Care Home: ICS 11&12 Wembrook Close

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What the care home does well The home provides a comfortable homely environment with a positive ethos for the people that live there. People have access to a range of healthcare professionals to ensure that all their healthcare needs are met. People are offered activities during the day that are appropriate and take into account interests and hobbies. The home has an open visiting policy so that people can see their visitors as they choose and can continue to maintain relationships that are important to them. What has improved since the last inspection? The last key inspection of this service generated 18 requirements that required addressing to improve the care and outcomes for people. Compliance with these requirements was checked at the random inspection of the service which took place in October 2009. This visit confirmed that work to address all 18 requirements had either been completed or was ongoing. Two peoples` support and care plans have been fully reviewed and rewritten, with a third was nearing completion at this visit. The diets of the people living in the home have been reviewed. People are now offered a much more structured menu that incorporates choices, preferences and healthy eating. The requirements to improve medication management have all been addressed and include ensuring that all prescribed medicines are available for people and that they are only administered to people they are prescribed for; the installation of a quality assurance system to assess the competency of staff in handling medicines and accurate recording of medicines received and those carried forward onto the next medication administration record chart (MAR). The complaints procedure is available for people in large bold text and picture format, making it easier for the people living in the home to understand and access. At the time of the inspection the refurbishment of 11 Wembrook Close (purchased by the organisation earlier in 2009) was nearing completion and the people living at 8 Wembrook Close who were to move into the property were actively involved in choosing the decor for their rooms. The home has successfully recruited two new staff members since the random inspection in October 2009, which means that there are more staff available to meet peoples needs. Staff have been provided with key mandatory training such as basic food hygiene, first aid and fire safety. Training in areas such as medication administration and safeguarding vulnerable adults has also been provided. A permanent manager for the home has been appointed, and is planning to apply for registration with us so that people living in the home can be certain that the home will be run in their best interests. Comments received from associated healthcare professionals in the completed surveys we received included "This (acting) manager has turned the service around" and "...Staff are more welcoming and follow guidelines set, asking for guidance and support when appropriate". What the care home could do better: The following requirements have been made as a result of this inspection: Support plans must be regularly reviewed and updated to reflect any changes in peoples` in needs so that staff can be confident that they have access to accurate information to ensure that they can meet these needs. Risk assessments must be put in place for all people living in the home. These must be reviewed on a regular basis to reflect any changes in peoples` needs to ensure that they are supported with taking meaningful risks in a safe manner. Care plans addressing individuals` diverse needs must be put in place to ensure that people are receiving appropriate care and support thus ensuring that peoples` holistic needs are being addressed and met. Key inspection report Care homes for adults (18-65 years) Name: Address: ICS 11 & 12 Wembrook Close 11&12 Wembrook Close Attleborough Nuneaton Warwickshire CV11 4LJ     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: Justine Poulton     Date: 0 7 1 2 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 31 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 31 Information about the care home Name of care home: Address: ICS 11 & 12 Wembrook Close 11&12 Wembrook Close Attleborough Nuneaton Warwickshire CV11 4LJ 02476327797 01527546888 allan.smith@individual-care.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Individual Care Services Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 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) 5 Date of last inspection Brief description of the care home 8 and 12 Wembrook Close accommodates up to three and two residents respectively, in the category learning disability. The houses are situated opposite each other in a small close. There is one staff group and one manager. One of the homes is a detached bungalow whilst the other is a detached house. They are in a quiet residential area on the outskirts of the town of Nuneaton. The accommodation in each is similar comprising of a shared lounge, kitchen and bathroom. 12 Wembrook Close has two Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 0 6 0 7 2 0 0 9 Brief description of the care home bedrooms on the ground floor. 8 Wembrook Close has two bedrooms on the ground floor and has a further two bedrooms on the first floor, one of which is used as the office/sleep-in staff room. The organsiation purchased 11 Wembrook Close early in 2009 and have been refurbishing it in order for the people currently living in number 8 to move into. Since this inspection visit the move from number 8 into number 11 has taken place and the address of the service has been changed accordingly. Information relating to the fees charged for the service provided at this home was not made available to us. The reader may wish to contact the the home directly for this information. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was the second key inspection of this inspection year. A key inspection addresses the essential aspects of operating a care home. This type of inspection seeks to establish evidence of safety and positive outcomes for the people using the service. The inspection focused on assessing the main key standards as defined under the Care Homes Regulations 2001. As part of the inspection process we reviewed information about the home that is held on file by us, namely, the last key inspection report and recent random report as well as notifications of incidents and accidents, allegations and complaints. We also sent an annual quality assurance assessment (AQAA) to the acting manager to complete. The acting manager completed and returned the annual quality assurance assessment (AQAA) containing helpful information about the home in time for the inspection. