Care Home: Highfield Court

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What the care home does well The manager sent us the AQAA when we asked for it and it had detailed information about how the service supports people who use the service, how it has improved since the last key inspection and what is needs to do to improve further. We saw that the service provides information to prospective users of the service and to people who live there in a Statement of Purpose and a Service User Guide. We saw that the service assesses prospective users of the service to ensure that it can meet their needs. One person told us that he had been asked if he wanted to move to the home and the majority of people using the service confirmed this in the surveys we received. We saw that the service is developing the model of Person Centred Planning that it had introduced at the last key inspection. People said in surveys, "Staff look after me well." "I like living here and don`t want to move." Staff said in surveys, "The home provides good quality care and support to the people who live here." "The staff team work well together and support people living at the home to be as independent as possible." People living at the home told us, "I`m okay here, I can do what I want to do and know who to go to if I have a problem." "I have my own bungalow and staff help me to become more independent." The expert by experience said, "The manager explained to me that the home consists of a number of bungalows in which people live. She said that some of the people living at the home are very independent and require only limited support whilst others with more complex needs have full time care. It was good to hear that appropriate support levels have been put in place according to people`s needs." We saw that record of complaints the home has received, and how they are resolved is kept up to date. What has improved since the last inspection? Relatives and service user meetings are now planned every 3-4 months. We saw that the service has a development plan for improving the service. We saw that the staff team has remained fairly static since the last inspection with fewer staff leaving. We saw that recruitment procedures and staff training opportunities have improved. The frequency of staff meetings have increased. What the care home could do better: All care and support records should be produced in formats that people using the service can easily understand, and they should be supported to be involved in all aspects of planning and reviewing their care and goals. The service should ensure that the bungalows are suitable for the needs of people who live in them, this includes providing the equipment necessary to support individuals to become more independent People using the service told us in surveys that, "I`d like to be able to go out more often." " I don`t like it when staff tell me how to keep my bungalow tidy I can do it myself." They also said,"I`d like to be more independent, do my own cooking and get a job." Staff have said in surveys, "We could do with more staff and the communication with management could be better." The expert by experience said, "I did not enjoy my time at Highfield Court, and would certainly not like to live there myself." The pharmacy inspector has asked the service to provide a controlled drug cupboard so that any controlled drugs that are prescribed are safely stored. That the container used to carry medication around the site is lockable. We saw that the records for home leave medication have not been properly completed in one example. A health worker said, "The service needs to act upon the advice we give to ensure that people using the service`s health needs are satisfactorily met." We (CQC) made a requirement of the service to seek a GP visit for one person who`s health needs were not being met. They have confirmed that they have done this and that the individual has received the support and treatment they need. Staff should receive training about the Mental Capacity Act 2005 and Deprivation Of Liberties, so that they can properly support people who may not be able to make a decision for themselves. And recognise when they should refer to the appropriate agency to assist with making decisions in the best interest of people. Key inspection report Care homes for adults (18-65 years) Name: Address: Highfield Court Stafford Road Uttoxeter Staffordshire ST14 8QA     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: Wendy Jones     Date: 1 3 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 34 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 34 Information about the care home Name of care home: Address: Highfield Court Stafford Road Uttoxeter Staffordshire ST14 8QA 01889568057 F/P Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rushcliffe Care T/A Moorcourt Developments Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category 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: Learning Disability (LD) 59 Mental Disorder, excluding learning disability or dementia (MD) 9 Date of last inspection Brief description of the care home Highfield Court provides care for up to 59 adults with a learning disability but also provides care to some people with a mental disorder who have lived at the service for sometime. The accommodation is provided in bungalows for individual or small groups, (maximum six) of people. There are 8 staffed bungalows supporting up to 29 people. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 59 9 2 1 0 1 2 0 0 9 Brief description of the care home The other bungalows provide support flexibly according to the assessed needs of the individual although 24-hour staff support is provided to all, and staff are available to support people who use the service to attend to their personal care and health care needs. All bedrooms are for single occupancy. Many of the staffed bungalows run as independent units with people cooking their own meals, doing their shopping and their own laundry. Most of the other people have their meals in the main dining room. Several people in the unstaffed bungalows do their shopping, cooking and washing with staff support. There is a central laundry. The service has an activity centre that is available to all of the people who use the service. The service offers some trips out and a few people attend college. The service is situated in a rural location on the outskirts of Uttoxeter and is set in extensive grounds. The service has its own transport. Prospective users of the service should contact the provider for the fee range and charges for the service. People who live at the service have to pay for transport, the cost of this is under review. They also pay for their own toiletries, some activities and for trips out and holidays. Care Homes for Adults (18-65 years) Page 5 of 34 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We carried out an unannounced key inspection visit over two days, 11 and 13 November 2009. We were accompanied by a pharmacy inspector and an expert by experience on one of the days. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The focus of our inspections is upon outcomes for people who live in the home and their views of the service they receive. This process also considers the homes capacity to meet regulatory requirements, national minimum standards of practise and focuses on aspects of the service that may need further development. Care Homes for Adults (18-65 years) Page 6 of 34 To prepare for the visit we looked at the last inspection report and our records of the information we have received about the service since the last inspection visit. Each year the service has to complete and return an Annual Quality Assurance Assessment (AQAA) to tell us how they meet the needs of the people who use, or may use the service. This focuses on what they do well, how they evidence this, and any areas they feel are in need of improvement. Before key inspections we send out surveys to people using the service, staff, relatives and anyone else who has involvement with people who live there. We have used the information in the 15 service user surveys, 11 staff, 2 others we received, to help us make a judgement about how the service supports people living at the home. When we were at the home we focused on a small number of people who use the service. This involves discovering individual experiences of living at the home by meeting and talking with them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people. This helps us to understand the experiences of people who use the service. We looked around the home to make sure it is safe, clean and comfortable and we looked to see whether people who use the service are being protected, and the arrangements the service has for listening to what people think about living at Highfield Court. We have made 7 requirements and 19 recommendations as a result of this visit and have asked the service to provide an improvement plan telling us how it intends to address the matters we have raised. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: All care and support records should be produced in formats that people using the service can easily understand, and they should be supported to be involved in all aspects of planning and reviewing their care and goals. Care Homes for Adults (18-65 years) Page 8 of 34 The service should ensure that the bungalows are suitable for the needs of people who live in them, this includes providing the equipment necessary to support individuals to become more independent People using the service told us in surveys that, Id like to be able to go out more often. I dont like it when staff tell me how to keep my bungalow tidy I can do it myself. They also said,Id like to be more independent, do my own cooking and get a job. Staff have said in surveys, We could do with more staff and the communication with management could be better. The expert by experience said, I did not enjoy my time at Highfield Court, and would certainly not like to live there myself. The pharmacy inspector has asked the service to provide a controlled drug cupboard so that any controlled drugs that are prescribed are safely stored. That the container used to carry medication around the site is lockable. We saw that the records for home leave medication have not been properly completed in one example. A health worker said, The service needs to act upon the advice we give to ensure that people using the services health needs are satisfactorily met. We (CQC) made a requirement of the service to seek a GP visit for one person whos health needs were not being met. They have confirmed that they have done this and that the individual has received the support and treatment they need. Staff should receive training about the Mental Capacity Act 2005 and Deprivation Of Liberties, so that they can properly support people who may not be able to make a decision for themselves. And recognise when they should refer to the appropriate agency to assist with making decisions in the best interest of people. 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 34 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 34 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. People using the service can be confident that their needs will be assessed prior to agreeing that they will move into the home. And will usually receive enough information about the service to help them make this decision. Evidence: The service told us in the AQAA that, We conduct a pre-admission assessment process for potential residents as well as offering open door visiting for anyone interested in applying for residence. A trial period of residence is also available for all potential residents. We looked at one persons care records who has been admitted since the last key inspection. The records provided evidence of pre and post admission assessments and that the individual has been involved in decision making. We spoke to the person about this, they confirmed that they been involved in choosing the home. 13 people said in the surveys that they were asked if they wanted to move into the home, 2 people said they hadnt. 