Care Home: Heads Meadow

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What the care home does well People have lived at the home for a number of years and are well known to members of staff. People have built up good relationships with members of staff. People have their healthcare needs set out in a health action plan. If people need to go to hospital, there is a form with relevant information that they can take with them. Good information about people`s communication needs are set out in their care plans. Care plans identify people`s preferred daily routines. People receive intimate personal care from members of staff of the same gender. What the care home could do better: People must not be accommodated in the sitting room if they cannot access their own bedroom. Suitable arrangements must be made for other people who use the service to benefit from adequate communal space. People`s files should be rationalised so that only current information is available and to reduce duplication. Documents should be signed and dated. The supplying pharmacist should be consulted about the possibility of affixing prescribing labels to tubes of medicine so that it can be established who owns the medicine more easily. The pharmacist should also be asked whether they could cut tablets rather than members of staff doing it themselves. This is to reduce the risk of people not receiving the correct dose.Body maps should give more information about the size and colour of wounds, including details of whether the skin is broken. Although it is not members of staff`s responsibility to directly report to the local safeguarding procedure, they should be more familiar with the process. So that people are properly safeguarded. Two written references must be obtained as part of the staff recruitment process. The accident sheets for people who use the service should not be removed from the accident book. This will aid review and monitoring of accidents. We must be informed of any events that affect people who use the service. Random inspection report Care homes for adults (18-65 years) Name: Address: Heads Meadow 41 Ball Road Pewsey Wiltshire SN9 5NB one star adequate service 29/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Walker Date: 0 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Heads Meadow 41 Ball Road Pewsey Wiltshire SN9 5NB 01672563851 Telephone number: Fax number: Email address: Provider web address: Steven@StevenAbbott.wanadoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Ms Jane Abbott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Jane Abbott care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: Date of last inspection Brief description of the care home 5 2 9 0 7 2 0 0 9 Heads Meadow is a detached property in the village of Pewsey. It is one of a number of care homes in the Pewsey area of Wiltshire that are run by Mrs Jane Abbott. Together, the homes are known under the name of Valued Lives. Mrs Abbott is also registered as the manager of Heads Meadow. The people who live at the home receive support from a permanent team of support workers. They have their own rooms. The communal areas include lounges for different activities and there is a kitchen with a dining area. The home has a large garden and parking spaces at the front. A vehicle is available for trips out. The fees range from 677 to 1100 pounds per week. Information about the home is included in a Statement of Purpose. Copies of inspection reports Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home are available from the home and they can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 3 of 13 What we found: This announced Random inspection took place on 4th June 2010. We had tried to carry out the inspection the day before but no one was available at the home. We telephoned Mrs Abbot the evening before our visit, so there would be someone there to give us access to the home. The deputy manager was present during the inspection as Mrs Abbot had a prior appointment. When we arrived at the home people were having breakfast and getting ready to go to the day service run by the provider. The deputy manager told us that no one goes out unaccompanied. We spoke with one person who used the service. We looked at two peoples care plans, daily records, health action plans and risk assessments. We spoke with two members of staff who were appointed since the last inspection. We looked at their recruitment and training files. We were given a tour of the premises by the deputy manager. We looked at accident records. Before the inspection we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, staff, relatives and healthcare professionals to tell us about the service. We did not receive any replies. The last Key inspection was on 29th July 2009. Following that inspection we asked the home to send us their improvement plan. This was because there were a number of requirements outstanding from the previous inspection of 24th June 2008. Mrs Abbot sent us her improvement plan on 20th November 2009. We did not look at all the requirements from the last inspection this time. People who used the service had lived at the home for between nine and twenty years. We spoke with one person who used the service. They told us that staff were nice people, very kind. They told us that staff reminded them about things they were going to do that day and supported them with their memory. They told us they did not need any medicine. They said they were tending an orange tree and tomato plants in the green house. They told us they could smoke in their bedroom. They told us they enjoyed the meals and particularly curries. We looked at peoples care plans. The person who was described as being unable to access the stairs to their bedroom was described in their care plan as fully mobile. There were many forms and documents which were not fully completed, signed or dated. There was however good information about how people communicated and their preferred daily routines. There was a detailed health action plan with separate records of medical appointments. GPs had signed lists of homely remedies that people could take with their prescribed medicines. People had had their medicines reviewed in January 2010. The home had developed a form with basic details of peoples care and support