of the policy. This is required to ensure that people who have a limited income and may not be able to agree to how their money is spent are not at risk of financial abuse. A clear policy will also protect staff and the homes manager from allegations of mismanagement of peoples personal money. The home does not employ separate catering staff so care staff take turns to cook each day. Information in care plans stated what support people require in respect of meals and food preparation. People have lighter lunch meal or take packed lunches to day services and have a main cooked meal in the evenings. Service users stated that they enjoyed the food at the home. Staff stated that menus are planned weekly with service users who also help staff shop at the nearby supermarket. Care Homes for Adults (18-65 years) Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care and support in the way they prefer and their health needs are generally met. The home failed to take action when a persons weight recordings indicated that they had lost weight placing them at risk of not having medical needs identified and met. Medication is appropriately stored and recorded with information for staff as to when as required medication should be administered. Evidence: Information about personal and health care needs and that provided was viewed in care plans. Discussions with staff are also considered. The arrangements for the storage and administration of medication were viewed with any related records. The report following the random inspection undertaken in March 2009 identified that information in care plans was incomplete and did not provide clear information as to how health needs were being met. Care plans viewed during this inspection contained individual information as to how people should be supported with personal care routines and these should ensure that peoples personal care needs are met and their rights to dignity and privacy are Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: maintained. The home operates a key worker system. People living at Greengates are independently mobile although one person requires a wheelchair for use outside the home. The bathing facilities are appropriate for the people who live at the home. A wet room shower room is now available for one person eliminating the risk posed by stepping into a shower tray. It was noted that there were no window coverings in the wet room. This was identified to the manager who stated that they would arrange a glass film for the window such that people would not be able to see in. Times for getting up and going to bed are flexible with various times seen recorded in care plans viewed. Interactions observed during the inspectors visit to their home indicated that people felt relaxed with care staff. The home has a consistent staff team who have got to know the people who live there so should recognise if someone were unwell and not their usual self. Evidence of personal care is recorded in daily recordings made by care staff and indicated that peoples personal care needs as identified in their care plans are met. People appeared to have their personal care needs met. People living at the home are registered with local GPs and support is provided from care staff to make and attend appointments. Care plans contained a record sheet that indicated that people are able to see Chiropodists, Dentists, Opticians and Doctors when required. Care plans contained limited information about mental capacity and how decisions about treatment would be made. Evidence did indicate that peoples rights to refuse flue immunisations had been respected when they had been taken to the local GP but then refused to have the injection. Other service users had received the immunisation. Recording of peoples weight no longer appeared to be undertaken monthly with one persons care plan only recording that their weight had been checked three times in 2009. The records showed that the person had weighed 10 stone 2 in January, this had dropped to 8 stone 9 when next weighed in June and the person had not been weighed again until October when their weight was recorded as being 9 stone 3. When people are unable to express fully how they are feeling from a health viewpoint weight can be an important indicator of ill health. The failure of the home to take any action when they recorded the persons weight to have dropped significantly in June and then not to have re-weighed the person until October places the person at risk of health needs not being detected and addressed. There was no update to the care plan to reflect the persons weight loss or that a closer watch and regular weight recordings or consultation with health professionals should be undertaken. At the time of this key unannounced inspection all medication was found to be stored correctly. Administration records were viewed and had been fully completed. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: Medication coming into the home is recorded on the Medication Administration Records. Care staff informed the inspector that only staff who have completed medication training administer medication. None of the people living at the home self medicate, therefore all medication is administered by care staff who have received external training and been deemed competent. Some medication such as pain killers is prescribed to only be given when required. The home has as required guidelines for staff to help them determine when this medication should be administered. Medication is securely stored in the kitchen. Although the storage of medications in the kitchen is not recommended because heat and humidity may affect the medicines, the cupboard is not near any direct sources of heat or humidity, temperatures in the cupboard are checked several times a day and the kitchen is well ventilated. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate complaints procedures. The home does not have clear procedures in respect of the purchase of staff refreshments when on outings resulting in service users being at risk of financial abuse and staff at risk of allegations of financial abuse. Evidence: The provider has a complaints policy which is made available to people or their representatives. This is also available in a format more suitable for people who live at the home. There is also information as to how to complain available in the hall at the home. The complaints policy should ensure that all complaints are appropriately investigated within twenty-eight days. The home maintains a complaints book and has received no complaints in the past twelve months. No complaints have been received at the Commission in respect of Greengates. During the inspection people who live at the home were seen to refuse to do some things that staff suggested or asked them to do and to make requests which staff complied with. This would indicate that although service users may not be able to make a formal complaint they do feel able to say no to staff and to express wishes. Prior to the random inspection in March 2009 a safeguarding investigation had been undertaken by the Isle of Wight social services department into inappropriate care practices at the home. The random report identified that care staff were undertaking Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: inappropriate and institutional care practices. During this inspection care plans had been updated and these no longer contained information about institutional care practices. No examples of inappropriate care were observed during this inspection visit. Whilst viewing financial records the inspector saw evidence of money spent on outings and refreshments. The manager was unclear about the homes policy concerning service users paying for staff refreshments. Staff stated that they just have a small cheap item such as a bowl of chips and a soft drink which is paid for by service users. Staff were unsure about the exact policy in respect of refreshments or if there is a limit on what they can spend from service users personal money. There was no information in the service users guide concerning the use of service users personal money for staff refreshments whilst on outings. A requirement is made that the home must have a clear policy relating to the use of service users personal money for staff refreshments whilst on outings. The person responsible for the service users financial affairs must be made aware of the policy. This is required to ensure that people who have a limited income and may not have the capacity to agree to how their money is spent are not at risk of financial abuse. A clear policy will also protect staff and the homes manager from allegations of mismanagement of peoples personal money. Care Homes for Adults (18-65 years) Page 24 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. The standard of accommodation within the home is good providing people with a safe, comfortable and homely place to live which meets their individual and collective needs. Evidence: The home is located in a residential are of Ryde within walking distance of the seafront, GP surgery and local shops. The town centre and public transport links are also within a short walk of the home. The house is divided to provide a ground floor flat comprising of a bedroom, en suite shower/wet room and a lounge/diner/kitchenette for one person. The rest of the house provides a kitchen/dining room, lounge and four upstairs bedrooms with appropriate bathroom and WC facilities and a laundry room. Outside there is a good sized rear garden and driveway for the house car. The inspector viewed the homes communal rooms and first floor bedrooms and bathroom. The service user in the flat showed the inspector their accommodation including the new wet room. Following the random inspection in March 2009 a requirement was made that the home and garden must be safe for the service users especially one service user who Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: has decreased mobility and uses a wheelchair when out of the home. The home now has bright yellow marking painted on uneven steps around the homes gardens and a new path across the lawn to the driveway making it safe now for people to access the home using a wheelchair. This requirement has therefore been met. Also since the random inspection the homes communal areas have been redecorated as have two of the bedrooms in the main part of the house. The en suite bathroom in the flat has been converted to provide a wet room with walk in shower, washbasin and WC. This is more appropriate for the person who lives in this part of the home and eliminates previous risks due to accessing bathing facilities with decreased mobility. The service user was very proud of their new bathroom. The manager is organizing window screening which was not present at the time of the inspection. The home is safe, well maintained and at the time of the unannounced inspection clean with no unpleasant odours. Care staff undertake all domestic tasks and encourage the people who live at the home to participate. The home meets peoples needs in a homely and domestic way. Bedrooms are all single with communal areas, lounge, dining room and kitchen appropriate for the people who live at the home. Bedrooms seen were pleasantly decorated and individually personalised. The home is maintained with the help of a handyman and gardener employed by the provider and by the housing association who own the home. The homes laundry is situated in a separate room away from the kitchen which is locked however service users can access this with staff support to help with their laundry. The equipment is domestic and appropriate for the number and needs of the people who live at the home. Care staff confirmed that they have adequate supplies of disposable gloves, aprons and any other infection control equipment required. Substances hazardous to health were stored securely at the time of the unannounced inspection. Certificates relating to services such as gas, electricity and fire detection systems were viewed and all are up to date. Care Homes for Adults (18-65 years) Page 26 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. The home has a consistent staff team who are provided in sufficient numbers however although staff have completed most mandatory training they have not