14 people said that that they had received enough Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: information about the home prior to making a decision to move in, 1 person said they hadnt. We spoke to the manager of the service about the Statement of Purpose and the Service User Guide. She confirmed that the statement of purpose has been revised since the last key inspection visit and that all people living at the home have a copy of the guide in their records. We saw a copy of the Statement of Purpose in one persons file, it wasnt in a user friendly format. We also couldnt see that the fee range and costs of the service had been included in the user guide. The expert by experience said, Highfield Court is situated on a very large site, which is some distance from not only the main road, but also at least 25 minutes to the local town. There is a local bus service, but this is an infrequent service. To get to the main buildings and peoples home, I had to travel up a long drive, which was single track. Immediately I was concerned that people who lived here were very isolated, and more so in the winter months. There were lots of confusing signs and it felt more like a holiday complex than someones home. I found extreme difficulty in finding reception from the car park and had to ask a resident to direct me. The manager explained to me that the home consists of a number of bungalows in which the residents live. She said that some of the residents are very independent and require only limited support whilst others with more complex needs have full time care. It was good to hear that appropriate support levels have been put in place according to peoples needs. Care Homes for Adults (18-65 years) Page 12 of 34 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. People using the service need to be more involved in care planning and setting their goals, so they can be confident that their wishes and needs are being addressed. Evidence: The service has told us in the AQAA that, We ensure that our residents are empowered to make decisions and have choices that maintain their independence and meets specific identified individual needs whilst maintaining dignity. We have also been told that the service is now implementing a new Person Centred model for care planning. This is a work in progress and will take some time to achieve over the site. We looked at a sample of care records to evidence the progress, and how people are involved in planning and reviewing their care needs and goals. We saw that the new care planning model has been introduced in two out of five of the records we looked at. But it was not easy to see from the documentation if individuals have been involved in the process. We were also disappointed with the Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: quality of information we saw, in one example a persons only goal was recorded as going shopping once per week. We spoke to seven people about their care records, five said that they didnt know what their care records said, one person said, The staff have them in the office. Where bungalows are not staffed, care records are kept in the main staff office and are not easily accessible by people using the service. In one of the staffed bungalows we spent some time with two people looking at and talking about their care records and plans, we noted that the documents need to be in a more user friendly format for these individuals to fully understand them. We saw that risk assessments are in place for individuals. We have spoken to social workers who have been involved with the service. We have been told that where there have been problems with care planning either identified at review or through a safeguarding referral. They have told us that the service is trying to address the problems and improve. The expert by experience said, I was introduced to 2 people living in one bungalow, and I asked them whether if was ok to come into the lounge and talk to them. They invited me to sit down, and I asked them about living here. During our conversation a member of staff walked straight into the bungalow, and walked through the lounge into the kitchen to speak to another member of staff who was in the kitchen preparing a meal. They closed the kitchen to have a conversation. I thought this was very rude, as this was not their home, and should have had their conversation outside, and should have knocked on the lounge door before they entered. It seems that people homes are not their own personal space, or that the staff respect it. I was invited to meet 2 other people in another bungalow. Again the member of staff knocked on the door and walked straight in, into the lounge. I was introduced to 2 men, who said they were very happy to talk to me. I asked a member of staff about communication and they said that some people communicate verbally but others communicate using Makaton signs. I asked how many staff members were trained in Makaton. The new staff member said that she is the only staff member that is fully Makaton trained. We (CQC) have been provided with the training records for the service which show that 5 staff have received makaton training. Care Homes for Adults (18-65 years) Page 14 of 34 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. People using the service need to be supported to develop their life skills and independence. Opportunities for social, recreational and occupational activities should meet their aims and goals. Evidence: The service told us in the AQAA that, We create a lifestyle that meets the needs of individual residents through the provision of on-site activities and local community participation. People told us in surveys that, Id like more outings. The staff take me on holiday and to college. Id like to go out on more and more activities. 7 people said they would like more activities and opportunities to access the community in surveys. 7 said they are happy at the home and are satisfied with the service they receive. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: One person told us during the visit that, Id like to be more independent and do more for my self. Another said, Id like a job. One person said, I keep busy and have a job cleaning cars. Staff said in surveys, We could provide more opportunities for people to go out of the home and need more staff to do this. Another said, One of the vehicles been out of action for a couple of months, this has limited the opportunities people have for going out. We found, that there are limited opportunities for people to be involved in activities out of the home. Although the manager stated that improvements have been made to how the activity team operate and engage with people, and also in how activities are recorded. We found in one example that a person using the service has not been supported to maintain contact with his family as his Person Centred Plan says he should and has not been supported to follow his religious beliefs. We found that people have not always been supported to achieve their stated goals re work opportunities. But noted that some people are accessing college courses. The expert by experience said, I wanted to understand more about how people were supported and encouraged to make a choice. While I was in the communal dining room called the Bistro. One member of staff took 2 plates of food around to the people using the service and asked them to choose. Both meals were hot meals, but no one had a choice about vegetables or salad for example, and without the evidence of a menu, I could not see how people had contributed to the planning of their own menus. People should always plan their menus, and the menus should be in an accessible format so people can choose themselves and understand them. Also instead of asking what would you like to drink? The member of staff was saying do you want tea?. That is not giving someone a choice, or encouraging them to make a choice and promoting their independence. A member of staff was standing in the dining room against the serving hatch. She was wearing a clinical apron, which looked awful. She was just watching over people using the service like a dinner lady in a school canteen. She was also having conversations with people across the room, and was talking quite loudly. I found this quite intimidating and felt like I was being watched all the time. Meal times should be a social experience and a pleasant one. This was not my experience at all. There was an activity board in the dining room. It was a blackboard and all the Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: activities were written in chalk. My first observation was that it was not in an accessible format, so a lot of the people using the service would not be able to read or understand it. I was concerned that the planner had the same activities most days, which were arts and crafts, and shopping on a Friday. I think people should be offered more varieties of activities, and there was no evidence of how people has planned their own activities. I do not regard shopping as an activity; it is more of an essential part of life. People should be supported to engage in social activities, and be encouraged to lead full lives. It is my opinion that people at Highfield court are not doing this at all. Care Homes for Adults (18-65 years) Page 17 of 34 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 using the service need to have confidence that the service manages medication safely and that their health needs will be properly monitored and met. Evidence: The service told us in the AQAA that, All major health care problems have been addressed and promptly acted on. There are no residents currently exhibiting major health care problems that have not been assessed or treated. Staff have been fully involved with residents in respect of health care issues on an educational basis, and this has resulted in a more proactive approach to the identification of individuals problems. Consequently this has enabled staff to prevent further deterioration of health of residents. We hold on site clinics to support healthcare and address Health Care Action Plans as individually identified are required. There is an increase in health promotion and access to community facilities that address health needs such as Balance Street Health Centre gym. A health professional stated, I have not been satisfied with the response I have received about the care of one person. I have asked the manager to contact the GP immediately to ensure that this person is prescribed appropriate pain relief. We spoke Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: to the manager about this and required that the GP was contacted and attended this individual. This was actioned. We have been provided with documentary evidence that the service has responded to requests by the health professional to support this individual. We found in health records that Health Action Plans(HAP) have not been developed for people. But we saw that each persons record has an information sheet that can be taken with the individual to the hospital in an emergency. We found that in one example where one person was described as having a significant health issues that require eating healthy meals and frequent weight monitoring. We could not find evidence that this individuals food intake is record or being properly monitored. We spoke to the catering team, who stated that they try to encourage the individual to make healthy food choices but have not been asked to make a record of what the person eats. The weight charts show a recent increase of 6 lbs in weight. We saw that people using the service have regular health checks with the GP and other professionals. A monthly clinic with health professionals is held on site. We found that accurate records of the receipt, administration and disposal of medicines are kept, providing a clear audit trail of medicines used in the home. Controlled drugs are not currently prescribed for people in the home. The service does not have a CD cabinet as required by the Misuse of Drugs (Safe Custody) regulations, 1973. Protocols on the use of medicines prescribed when required were filed with the medicine charts. The protocols guided staff as to when the medicines should be administered. A form for recording medicines given to people going away from the home for a few days was available but in one example we found that the form had not been completed and found that one dose of medication had not been administered when it should have been. Medicines were supplied by the pharmacy in multi dose blister packs. There were no descriptions on the pharmacy labels to allow staff to identify individual tablets or capsules in the packs. Some creams were labelled use as directed. We