needs that they could take with them if they went into hospital. Care Homes for Adults (18-65 years) Page 4 of 13 In the AQAA Mrs Abbott told us that personal care delivered to a female service user is always delivered by [staff of] the same gender as themselves, and every effort is made for male service users to receive support in personal care from a male support worker. At the last inspection we required that strategies for management of behaviour management must contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them and be kept under review. The deputy manager told us of the difficulties in getting the care managers to sign peoples behaviour management plans as they had not written them. In her Improvement Plan Mrs Abbott told us: We will send copies to the relevant people for signing in agreement with. The deputy manager told us that one care manager was assessing one persons care. A member of staff showed us a pack of pictorial communication cards which were being developed with people. They told us that one person benefited from their use and would show members of staff what they wanted, using the cards. The deputy manager showed us the arrangements for storing peoples medicines. At the last inspection we recommended that the location of the medicine cupboard was reviewed so that it was less public and not affected by environmental factors. The medicines were still being stored in the same cupboard. There was a bottle of half tablets with a hand written label on. The deputy manager told us that the tablets were cut in the home as only half the dose was needed. During the inspection the deputy manager discussed this with the supplying pharmacist. There was a nearly used tube of prescribed topical cream without a label in one persons medicine box. We advised the deputy manager to discard the tube and request that the supplying pharmacist places the dosage label on the tube rather than on the box which may be discarded. At the last inspection we required that the home must follow its own procedure for the administration of medicines prescribed to be taken only when required. This included completing the Functional Analysis Forms. In her Improvement Plan, Mrs Abbott told us that a more user friendly functional analysis will be developed. There was guidance to members of staff on when to give medicine which was prescribed to be taken only when required. If the medicine was needed members of staff had to consult with the provider or a senior member of staff. The Functional Analysis form was then completed to record the these details. Peoples bedrooms were decorated and furnished to suit their personalities. In the AQAA Mrs Abbott told us that the bathrooms, utility room, hallway, landing and one persons bedroom had been redecorated. One persons room was being used as a store. We were told that the person had been sleeping in the sitting room since their mobility and general wellbeing had deteriorated around Christmas time. Their clothing was stored in their chest of drawers located in the hallway. Some clothing was hung up nearby. The deputy manager told us that the occupational therapist had been involved and Mrs Abbott was considering installing a stair lift so the person could go upstairs to their bedroom. We said that this arrangement was entirely unsuitable for the person as they were afforded no personal space, privacy or dignity. The room, which was also used by other Care Homes for Adults (18-65 years) Page 5 of 13 people, opened up onto the hall and the dining room. This arrangement also meant that other people were not able to benefit from the sitting room. We had not been informed of this arrangement. There was no record on the persons file as to whether the persons family or care manager had been told or consulted about this arrangement. We said that there must be an urgent review of the arrangements so that the person can be better accommodated to suit their needs. We were shown the laundry room. The deputy manager told us that some people were involved with some household tasks. All of the radiators in the home were guarded to ensure that people were not at risk of scalding. All of the upstairs window had their openings restricted so that people were not at risk of falling out. Some of the hand wash basins had the taps restricted because of some peoples behaviour. The deputy manager told us that the towels and toilet paper in some of the toilets had been removed because some people would put them down the toilet and block the system. The staffing rota was compiled up to the coming Saturday. The staffing cover was inconsistent over alternate weekends of 3rd and 4th April 2010, 17th and 18th April and 1st and 2nd of May 2010. There were only two staff on duty during the day on the Saturdays and Sundays. On the other weekends and week days there were three members of staff from 8.00am to 9.00pm. Since the inspection Mrs Abbott told us that staffing levels at the weekend would depend on what people had planned. At night there was one member of staff sleeping on the premises. One member of staff told us that some staff work in some of the other homes run by Mrs Abbott and her husband. We looked at the recruitment records of the last two members of staff to be appointed. There was only one reference for one member of staff. All the other documents and information required by regulation were on file. A member of staff with the delegated responsibility for inducting new members of staff showed us the induction packs. They told us that staff training was updated regularly with both in house and outsourced training sessions. One of the newer members of staff told us they were shadowed whilst they were inducted. They told us they did not give personal care alone. They said they would not give people their medicines until they had been trained in medicine administration. They told us they were undertaking NVQ Level 2 in care. They said they had undertaken training in Autism, sexuality and conflict management. They told us they had been shown safe handling techniques for moving people. Another new member of staff told us they had previous experience of working with people with learning disabilities in a similar home and in a hospital. They told us they had been inducted into their work in this home. They said that Mrs