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection included meeting all of the people living in the home and case tracking the needs of one person. Case tracking involves looking at peoples care plans and health records and checking how their needs are met in practice. Other peoples files were also looked at in part. Discussions were held with the acting manager and newly appointed permanent manager, as well as with all of the people currently resident and four staff members. A number of records, such as support plans, complaints records, staff training information and health and safety records were also sampled for information as part of this inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The last key inspection of this service generated 18 requirements that required addressing to improve the care and outcomes for people. Compliance with these requirements was checked at the random inspection of the service which took place in October 2009. This visit confirmed that work to address all 18 requirements had either been completed or was ongoing. Two peoples support and care plans have been fully reviewed and rewritten, with a third was nearing completion at this visit. The diets of the people living in the home have been reviewed. People are now offered a much more structured menu that incorporates choices, preferences and healthy eating. The requirements to improve medication management have all been addressed and include ensuring that all prescribed medicines are available for people and that they are only administered to people they are prescribed for; the installation of a quality assurance system to assess the competency of staff in handling medicines and accurate recording of medicines received and those carried forward onto the next medication administration record chart (MAR). The complaints procedure is available for people in large bold text and picture format, making it easier for the people living in the home to understand and access. At the time of the inspection the refurbishment of 11 Wembrook Close (purchased by the organisation earlier in 2009) was nearing completion and the people living at 8 Wembrook Close who were to move into the property were actively involved in choosing the decor for their rooms. The home has successfully recruited two new staff members since the random inspection in October 2009, which means that there are more staff available to meet peoples needs. Staff have been provided with key mandatory training such as basic food hygiene, first aid and fire safety. Training in areas such as medication administration and safeguarding vulnerable adults has also been provided. Care Homes for Adults (18-65 years) Page 8 of 31 A permanent manager for the home has been appointed, and is planning to apply for registration with us so that people living in the home can be certain that the home will be run in their best interests. Comments received from associated healthcare professionals in the completed surveys we received included This (acting) manager has turned the service around and ...Staff are more welcoming and follow guidelines set, asking for guidance and support when appropriate. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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 living in this home are being supported with their impending move into the organisations new property in a manner that is sensitive to their needs and anxieties. Evidence: We did not look at the homes statement of purpose or service user guide on this visit. No new residents have moved into the home since the last inspection. There is an organisational policy and procedure for referal and admissions to the service in place. Number 11 Wembrook Close has four bedrooms, which will provide an opportunity for an increase in occupancy in the near future. All of the people living in number 8 Wembrook Close have been consulted about their imminent move into number 11 Wembrook Close upon its completion. Information provided in the AQAA states that one person was supported by a former social worker when being given details about the new property, and has subsequently asked in conversation if she could take her new chair to the new house. Details provided in Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the AQAA also indicate that all three people have made encouraging comments regarding the move to number 11. The acting manager said that the organisation was taking the move slowly and were gradually introducing people to the property through visits to look at their new bedrooms, choose the decor and spend time in the house having lunch for example. One person said she knew about the new house and had chosen the colour of her bedroom and her new carpet. Information available clearly indicates that the acting manager and staff are supporting the people currently living in number 8 with their impending move sensitively, and are ensuring that they are fully involved in the process of moving to a new home, to minimise any fears and anxiety that people may have. Care Homes for Adults (18-65 years) Page 12 of 31 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 can be confident that support planning is improving, however there remains scope for increasing the level of information in some care plans to ensure that staff have the information they require to meet peoples needs in the way they prefer Evidence: A requirement made at the last key inspection of this service was for all of the care plans to be enhanced to include the basic care needs of each individual and how they like to be supported with these. At the random inspection undertaken in October 2009 we looked at three support plan files, two of which had been reviewed and rewritten and were completed, with relevant information available that enabled staff to provide care and support inline with assessed needs. The third needed further work which the acting manager said at the time she was hoping to complete imminently. Information provided in the AQAA for this inspection says that Service users changing needs and choices are identified and well documented. This was not reflected in the information we looked at for all of the people living in the home, as although three of Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: the support plans had been reviewed and rewritten two support plans had not yet been addressed following the last key inspection. One support plan was looked at as part of the case tracking process during this visit. The acting manager said that work on this support plan had now been completed, with the relevant guidance notes to accompany the care plans in place. Upon looking