Care Home: Herbert Road, 185

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What the care home does well Prospective residents have comprehensive needs assessments and can "testdrive" the home before moving in on a trial basis. Resident`s are supported to make choices in their daily lives and are able to choose activities they like to take part in. They are supported to develop their daily living skills and are also enabled to follow their own chosen routines. Residents are offered healthy food and can choose what they want to eat. The people living in the home are supported in a manner that protects their privacy and dignity. Staff deal with some difficult situations in a calm manner and communicate well with social services about resident’s incidents and safety issues. Each person is supported to access professional healthcare based on their individual needs. Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 What has improved since the last inspection? Staff have had fire safety training and medication training so that they can adequately support and protect residents. Complaints are now formally recorded and dealt with by the homes manager. Any incidents concerning residents are now reported to the Care Quality Commission and social services quickly so that residents are now better protected. The manager has now registered with the Care Quality Commission. What the care home could do better: The residents must be given information about the cost of their service in writing so that they are informed about their rights and cost of their support. Risk assessments must be reviewed more often so that the ways that staff help residents to stay safe are always up to date. The home must check whether any residents can be responsible for their own medication and also provide a locked cupboard or drawer in their rooms for their valuables or medication should they need it. The home needs to be completely redecorated so that residents can be more comfortable in their home. Residents themselves said this and I saw this to be the case at the inspection. One residents bed needs to be removed and the best means of providing a bed to be decided with her. Staff induction and training needs to be improved especially in the areas of safeguarding, mental health support and moving and handling so that residents will always be supported safely. The management from outside of the home need to visit at least every month so that they know the support and help that the staff and residents need. The water in some areas in the home is too hot and needs to be regulated so that it’s cooler and some health and safety paperwork needs to be brought up to date, such as the fire risk assessment and the safety tests for some appliance. Key inspection report CARE HOME ADULTS 18-65 Herbert Road, 185 London SE18 3QE Lead Inspector Sean Healy Key Unannounced Inspection 5th August 2009 10:00 Herbert Road, 185 DS0000065983.V376353.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. Herbert Road, 185 DS0000065983.V376353.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 Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Herbert Road, 185 Address London SE18 3QE 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) 020 8854 9393 020 8854 9393 info@hillgreen.co.uk Hillgreen Care Ltd Mr Rodney Elton Edwards Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Herbert Road, 185 DS0000065983.V376353.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 service users of the following gender: Either 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 29th July and 6th August 2008 Date of last inspection Brief Description of the Service: The home is registered to provide care for three people who have been assessed as having a learning disability. The home is owned and managed by Hill Green Care Ltd. The home is an older style detached house set back from the road in a large garden. The home is within easy reach of local transport, services and shops. There is off road parking. Accommodation consists of three single bedrooms, one of which is on the ground floor. There are bath/shower rooms and toilets on both floors. Also situated on the ground floor are a lounge dining room, kitchen, utility room and office which is also used as the staff sleeping in room. Currently there are three residents and no vacancies. At 5/8/09 the homes fees for support for three residents range between £1,575 and £1,800 per week for support and accommodation, and are paid by three separate placing authorities, Barnet, Islington and Bristol. This charge includes food provided. Residents do not yet have adequate contracts to describe the fees or the reason for differences in charges. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. Herbert Road, 185 DS0000065983.V376353.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 that the people who use this service experience adequate quality outcomes. This inspection site visit took place over one day on 5th August 2009. It was unannounced, and was facilitated by the Manager, who has now registered as care manager with the Care Quality Commission. During the inspection three residents were observed being helped by staff and their assessment/planning files were examined. Two support staff were interviewed and three staff files were examined to see recruitment, supervision and training records. The inspection included examination of records and policies and procedures, and a tour of the building. All five of the requirements made at the previous inspection have now been met. The main area lacking in progress is that the home does not yet tell residents in writing the cost of their service, staff training needs to be improved and some health and safety issues and documentation needs to be updated. The home itself is in need of redecoration and updating. Residents seem to be generally happy living at the home, and comments from commissioning authorities suggest that they are happy that resident’s needs are being met. The atmosphere was relaxed and friendly. The manager and staff involved Residents and spoke with them regularly. What the service does well: Prospective residents have comprehensive needs assessments and can testdrive the home before moving in on a trial basis. Residents are supported to make choices in their daily lives and are able to choose activities they like to take part in. They are supported to develop their daily living skills and are also enabled to follow their own chosen routines. Residents are offered healthy food and can choose what they want to eat. The people living in the home are supported in a manner that protects their privacy and dignity. Staff deal with some difficult situations in a calm manner and communicate well with social services about resident’s incidents and safety issues. Each person is supported to access professional healthcare based on their individual needs. Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 7 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 Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 8 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 and 5 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. Residents have comprehensive assessments and can test-drive the home before moving in. However they are not given adequate information about the cost of their service or their rights and obligations. EVIDENCE: The home has an up-to-date Statement of Purpose and Service Users Guide both of which were reviewed in 2007. There is good use of pictures to enable residents to understand these documents so that they can make a judgement about whether to live at home. Copies are given to each resident, and to social services when they are referring residents. As was the case at the last inspection all the residents have a full assessment of their care needs provided by the placing authorities. I inspected two resident’s care assessments and these included a full range of health care needs and social care support needs. All residents were assessed as having learning disability support needs, but some support required with personal care. Mental health support and physical disability support needs also feature in these assessments. Two social workers involved in placing residents said Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 9 that the home was good at collecting information needed and is generally providing a good service for residents. At the moment the home does not provide residents with completed statements of terms and conditions or contracts showing fees to be charged and their rights and obligations. The registered provider must ensure that each resident is given a written contract showing all fees charged, including support costs, and these are agreed and signed by them or by their Representative. (Refer to Requirement YA 5) The following general guidance should form a basis for these contracts, but more detailed information is to be found under Standard 5 of the care homes regulations: “The fees to be charged must specify the amount of fees to be paid, with a breakdown of what the fees are for, e.g. care and support, food, transport, or any other services. They should also be clear reference as to who pays the fees where the fees are being paid by anyone other than the resident. In this case a number of local authorities pay fees for all residents and this should be referred to in the Service Users Guide and in contracts/terms and conditions.” Herbert Road, 185 DS0000065983.V376353.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 and 9 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. Residents can be sure that all of their assessed needs and personal goals are reflected in their individual plan, and they do get help to make decisions about their lives. They are supported to take assessed risks, which enable them to be more independent. EVIDENCE: I examined three residents care plans and risk assessments. Each of these residents has a personal profile and a personal care plan, which has been regularly updated. There is also a person-centred plan showing their personal needs and plans for the future. This allows the residents to have a better voice in their care planning. All have had an annual review during the past 12 months and all except one had a six month review during that time. The annual reviews were attended by the resident, social worker, the Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 11 resident’s keyworker and the registered manager. There was also involvement from relevant GPs and other health care professionals. The notes taken from these reviews are very detailed and show that previous aims of service users have been reviewed and new aims for achievement or activities have been set. However the home needs to review all resident’s care plans at least every 6 months including risk assessments. The manager said one six month review due in June had been missed while awaiting a date from social services. It is the case that social services do not need to attend the 6 monthly reviews and the review should take place in their absence but in consultation with them. (Refer to Requirement YA6 AND YA9) All residents have learning disabilities support needs, and some have personal care support needs and physical disability and mental health support needs. A description of how to provide care in these areas is outlined in the care plan for each resident. Two residents have family involvement on a regular basis, and the other resident has begun having involvement from the citizen’s advocacy group. Two residents manage their own finances and one has the support in managing their benefits and bank accounts. In this case a corporate appointee manages this residents finances and ensures that the resident has enough money for day-to-day expenditure, and that the correct benefits are claimed on their behalf. This resident’s finances are being safely managed, and receipts are kept for expenditure. However regularly money from the household petty cash is used to buy things for this resident and is later reimbursed by the resident to the household petty cash. This process can be difficult for the resident to understand and it is recommended that the home consider reviewing the process so that the resident will always have his own money available to him at home. It is further recommended that the home devise a separate system for each resident for recording their bank and cash balances, so that there is a single record for each resident, which does not include other resident’s information. (Refer to Recommendation YA7) There are a good range of risk assessments on file for each resident, which are truly original and typed so that staff can easily understand them. However these need to be reviewed at least every six months, so that residents will always be safe. (See Requirement YA6 and YA9) Herbert Road, 185 DS0000065983.V376353.