observed the lunchtime medicine round, which was carried out by two members of staff, both of whom were trained to administer medicines. We were told that it is the homes policy that two trained members of staff give out medicines, so that one can check the other. We noticed that one person removed the medicine from its container Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: and administered the medicine. The other person read the directions on the medicine chart aloud and signed the administration record. This meant that the person who administered the medicine did not sign the chart. Medicines were carried around the buildings in a heavy duty, unlocked bag. We were shown the medication management induction pack that staff complete; we found that staff are well trained in the handling and use of medicines and that the ability of each staff member to administer medicines safely is checked by the homes manager. We saw records of attendance for recent courses on epilepsy awareness and have been provided with a staff training matrix that shows that training in Epilepsy has been provided to the majority of staff. We spoke to a member of staff who had attended this course: She told us that she now felt more confident about recognising a seizure and responding appropriately. However, no written guidance on how staff should care for a person suffering a seizure, or a description of what a seizure might look like, was included in the care plans of people diagnosed with epilepsy. Care Homes for Adults (18-65 years) Page 20 of 34 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. People using the service need to have confidence that there needs will be listened to and acted upon. Evidence: The service told us in the AQAA that, We act promptly to acknowledge all complaints and provide responses where necessary. At all times we ensure that policies and procedures are followed. People using the service confirmed in the surveys that they know how to make a complaint and who to go to if they have any concerns. Staff told us that they know how to deal with complaints and who to report to. The expert by experience said, I was interested to know about whether people know about the complaints procedure. I spoke to 2 ladies who said they did not know about it, and this concerned me. I talked about complaining with another person, who said they knew how to but would not complain. Which is a concern as there may be things about the home they dont like and should have the confidence to complain and be sure their complaint will be dealt with. We are aware that the service has received a number of complaints since the last inspection and has made safeguarding referrals to the local authority. We are also aware that safeguarding issues have been referred to the authority where concerns Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: have been identified about the welfare of service users during reviews. We have been told by the Local Authority that the service has co-operated during any investigation or enquiry and where there has been a need to improve or change practise the service has acted to do so. A health professional has raised concerns about how the service responds and acts upon health advice, another professional has raised concerns about the attitude of staff during a training session she had arranged. Another health professional has expressed concerns about how the service has managed one person, by moving them from a shared, staffed bungalow to a single person unstaffed bungalow with out consultation. And as a consequence the individual isnt receiving the level of support and care they are funded to receive. This is being addressed through review. We couldnt see evidence that all staff have received training relating to the Mental Capacity Act 2005 or Deprivation of Liberty. Care Homes for Adults (18-65 years) Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service should all have access to a well maintained and suitable environment in which to live. Evidence: The service told us in the AQAA that, We provide and maintain to a good standard small group living environments that meet the residents needs. We continue to attempt to keep these as homely as possible whilst providing opportunity and encouragement to the residents to be involved in this process. Of the 16 people who returned a survey 14 said that, The home is always clean and fresh. Staff said, One bungalow doesnt provide adequate bathing facilities to enable wheel chair users to be independent. The expert by experience said, When I walked into the dining room, referred to as the bistro I was disappointed to see how drab the room was. It was decorated in dull colours, will poorly matched furniture, and it felt very cold. The residents were sitting at the table. The table I sat at was grubby, and the room was in much need of a redecoration. The room felt quite clinical and not at all homely. It was large in size. I did Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: not think it was a nice place to eat a meal in. The service provides accommodation to people using it in a range of bungalows, some are for single occupancy and others for multiple occupancy, from two to six people. All bungalows are located around a central court yard. Since the last inspection the service has changed how it names the bungalows for example A and B, to giving them a name ie Chartley View in an attempt to give the bungalows a proper identity. The expert by experience said, As we were walking around, a member was describing the homes by letters, which confused me as the homes were clearly named. The staff said it was because they used to identify them as letters, and it is just easier to describe them by the letter than remember the new names. What was the point of changing the names then? We found the standard of environment varied markedly. We visited 6 bungalows in total, all were for shared occupancy. We found that one is very sparsely furnished, giving the impression in the communal lounge that the bungalow was unoccupied. An occupant told us that he would like to be more independent and cook his own meals. But the bungalow doesnt have cooking facilities. We were invited to visit a bedroom in this bungalow