through this support plan we saw that care plans and guidance notes were in place for areas such as using the toilet, communication and domestic skills. We noted during this visit that this person had diverse needs that were not being addressed however. This was discussed with the acting manager and the newly appointed manager who both said that they would ensure that the relevant information was added to the support plan. We were told that little if any work had been undertaken on the remaining two peoples plans with regards to reviewing and updating them. A cursory look at these plans confirmed this. The acting manager said that this was because it takes time to get to know people enough to be able to write accurate support plans that clearly address identified needs. This means that these two people cannot be confident that their plans reflect their current needs and staff cannot be confident that they have accurate and up to date information to support them with meeting their assessed needs. As recorded following the random visit, the risk assessments for two of the people living in the home had been reviewed and updated into a more robust format that contained detailed information. Risk assessments in the same new format were available within the support plan looked at during this visit, although review dates were scheduled however there was no evidence available to confirm that these reviews had taken place, which means that the information within them was not necessarily the most accurate and up to date. As with the support plans, there were no risk assessments in place pertaining to the diverse needs of this persons life and well being. Again this was discussed with the acting manager and newly appointed manager who gave a commitment to ensuring that this was addressed and, along with the relevant care plans, would be put in place. Care Homes for Adults (18-65 years) Page 14 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are offered a variety of age, peer and culturally appropriate activities that make best use of in house and community facilities. Peoples relationships with families and friends are promoted. People benefit from a healthy, nutritious diet. Evidence: As at the previous key inspection of this home in July of last year, people continue to be offered positive experiences in regards to activities and leisure pursuits. People continue to access the organisations day service provision in Hartshill on an occasional basis as they choose. When they are not attending this day service provision, staff continue to be provided to ensure that that people can participate in activities of their choosing. Examples given by staff of activities undertaken recently Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: included meals out, shopping trips, bingo at a local facility, films and television, music and walks.Staff spoken with said that people really enjoy the bingo as they like to show off what they have won upon their return to the home. One person showed us some items of jewellery that she had won at a recent trip out to play. Staff continue to record any activities undertaken by people in their daily diaries, and these are also reviewed regularly with a view to determining what people do and do not enjoy doing in order to use this information with future activity planning. Information provided in the AQAA records that two people like to attend church each Sunday. This was was confirmed by one person spoken with during the inspection, who said that she likes to go to the services. The organisation continues to consider the involvement of families and friends as important, with regular contact with relatives being supported where it is requested. Since the last key inspection of the home, the acting manager has completely reviewed the foods offered to the people that live in the home to ensure that people are offered a healthy eating plan that incorporates their favourite meals, but does not rely solely on them. Menus are planned on a more formal basis, with at least two choices being offered for each main meal. Meals are now presented to people in a visual form in order for them to choose what they would like to eat, and staff and the acting manager said that they had seen a marked improvement in the choices being made and the meals being eaten by people. Both kitchens were clean and tidy, with one having been very recently decorated. Plenty of fresh, frozen and processed foods were available for people to choose from. One person said that they had noticed a difference in the meals I am being offered, there is more choice now. We also spoke to two people about the meals and foods that they are now offered. Both said that the food had improved recently. One comment received in a returned survey form a person living in the home said the meals they cook are very balanced. Care Homes for Adults (18-65 years) Page 16 of 31 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 can not always be confident that they will always receive the care and support they need. People can be sure that they will have their health care needs monitored. People can be confident that their medication is being managed safely on their behalf. Evidence: The random report written following the compliance visit to the home in October 2009 records that we saw written notes by staff recording information about how they were providing care and support to people on a daily basis. Records looked at on this visit confirmed that this is still ongoing. Information in the AQAA states that care plans are well documented describing how service users prefer to be supported with personal care. Of the five care plans in place, only two had been completely reviewed and updated, one required further work in relation to the persons diverse needs and two had not been reviewed and updated since the last key inspection in July 2009. Care plans and step by step guidelines for Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: areas such as accessing the bathroom, moving and handling, activities and eating and drinking were in place within the three support plans looked at during the random inspection and this visit. These provide staff with information to ensure that they are able to met peoples needs effectively in these areas. As recorded previously within this report, information regarding the diverse needs of one person was not recorded within the support plan looked at. This means that there is a large gap in care planning and risk assessment for this person which could result in the provision of poor care because of a lack of knowledge in how best to provide appropriate support. This was clearly demonstrated through an incident during the inspection where a person fell whilst