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 and 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. Residents have appropriate activities and are part of the local community. They have good relationships with family and friends, and their rights are respected and responsibilities are recognised in their daily lives. A healthy diet is provided for and meals are provided at times which suit residents best. EVIDENCE: All residents have assessments and care plans that clearly state their interests and preferred activities. These include education, training and leisure activities. Care plans reflect these activities, and these include residents’ views on desired new activities. There are also good links with the local adult education system and a number of residents attend classes. Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 13 All residents have full access to activities in the local community and this sometimes involves strangers becoming involved with one resident posing potential risk. The home communicates well with the resident about this and is supportive while also discussing any concerns with the resident and social services. Staff provide support when necessary but also enable residents to go out independently when they are able to. Daily records showed that staff do work well and creatively to involve residents in the daily running of the home, in order to foster their abilities as much as possible. Activities include going to public houses, cafes, walks in the park, bowling swimming watching TV and writing. Residents said the staff and manager are very nice and helpful and support them to get out to meet other people. While one resident expressed a need to live more independently, and said this sometimes causes some friction with staff, it is also the case that the homes manager and staff listen and discuss all concerns with the resident and social services. Two residents have regular family who come to see them. One resident has begun having some support from citizen’s advocacy and the home has supported this to happen. I observed staff working in supporting a resident in preparing to go out and there was excellent communication about where they were going and what they were going to do. All residents have their own rooms for which they have their own key. Staff respect service users’ right to privacy and only enter the room with permission. Two residents said “Staff are very respectful and don’t come into my room without being asked.” Residents are involved fully in shopping and cooking and are offered choices of food on a daily basis. Good records of menus are kept, and the manager reviews these to see that good food is being offered. Laminated pictures are regularly used to help residents make choices. One resident said they choose what they want to eat, and the food is good. It is recommended that the home explore the best means of supporting residents to conduct relationships in their own home, and where there are reasons for any undue restrictions in doing so that these be discussed with the resident and social services and be recorded on relevant care plans so that residents can fully understand their rights. (Refer to Recommendation YA15) Herbert Road, 185 DS0000065983.V376353.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 and 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. Residents receive personal support in the way they prefer and their needs are being met in all other areas. Support with medication is appropriate for the service users’ assessed needs but the home needs to assess resident’s ability to retain control of their own medication. EVIDENCE: During the course of the visit we observed that staff respected resident’s privacy and dignity. Residents were addressed by their preferred name. It was observed that all the residents were wearing age appropriate clothing that reflected their individual personalities. We looked at the healthcare records for the three people living in the home. They had all been supported to access a range of healthcare professionals including the GP, psychiatrist and other appointments according to their individual needs. One person living in the home has difficulty verbally expressing themselves and a speech therapist from the Community Learning Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 15 Disability Team is now involved with the resident and staff to provide help in relation to this. We looked at the medication, administration records and discussed staff training in relation to medication. The home has an up to date medication policy and two residents are receiving medication on a regular basis. The home uses the Boots blister pack system. The medication is stored in a medication cupboard in the manager’s office. There was a requirement made at the last inspection for the home to ensure that all staff responsible for giving medication had appropriate training. This requirement is now met and all staff have had this training. Recommendations were mad at the last inspection for a protocol for administering PRN to one resident to be put in place. This has now been done and two members of staff now sign the record to ensure that details of the medicine have been accurately recorded. Of the two residents who take medication none have as yet been assessed regarding their abilities or wishes to self medicate at any level. The home must ensure that all residents who take medication are assessed in accordance with the provider’s medication policy and that a record of this is maintained on their care plans. (Refer to Requirement YA20) Herbert Road, 185 DS0000065983.V376353.