and found a poor standard of maintenance and cleanliness. We saw an arm chair that is badly worn and stained, a single bed with no headboard, damaged wardrobe doors and general poor appearance of decor. We were invited to visit one bungalow occupied by two people who use wheelchairs. People living in this bungalow stated that they struggled to access the bathroom because of the limited space. We saw that the bathroom door wouldnt open fully to allow easy access. There was evidence of damage to walls and woodwork from the wheelchairs. We found four other bungalows were satisfactorily furnished and decorated, one to a really good standard. People living in these bungalows told us they are happy with their homes. We found that further work is needed to support people to be more independent with their environment and to ensure that staff are respectful of peoples rights and privacy. The expert by experience said, A member of staff took me into a bungalow. I was upset by the fact that they just knocked the door, walked into the bungalow and was shouting hello, hello over and over again. I felt this was an invasion of someones privacy, and the staff was not respecting their home. In this bungalow I noticed the decor was quite drab and neutral, and I wondered how much choice people had in choosing the decorations and furnishings in their own home. Care Homes for Adults (18-65 years) Page 24 of 34 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. People using the service can be sure that staff are receiving training opportunities but need to know that staff have the necessary understanding and values to respect their rights, privacy and wishes. Evidence: The service told us in the AQAA that, We make all effort to ensure that our staff are provided with the knowledge and skills necessary to provide care that meets the identified needs of our residents. The skill mix of staff on duty is regulated to provide a quality service. Training in areas specific to the needs of the resident group is provided on an ongoing basis. We try to ensure that the staffing numbers on duty are appropriate to the number and dependency level of the residents. People using the service said,I know who my key worker is and feel that staff support me. I think that staff could help me to be more independent. We need more staff so we can go out more. Staff said in surveys, The residents are cared for properly and the home is run to a high standard. We could do with more staff. Staff told us, The staff work well as a team, but communication with management is not always as good as it could be. The home does most things well. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: We have received concerns about staffing levels at the home but we looked at the staff numbers and found these to be sufficient. 12 staff plus additional management, domestic administration, catering and maintenance people are provided daily. We looked at a sample of staff rosters to ensure that levels are usually maintained at this level. We have also received a copy of a letter to the home relating to poor attendance at a staff training event and concerns about negative staff attitudes during it. The expert by experience also expressed concerns about the values and attitudes of some staff saying, While in the Bistro, I over heard a conversation in which a male resident was asking whether another resident had stopped shouting. A member of staff said yes he had, and that he was just being silly. I was upset by this as firstly this is was not an appropriate conversation to be having in a public area in front of visitors and secondly to dismiss someones behaviour as being silly is demeaning to that person, and not addressing the issues of why they are shouting. I felt the staff member acted inappropriately. While talking to two people in their bungalow member of staff walked straight into the bungalow, and walked through the lounge into the kitchen to speak to another member of staff who was in the kitchen preparing a meal. They closed the kitchen to have a conversation. I thought this was very rude, as this was not her home, they should have had their conversation outside, and should have knocked on the lounge door before entering. It seems that people homes are not their own personal space, or that the staff respect it. We have been provided with evidence of staff training that shows some improvements in the opportunities people have to access training, and the numbers of people trained to National Vocational Qualification at level 2 in care exceeds the recommended minimum number. We saw evidence that staff meetings are being held more frequently than they were at the last key inspection visit and that relative meetings are now planned 3-4 times per year. We couldnt see evidence that all staff have received training relating to the Mental Capacity Act 2005 or Deprivation of Liberty. We looked at a sample of 5 staff recruitment records and noted these are satisfactorily maintained. We asked if staff have regular supervision. The manager said that they did, but we couldnt tell if this was the case from the records we had available to us. Four staff said in surveys that they sometimes, meet with a manager to discuss their performance two said they did so regularly. Care Homes for Adults (18-65 years) Page 26 of 34 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. People using the service need to be confident that the service is managed well. Evidence: The service has told us in the AQQA that, We provide an open management structure that is staffed to by qualified and competent individuals who work well as a team. We adhere to all policies and procedures that are designed to ensure that the service provided operates smoothly for the benefit and protection of the residents at all times. We have been told that policies and procedures are up to date and the equipment in the service is checked and regularly serviced, we have not received any concerns about the service from Fire safety or environmental health officers. We are concerned that not all policies and procedures are followed as identified in the health section of this report. We have found that although the service is introducing Person Centred Plans for