Abbott had trained them to give people their medicines. The member of staff told us they had NVQ Level 3 in care. We asked staff about supervision. One staff said that they did not work alone and the other said they had not yet had formal supervision. They both said they would discuss any issues with Mrs Abbott or the deputy manager. They both had supervision contracts on file. The supervision agenda was set by senior members of staff and comprised of a set of questions about different subjects. Care Homes for Adults (18-65 years) Page 6 of 13 We asked members of staff about the local safeguarding process. They told us they would report any allegations or observations of abuse to Mrs Abbott. We asked members of staff if they had been given a copy of the local procedure, No Secrets in Swindon and Wiltshire. It was clear from discussions that staff were not familiar with the process and did not recall being given the booklet. We later found a copy on file. In the AQAA Mrs Abbott told us daily body maps aid possible early detection of physical abuse. Inappropriate Practice leaflets handed out to all staff. We looked at the accident book. The numbered sheets had been taken out. The deputy manager told us that the records had been placed on peoples files. There were body maps which gave brief details of accidents and incidents such as graze on elbow. We said that the records would benefit from more detail, for example, the size and colour of wounds, together with details of whether the skin was broken. The deputy manager told us that she and Mrs Abbott were undertaking the Leadership and Management Award. The deputy manager told us that she attended the same mandatory training as everyone else. They told us they had recently completed training in record keeping, Autism, care planning, bi-polar disorder and person centred planning. The deputy manager told us that the fives homes run by Mrs Abbott and her husband now have secretarial support. What the care home does well: What they could do better: People must not be accommodated in the sitting room if they cannot access their own bedroom. Suitable arrangements must be made for other people who use the service to benefit from adequate communal space. Peoples files should be rationalised so that only current information is available and to reduce duplication. Documents should be signed and dated. The supplying pharmacist should be consulted about the possibility of affixing prescribing labels to tubes of medicine so that it can be established who owns the medicine more easily. The pharmacist should also be asked whether they could cut tablets rather than members of staff doing it themselves. This is to reduce the risk of people not receiving the correct dose. Care Homes for Adults (18-65 years) Page 7 of 13 Body maps should give more information about the size and colour of wounds, including details of whether the skin is broken. Although it is not members of staffs responsibility to directly report to the local safeguarding procedure, they should be more familiar with the process. So that people are properly safeguarded. Two written references must be obtained as part of the staff recruitment process. The accident sheets for people who use the service should not be removed from the accident book. This will aid review and monitoring of accidents. We must be informed of any events that affect people who use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13 Strategies for management 31/10/2009 of behavioural needs must contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them, and be kept under regular review. This requirement from the last inspection has not been met in full. The strategies need to be shared with the relevant professional to ensure that they are appropriate for the people who use the service. 2 39 24 The homes system for quality assurance must be implemented in full. This is to ensure that the outcomes are clearly identified and peoples views are reflected in a development plan for the home. 30/11/2009 3 41 17 Records must be maintained 30/07/2009 so that they are accurate and up to date. This is to ensure that the correct procedures are being followed and there can be no Care Homes for Adults (18-65 years) Page 9 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action misunderstandings about what has been done. Care Homes for Adults (18-65 years) Page 10 of 13 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, 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 26 23 People must not be 30/06/2010 accommodated in the sitting room if they cannot access their own bedroom. Suitable arrangements must be made for other people who use the service to benefit from adequate communal space. Because people have contracted with the home to provide private accommodation and people should expect their privacy and dignity to be respected. 2 34 19 Two written references must 30/06/2010 be obtained as part of the staff recruitment process. As evidence of a robust recruitment process. 3 37 37 We must be told about any event in the home which affects people who use the service. As required by regulation. 30/06/2010 Care Homes for Adults (18-65 years) Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 Body maps should give more information about the size and colour of wounds, including details of whether the skin is broken. The supplying pharmacist should be consulted about the possibility of affixing prescribing labels to tubes of medicine so that it can be established who owns the medicine more easily. The pharmacist should also be asked whether they could cut tablets rather than members of staff. This is to reduce the risk of people not receiving the correct dose. Although it is not members of staffs responsibility to directly report to the local safeguarding procedure, they should be more familiar with the process. So that people are properly safeguarded. Peoples files should be rationalised so that only current information is available and reduce duplication. Documents should be signed and dated. The accident sheets for people who use the service should not be removed from the accident book. This will aid review and monitoring of accidents. 2 20 3 23 4 41 5 42 Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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