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 and 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. There is a complaints procedure in place, and staff do record complaints brought to their attention and action taken to address them. Procedures and training on safeguarding vulnerable adults are in place to help protect people living in the home but not all staff have had this training. EVIDENCE: The home has a good complaints policy in place that was last reviewed in 2009. One Resident’s describe who to speak to if they had any concerns about the service being provided and two others said they know how to complain if they are not happy. There is a good relationship between the staff and residents, and the staff showed a good awareness of how to deal with complaints. There have been no complaints since the last inspection. Two residents said that the staff and manager listen to them but that they have no reason to complain. Currently the system for recording complaints means that any complaint received will be written into a complaints book which is available to all staff, although the provider’s complaints policy has a system for having complaints recorded on loose leaf forms which are then given to the manager. It is recommended that the home use this system and ensure that any complaints received are given to the manager in confidence and that he then record these Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 17 in a confidential complaints book to be kept in a locked cabinet. This is in order to maintain confidentiality and to foster confidence in the complaints system. (Refer to Recommendation YA22) The home has a copy of the Greenwich Adult Protection Policy and also a copy of the providers safeguarding policy. There have been two safeguarding issues reported to social services since the last inspection. The home reported these quickly and efficiently to social services and to the Care Quality Commission, and participated fully in subsequent intervention. Some residents support needs merit this staff team being highly aware of how to operate the safeguarding policy. It is a number of years since some of the staff have had a stand alone adult protection training session. One of the staff I interviewed showed a good knowledge of how to respond to allegations or suspicion of abuse but another said they had not had any formal training and examination of two other staff files showed that they had not had a record of this training taking place. The homes induction system did not show specifically that safeguarding training had taken place although the homes manager and area manager assured me that it is part of the induction process. The home and registered provider must ensure that the induction process for new staff clearly specifies safeguarding induction, and also that all of the staff receive a fuller training session as part of their scheduled training. (Refer to Requirement YA23/35) Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 18 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): 24,26 and 30 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 home is generally safe and clean but many areas are in need of redecoration to make it a homely environment EVIDENCE: The home is detached and is situated just off a quiet road, set well back in a garden area. It is private and secluded. Accommodation consists of three single bedrooms, one of which is on the ground floor. There are bath/shower rooms and toilets on both floors. Also situated on the ground floor are a lounge dining room, kitchen, utility room and office, which is also used as the staff sleeping in room. The house has a large garden. Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 19 The house has satisfactory laundry facilities and storage for chemical cleaning materials. The home was clean and tidy and the staff clean it on a daily basis. There is a fire alarm system which is maintained under contract and suitable fire safety arrangements are in place, with the exception of a fire risk assessment which was not available during the inspection. (See Requirement under Standard 42 of this report) The home is generally in need of complete redecoration involving residents, in order to make it comfortable and appropriate for their needs. Some bedrooms, and much of the communal areas, are in need of redecoration, and have not been decorated originally in colours chosen by residents. There are general information posters attached to the hallway walls, which would be better kept in files. There is damage to the living room carpet which has been taped up and this needs to be replaced. One resident’s bedroom is in need of redecoration, and some windows on the ground floor which had glass replaced, was not well finished or repainted. The garden area has a fence which was broken and the main sections were removed leaving the concrete fence posts standing alone. The home’s management must ensure that the areas discussed above are included and prioritised in the refurbishment development plan for the home and addressed appropriately. (Refer to Requirement YA24) Water temperatures in the home are not currently effectively regulated to a safe temperature and this must be corrected so that temperatures are regulated to a safe level of 43 in order to protect residents. (See Requirement made under Standard 42 of this report) The bed in one resident’s room needs to be replaced as it is badly damaged. The home’s management feel that damage to the bed is a consistently recurring problem. The home needed to ensure that this resident had in place a method of sleeping which was suitable to her needs and was safe. The homes manager confirmed that a new bed had been purchased prior to writing this report and so no further action is necessary. One resident’s bedroom does not have any mirrors, which necessitates using the mirror in the living room area for personal use. Although there are reasons personal to this resident as to why this is the case, it is recommended that the home explore options for finding suitable unbreakable mirrors for Use in the bedroom. (Refer to Recommendation YA26) Two of the residents do not have a lockable space in their bedrooms for locking away personal valuables or medication. The home must ensure that all residents have a drawer or cabinet in which they can lock important personal items or medication should they choose to. (Refer to Requirement YA26) Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 20 Herbert Road, 185 DS0000065983.V376353.