completed some specific training in relation to the needs of the people who live at the home which may place people at risk. Staff do receive supervision however the duration of supervision may be too short to cover all necessary areas. The home was unable to evidence that full recruitment procedures had been followed before a new staff member commenced working at the home placing people at risk. Evidence: The inspector viewed staff files and training information. Interactions with people who live at the home and staff on duty were observed and the inspector spoke privately with staff on duty in the afternoon. Information in staff and service user comment cards is also considered. People who live at the home were seen to be relaxed around care staff and those able to respond verbally stated that they liked the care staff. Interactions observed during the visit indicated that people feel able to approach staff. Comment cards from staff stated that they receive supervision on a regular basis and this was confirmed by staff on duty on the day of the inspection visit. The manager Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: stated that they had undertaken appraisals and supervision training. The supervision records of two care staff were viewed. Supervision records record how long the supervision session had lasted. Those viewed recorded that supervisions had lasted no longer than 20 minutes with some lasting less than 10 minutes. Information received from the Isle of Wight safeguarding team stated that supervisions can last as little as five minutes. Although supervisions are occurring it is likely that they are of too short a duration to meet the requirements for supervision and enable both the manager and staff member to have sufficient time to raise and discuss all issues that should be covered in supervision. The inspector was shown the homes duty rota and the manager confirmed the staffing numbers within the home. One person has an individual staff member throughout the day and two other staff are provided for the remaining four people. At night one awake staff member is provided. The manager is in addition to these numbers and although he also manages a similar home nearby stated that more time is spent at Greengates as the computer is located in this home and the other home does not have one. Domestic and catering staff are not employed with care staff undertaking these roles assisted where appropriate by the people who live at the home. Care staff stated that they felt there were generally sufficient staff to meet peoples needs. The home does not use agency staff unless absolutely necessary. Additional shifts are covered by the homes staff wherever possible. At the time of the inspection visit two of the homes eleven staff were on long term sick leave. The homes staff were working extra shifts, one having worked twelve shifts without a day off. Discussions with staff indicated that they were happy with this and that they did not feel placed under undue pressure to do extra hours. However the responsible person must ensure that staff are not working excessive hours, even if they are happy with this situation, as they this may result in their becoming too tired to meet the intensive and challenging needs of the people who live at the home placing themselves and service users at risk. The home has a consistent staff team with the manager stating that only one person has been recruited over the past year. Staff on duty confirmed that they had all worked at the home for in excess of a year with the exception of the new staff member who was on a shadow shift being her second day working at the home. The inspector asked to view the recruitment records for the new staff member however these were unavailable the manager stating that they were still at head office and he had not seen these. The new staff member confirmed that appropriate procedures had occurred including application form, interview and that they had had to undertake a Criminal Records Check. They were unable to confirm if references or a POVA first check had been received by the employer prior to their commencing work. The Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: responsible person must ensure that the home can evidence by way of records that all pre-employment checks have been carried out before staff commence working at the home. The new staff member stated that they were booked on a range on training as part of their induction and the inspector was provided with a copy of the planned training. This occurs at the providers Island head office and covers all the mandatory training and would be completed over the first four weeks of the persons employment. The new staff member was working a shadow shift and stated that this was their second shadow shift and they thought they did about two weeks shadow shifts before going onto the main rota. The manager stated that five of the eleven care staff have at least an NVQ level 2 in care and that of the remaining six care staff, three are doing their NVQ level 2. Care staff confirmed to the inspector that they have undertaken all update training and that they felt they had the necessary skills and experience to meet peoples needs. The manager showed the inspector the homes training matrix which demonstrated that staff had completed most mandatory training however staff had not undertaken fire awareness training and there was no record on infection control, mental capacity or depravation of liberties training having been undertaken. Staff files viewed contained training certificates which confirmed the information on the training matrix. All staff were booked to attend external safeguarding training in December 2009. The training matrix evidenced that staff had not undertaken specific training in relation to the needs of some of the people who live at the home including Autism and Epilepsy. A requirement is made that staff must undertake all mandatory training and any training relevant to ensuring that the staff have all the necessary skills to meet the needs of the people who live at the home. Care Homes for Adults (18-65 years) Page 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not