trying to transfer herself from a wheeled chair into her arm chair in the lounge. Although the staff member involved in this incident advised that the person never stands up on her own, she clearly did in this instance and, as the brakes were not put on her wheeled chair this moved from under her as she attempted to stand resulting in a fall to the floor. The staff member said that this person requires her walking frame to assist with all transfers, and had left the person unsupervised whilst she went to fetch the frame from another room. Information regarding how this person is supported to transfer from chair to chair was not recorded within her support plan, and is part of the wider area of diverse need possibly pertaining to dementia, or changing needs as the person gets older, none of which was recorded within her support plan. Information gathered at the random inspection of this home and this visit confirmed that people are being supported to access both routine and more specialised health care support as necessary. The records looked at during this inspection confirmed that appointments with a dietitian, chiropodist and continence adviser had taken place since the last visit to the home. All of the requirements made at the last key inspection of this home in relation to medication were deemed to have been met by the pharmacy inspector at the subsequent random inspection in October. These included requriements for ensuring that all medicines held on the premises were recorded on the medication administration record chart, the installation of a system to check the prescriptions prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy, the recording of the current drug regime as prescribed by the clinician, referral to this before the preparation of individuals medicines and the signing of the chart directly after the administration of medications as an accurate record of what has occurred. Examination of medication management at this visit confirmed that medication continues to be management safely on peoples behalf, thus ensuring that people are getting their medications as presribed. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Care Homes for Adults (18-65 years) Page 19 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their views and concerns will be listened to and addressed, and that they will be protected from potential abuse. Evidence: The home has a complaints procedure in place for the people that live there. This is produced in large bold text and pictures to make it more accessible and understandable. Copies of this procedure were seen in the three support plans looked at during both the recent random inspection and this visit. In addition there is an organisational complaints policy and procedure available that staff were aware of. The home has a complaints log which we looked at during this visit. No complaints were recorded, although the AQAA records that one has been received during the previous 12 months. The manager should ensure that any complaints received, the subsequent investigation and final outcome are recorded. We have not received any complaints since the previous key inspection. We received three completed surveys from people living in the home, all of which indicated that they knew how to make a complaint. Three people spoken with during this visit confirmed that they would be able to raise their concerns if necessary, I would speak to staff, I am very happy these days; I know who to talk to if Im not happy but I generally dont have any grumbles; I tell the staff if they do something I dont like. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The home has an organisational policy and procedure in place for safeguarding vulnerable adults. Training records provided by the home confirmed that eight staff were provide with training in this area during 2009, with two left to do this as their records indicate that they had not received any training in this area since November 2005. One member of staff spoken with confirmed that she had received training in August 2009, and was also able to confirm what she would do should abuse be suspected. No allegations of abuse have been made since the last key inspection of this home in July 2009. The financial management of peoples monies was looked at and discussed with the new manager. People are provided with a weekly allowance that they are supported with. Records of financial transactions were maintained and were accurate against the amount of monies and receipts available. The new manager raised concerns about occasional overspending by people, and where the monies to fund this come from. Subsequent to the inspection she has advised us that she has looked into this and is satisfied that the people concerned have sufficient funds in their bank accounts to supplement their weekly spending money should they require it. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People continue to live in a comfortable homely environment. Evidence: Both number 8 and number 12 Wembrook Close provide comfortable, homely accomodation in a clean and hygienic environment. Each person has a bedroom decorated to their own preferences and tastes, with any necessary equipment available for them to use. The communal space in each house is pleasant and nicely furnished. One person in number 12 was keen to say that the house was being decorated throughout which he was pleased about. Laundry facilities are located away from the kitchen in each house, thus reducing the risk of cross infection with soiled laundry being transported through food preparation areas. Number 11 Wembrook Close was nearing completion at the time of this visit, and has been adapted to take into consideration each persons specific needs. Information in the AQAA records that number 11 Wembrook Close is far more spacious, accomodating wheelchair users... (it) offers much larger communal areas so that service users can benefit by carrying out activities in more than one shared space. Outdoor space is also much larger proprtionate to the number of service users and Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: staff on duty. The newly appointed manager said she was planning on looking into the installation of a ceiling hoist in one particular bedroom as this may go some way to alleviating any anxiety around using a manual hoist displayed by one person. We were advised that a proposed move date for people from number 8 to number 11 was early to mid January. The staff said that the people who will be moving into this property have been involved in choosing the decor for their bedrooms. One person spoken with confirmed this and said that she was looking forward to the imminent move. Number 11 Wembrook Close was