individuals that they are not always involved in making decisions or in their Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: evaluation. We cannot be confident that the manager or staff are able to put the PCP theory into practise. The manager keeps us informed of events in the home including accidents or incidents. We have also been routinely informed of any safeguarding referrals and the outcome of any investigation. But we are also aware a referral under safeguarding procedures was made as a result of a social work review where the service had failed to report it. People using the service said, I like living here. but I cant always do what I want to. Staff said in surveys, The management are always looking to provide more training. So that staff can do a better job. The service has developed a plan for improvements for the next 12 months including Person Centred Planning, the environment and staff training. And the organisation has a representative carry out monthly visits to the home to asses the services performance. Records of these visit and any action points from them and are kept in the home. Peoples finances are generally managed on their behalf by, we looked at a small sample of the records and found them to be satisfactory. But one person told us that she doesnt have a lock to her bedroom door or a safe place to keep her personal allowance. Care Homes for Adults (18-65 years) Page 28 of 34 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 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans should contain guidance for staff on how to recognise and respond to peoples specific medical needs (eg epilepsy) To be confident that appropriate care is given. 13/02/2010 2 20 13 The service must provide a controlled drugs cupboard. So that any controlled medication is properly and safely stored. 13/02/2010 3 20 13 The pharmacist must be asked to print a description of the tablet or capsule on each label for medicines packed in the multidose monitored dosage system (MDS) pack. So that medicines can be identified. 13/02/2010 4 20 12 The person who administers a medicine must sign the 13/02/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 medicine chart, in accordance with the homes medicine policy and national guidance on the administration of medicines. For safety reasons, to minimise the risk of error. 5 20 13 Medicines must be transported around the site in a locked container. For security reasons. 6 24 16 The service must ensure that bungalows are suitable for the differing needs of people using the service. So that people with physical disabilities have an appropriate environment in which to live. 7 24 16 The service must ensure that bungalows are well maintained, furnished and decorated. So that people using the service have a suitable place in which to live. 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 13/02/2010 13/02/2010 13/02/2010 1 1 The provider should ensure that people using the service Page 31 of 34 Care Homes for Adults (18-65 years) 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 have a Service User Guide, in a format they can understand and that clearly sets out the fees. costs and terms under which they have agreed to live at the home. 2 6 The service should ensure that staff have received guidance about valuing people and routinely put the guidance in to practice. To be confident that people using the service are treated with respect. The service should ensure that all staff are trained to be able to communicate effectively with people who have communication difficulties. The service should make further efforts to ensure that care plans are user friendly. To demonstrate that people using the service have been involved in decisions about their lives. People using the service should be able to make real choices and decisions about what they can do on a day to day basis. People using the service should be supported to access occupational opportunities where they have identified this as a goal or have indicated that they would like to find meaningful work. Information should be available in formats that people can easily understand. People using the service should be supported to live as independently as they are able to, by being encouraged to improve their life skills. The pharmacy should be asked to label all medicines (including creams) with full instructions for use. Where a service has a procedure for home leave medication it should be followed to ensure that the risk of error is eliminated. The service should inform CQC of the outcome of the complaints made to it by health professionals. The service should ensure that people using the service know how to complain and have the confidence and support to do so. The service should ensure that staff have received training and guidance about the Mental Capacity Act 2005 and Page 32 of 34 3 6 4 6 5 12 6 12 7 8 13 14 9 10 20 20 11 12 22 22 13 23 Care Homes for Adults (18-65 years) 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 Deprivation of Liberty. To ensure that they understand how to support people who are not able to make decisions for themselves and know what to do if there are concerns that an individual is being deprived of their liberty. 14 24 Lockable storage facilities should be provided in peoples bedrooms. So that they can secure personal items and money if they choose to. The service should ensure that each person has the equipment and facilities they need to enable them to be as independent as possible. The service should provide people using the service with a key to their bungalow, to demonstrate how it promotes peoples independence. The service should ensure that staffing levels are kept under review to be sure that the changing needs of people using the service are met. The service should ensure that staff receive regular supervision sessions to discuss their performance and training needs. The service should ensure that policy and procedures are followed so that people using the service can be confident that that their needs will be properly met. 15 24 16 24 17 32 18 36 19 40 Care Homes for Adults (18-65 years) Page 33 of 34 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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