had a registered manager for almost two years although there is now a manager in place who has commenced the registration process although the outcome has not yet been determined. The failure by the provider to ensure that the home had a registered manager prior to the appointment of the current person has placed people at risk as evidenced by the requirements made following the random inspection in March 2009 and new requirements made following this inspection. Outcomes for service users are not managed and organised to ensure that in all aspects of practice the service is equiped to meet peoples needs. Evidence: The home has been without a registered manager for almost two years since the previous registered manager was promoted within the provider company. The provider appointed a person to manage the home in June 2009 and that person has commenced the registration process however delays in the first part (the CRB) have resulted in the application not yet being received at the Commission. The manager showed the inspector emails from the commission registration department detailing additional information required to proceed with the CRB. The manager also showed Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: the inspector the completed application form and other documentation ready to send to the commission once the CRB had been received. The delay in the CRB is not the managers responsibility as this had been returned to the commission from CRB. The person appointed to manage the home has managed similar homes for the provider and has the necessary qualifications including the Registered Managers Award and an NVQ level 4 in care. The manager stated that he has also undertaken all update training with other staff and undertook safeguarding for provider/managers training in June 2009. A random inspection was undertaken in March 2009 following safeguarding concerns at the home. Four requirements were made following the random inspection. These were reviewed at this inspection and had all been complied with although there is a need for further work on care plans and risk assessment reviews. Following this inspection four new requirements are made covering staff recruitment and availability of recruitment records, there has been a lack of management of training such that staff have not completed all mandatory and service specific training, health care (monitoring and action in relation to weight) and the need to ensure the safety of staff and service users by the home having a clear policy in respect of service users purchasing refreshments for staff when on outings. The report also identifies that supervisions, although occurring may be inadequate. A representative of the provider undertakes a monthly visit to the home with the written reports of these visits being seen during the inspection visit. The reports viewed were on one page and provided limited information. The reports did not identify how long the person undertaking the Regulation 26 visit had spent at the home and it was not clear how any issues identified were followed up. The home was not required to complete an AQAA prior to this inspection as one had been completed in May 2009 by the person managing the home at that time. The AQAA had not been completed to a high standard and did not say how the requirements made following the random inspection had been complied with. The AQAA should be completed by the registered person, when a service does not have a registered manager this should be the responsible person. Throughout the inspection visit a number of records were viewed. These have been identified in the relevant section of this report. The home was unable to evidence via records that pre-employment checks had been completed and there is a need to consider care plans with a view to ensuring that only relevant up to date information is Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: included and that they are less bulky making them usable tools to influence care. The home has a range of polices provided by the provider. In relation to policies there is a need to ensure that the home has a clear policy in respect of service users paying for staff refreshments to protect both service users and staff. The home has addressed the previous requirement in respect of ensuring the outside of the home is safe for service users who may have mobility needs. This requirement has been met and additional work undertaken on one persons en suite to make this safer for the person. Certificates viewed, including those for gas, electricity and equipment indicate the home and services are safe. The home undertakes a regular weekly check of the fire detection equipment however the training matrix could not evidence that staff had undertaken fire awareness training. Care Homes for Adults (18-65 years) Page 32 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 33 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 19 13 The responsible person must 01/01/2010 ensure that action is taken when there is an indication that a person has lost weight. So that peoples health needs are fully met and they are safe. 2 23 13 The responsible person must 01/01/2010 ensure that the home has a policy relating to how staff refreshments are funded when on outings with people who live at the home. So that service users and staff are not at risk of abuse or allegations of abuse. 3 34 19 The responsible person must 15/12/2009 ensure that they can demonstrate by way of records that all recruitment checks have been completed before staff commence working in the home. Care Homes for Adults (18-65 years) Page 34 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 So that people are safe. 4 35 18 The responsible person must 01/02/2010 ensure that staff have undertaken all mandatory and service specific training relevant to the needs of the people who live at the home. So that staff have all the necessary skills and training to ensure that people ahve their needs met and are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care 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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