not inspected as part of this visit, however the move into this property has taken place whilst this report was being written and will therefore be looked at as part of the next visit to this service. Care Homes for Adults (18-65 years) Page 23 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that suitable staff are employed and that they have the knowledge and skills needed to meet their needs. Evidence: Two new staff have been recruited to the service since the random inspection undertaken in October 2009. Their records were looked at and confirmed that recruitment practices are robust and safeguard vulnerable adults from potential abuse. The information regarding criminal bureau disclosures was not available within the home, but this was faxed from the organisations head office when requested, and confirmed that both people had undergone these checks. The recent recruitment undertaken by the home means that there are currently no vacancies. Staff spoken with said that the staff numbers available per shift were now good and meant that they were able to meet peoples assessed needs in all areas and not just basic care needs. During the visit we saw that people were attended to swiftly when they asked for personal assistance, with bedroom and bathroom doors being closed when personal care was being provided. Similarly, staff were available to support people to attend health appointments and to go out to participate in activities they requested as staffing levels were such as to support this. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Training records at the last key inspection were in the most part scant or non existent. Since then, staff have been provided with training in the mandatory areas of food hygiene, moving and handling, fire safety and first aid. In addition training has been provided in medication administration, abuse awareness and communication. Training is also planned for dementia care. Information in the AQAA states that four staff have an NVQ II or above in Health and Social Care. Two of the staff on duty during the inspection confirmed that they have completed this qualification. Staff spoken with during the visit were appreciative of the training they had received recently, and said that they felt that they we being valued by the organisation. Care Homes for Adults (18-65 years) Page 25 of 31 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 who live in this home do not benefit from having a registered manager in post therefore they cannot be confident that the service is managed in their best interests. People can be sure that their health and safety is maintained. Evidence: The home has been managed for the previous six months by a manager seconded from another of the organisations homes. A new permanent manager has been appointed and commenced work on 30th November 2009. This person has transferred from another of the organisations homes where she was registered with us, however under the Care Standards Act 2000 she is required to apply for registration with us as manager of 11 and 12 Wembrook Close. We were advised that the acting manager would be handing over to the new manager during December and gradually withdrawing support. Comments received in three surveys received from key health care stakeholders included This (acting) manager has turned the service around; since X has been Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: managing Wembrook things have changed considerably. Staff are welcoming and follow guidelines set, asking for guidance and support when appropriate, Service is improving.... I have more confidence in new management team. The views of the people living in the home about the quality of the service provided have been sought since the last key inspection, with the response being one of satisfaction with the service that they receive. The views of other interested key stakeholders such as the staff team, peoples relatives and associated health and social care professionals have not yet been sought. This means that the home cannot demonstrate that it seeks to fully ascertain the views of all parties involved in the service with a view to improving the quality of care and support provided. The quality assurance review should be expanded to include and involve other interested key parties such as relatives, staff and associated health care professionals to ensure that a full picture of the quality of the service provided is sought. Quality is now being monitored via other routes such as the monthly visits by the provider required under regulation 26 of the Care Homes Regulations 2001, medication audits, health and safety audits, staff supervision, and team meetings. The acting manager said that if shortfalls or errors are identified via any of these routes they are addressed with immediate effect. Information in the AQAA records that all of the routine health and safety monitoring and checks are in place and up to date. A sample selection of these, such as the hoist servicing, portable appliance testing and the landlords gas safety certificate were checked and up to date. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 Support plans must be regularly reviewed and updated to reflect any changes in peoples needs. This will ensure that staff can be confident that they have access to accurate information to ensure that they can meet these needs. 26/02/2010 2 9 13 Risk assessments must be carried out and be regularly reviewed for any activity that may place people at potential risk of harm or injury. Risk assessments must be updated to reflect any change in peoples needs or circumstances. This will ensure that people are safeguarded and supported with taking meaningful risk in a safe environment. 26/02/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 3 18 12 Care plans must accurately 26/02/2010 reflect and take into account peoples cultural or diverse needs. This will ensure that staff have access to the information they need and people can be confident that their needs will be met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 22 The manager should ensure that any complaints received, the subsequent investigation and final outcome are recorded in order to demonstrate that people are listened to and their concerns are acted upon Key stakeholders such as relatives, staff and associated healthcare professionals should be included within the quality survey undertaken by the home in order to demonstrate that a range of information is gathered from a variety of sources that can then be used to inform and develop the service. 2 39 Care Homes for Adults (18-65 years) Page 30 of 31 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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