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 and 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. The staff team is committed and stable and more than 50 hold an appropriate qualification in care. Recruitment procedures are safe and well managed and staff are well supervised. Training and induction need some important areas included. EVIDENCE: The current staff team consists of a manager and four care staff, two of whom are women and one man, with one staff vacancy. The home intends to recruit to one this vacant post. The staff have a good understanding from their own personal experience and training of the cultural needs of the residents. The staff levels provide support each day as follows: • 8am to 1pm two care staff • 1pm to 5pm three care staff • 5pm to 10pm one care staff with a second sometimes for evening activities Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 22 • 10pm to 8am one sleepover staff with support from on call management The staff say that they feel they are able to do their job with this level of staffing although they feel that it is busy. They said the manager is available to provide extra support a number of days a week and also does shift work with the residents. 50 of the care staff are qualified to NVQ level 2/3 and two more are on the NVQ course. Two of the three staff interviewed said they had completed NVQ2 or NVQ3. This shows the home to have achieved the minimum required level of NVQ qualified care staff. Today’s inspections shows that the homes management has taken positive action to ensure that evidence of all of the recruitment and employment information for each member of staff is available. A well organised system has been put in place to include records of the information needed and all of the information needed is available at the home. Examination of three staff files showed that all of the necessary information is collected in a timely fashion and that all of the staff are fully CRB checked and proper references taken up before starting employment. All of the staff have undergone a 1 week induction at the start of their employment covering the main statutory required training. However there is a need to include more in depth stand alone training for staff in the induction regarding safeguarding adults for all new staff, and to ensure that all staff have up to date safeguarding training. (Two staff files showed that these staff had not had this training and this was also supported by comments received by a number of staff) (Refer to Requirement YA35) Staff files examined showed that there is generally a good level of training provided but that there is a need to ensure that all care staff receive more specific training on understanding mental health and regarding moving and handling. Two of the staff whose files were examined had not had this training. (Refer to Requirement YA35) It is further recommended that management of challenging behaviour training and drugs and alcohol abuse training be provided as part of the training prospectus for this home. (Refer to Recommendation YA35) All staff files examined showed that staff are receiving formal supervision with their manager at least every six weeks. The staff interviewed also confirmed that this is happening and said that they felt supported by the homes management. Herbert Road, 185 DS0000065983.V376353.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 AND 42 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. Residents do now benefit from a well run home but some improvements are still needed regarding management monitoring processes. Quality assurance does not include feedback to residents about findings and senior management auditing needs improvement. The health and safety of residents are generally protected by the homes practices but some improvements are needed. EVIDENCE: The manager appointed at the last inspection has now registered with the Care Quality Commission meeting a requirement made at that time. The manager has a qualification in youth work and has now awaiting a start date for Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 24 commencing on the NVQ4 in care and management. It is expected that the manager will complete this course over the next six to 12 months and no requirement has been made as this is now being addressed. Comments received about the manager’s abilities to provide for the care needs of residents have been positive and the manager has improved the reporting of incidents and safeguarding issues to relevant professionals. The home does experience sometimes difficult situations involving involvement from the police or social services and has on a number of occasions had to deal with difficult situations with members of the public. It is important that the home is monitored by a visitor appointed by the registered provider at least monthly in order to provide support and to proactively identify areas where additional help may be required. However these monitoring visits are not currently happening monthly and are sometimes not happening for up to three months. The provider must ensure that these visits happen monthly and that a written report is made available at the home showing area, which have been checked and recommendations made. (Refer to Requirement YA37) The home does not yet have a development plan in place and the manager confirmed this to be the case. However he also was able to show that he is in the process of producing one which will include comments from residents, training, the physical environment, activities and care issues for residents. There was an organisation wide resident’s survey conducted in the previous 6 months but the home did not receive any feedback about it’s findings and so could not inform residents of the outcome. The home must ensure that resident’s views are formally taken up at least annually, that they receive feedback on findings and recommendations, and that these be included in the homes development plan. (Refer to Requirement YA39) There was a requirement made at the last inspection for the registered provider to ensure that staff received training in fire safety and that the home should routinely notify the Care Quality Commission of any incidents affecting the health or wellbeing of residents. Both of these requirements were met. Generally there are good health and safety systems in place to protect residents and staff. Most of the health and safety paperwork such as maintenance of gas electricity and the fire alarm system were up to date and health and safety checks and risk assessments for residents are completed. Risk assessments need to be reviewed every 6 months at least instead of every year (see requirement Standard 9) Some areas of health and safety needed to be updated on the day on inspection as follows: 1. Water temperatures in the home are not currently effectively regulated to a safe temperature and this must be corrected so that temperatures are regulated to a safe level of 43 in order to protect residents. Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 25 2. Portable appliance tests were overdue since April 2009. Following the inspection the manager confirmed that these had now been done on 25/8/09 3. The Fire Risk Assessment for the home could not be found. A new risk assessment must be produced in liaison with the organisations health and safety representative and with the fire authority. Points 1 and 3 above are the subject of a new requirement. (Refer to Requirement YA42) Herbert Road, 185 DS0000065983.V376353.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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 2 X 2 X X 2 X Version 5.2 Page 27 Herbert Road, 185 DS0000065983.V376353.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 YA5 Regulation 5.1 Requirement Timescale for action 30/11/09 2. YA6 YA9 13.4 3. YA20 13.2 The registered provider and manager must ensure that residents have written contracts showing the cost of their care and support and all other information required by Standard 5 of the Care Homes Regulations 2000. This is to ensure they are aware of their rights and obligations The registered provider and 30/11/09 manager must ensure that residents care plans and risk assessments reviewed at least every 6 months. This is to ensure that residents and others are protected from risk and harm The registered provider and 31/12/09 manager must ensure that all residents be assessed regarding their abilities and wishes to manage their own medication and that a record of this is kept on their care plan. This must include whether they agree to the home managing medication on their behalf. This is so that residents are given choice about how their medication is managed and to promote their DS0000065983.V376353.R01.S.doc Version 5.2 Herbert Road, 185 Page 28 independence. 4. YA24 23.2 b &d The registered provider and manager must ensure that all of the areas of maintenance and decoration discussed in this report under Standard 24, are included in the homes plans for maintenance and renewal. This is to ensure that the residents home is comfortable and homely and of an acceptable standard The registered provider and manager must ensure that each resident has a lockable space in their bedroom so that they can safely store personal valuables and medication if needed The registered provider and manager must ensure that safeguarding adults training is included in the homes induction schedule and staff training schedule, and to ensure that all staff have up to date training in this area as discussed in this report. This is to ensure that residents will be protected and that any allegations are appropriately reported The registered provider and manager must ensure that Mental health and Moving and Handling training are included in the homes training schedule for care staff as discussed in this report. This is to ensure that residents receive safe and competent support from staff in these areas of need. The registered provider must ensure that monthly management monitoring regulation 26 visits happen consistently and that written reports are kept at the home as discussed in this report. This is to ensure that good quality management and care is DS0000065983.V376353.R01.S.doc 31/12/09 5. YA26 16.2 (l) 31/12/09 6. YA35 13.6 31/12/09 7. YA35 18 1(c) (i) 31/12/09 8. YA37 26 30/11/09 Herbert Road, 185 Version 5.2 Page 29 consistently provided. 9. YA39 24 The registered provider and manager must seek and publish views of residents about how the home is run and include relevant findings in the development plan for the home as discussed in this report. This is to ensure that residents are included in the development and improvement of the home. The registered provider and manager must ensure that an up to date fire risk assessment is completed in liaison with the fire authority as discussed in this report. This is to ensure that residents and staff are appropriately supported and protected in the event of a fire. The registered provider and manager must ensure that the homes hot water temperature is regulated to 43 degrees Celsius. This is to protect residents from the risk of injury. 31/12/09 10. YA42 23.4 30/11/09 11. YA42 13.4 30/11/09 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 Refer to Good Practice Standard Recommendations YA7 Devise a finance record system for one resident to record his personal expenditure which is separate to the hose expenditure system and ensure that this resident always has his own money available to him at the home Version 5.2 Page 30 Herbert Road, 185 DS0000065983.V376353.R01.S.doc 2 YA15 3 YA22 4 5 6 YA24 YA35 YA42 as discussed in this report. Explore how the system for enabling residents to conduct personal relationships in their own home could be improved as discussed in this report Apply the providers guidance for recording complaints in a confidential manner as discussed in this report Remove posters from entrance hallway Challenging behaviour and substance abuse training for staff Include guidance for staff in how to respond to difficult situations involving members of the public as discussed in this report Herbert Road, 185 DS0000065983.V376353.R01.S.doc Version 5.2 Page 31 Care Quality Commission London Region 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). 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