Care Home: Josephine Butler

What the care home does well People living in the service told us that they were able to come and go from Josephine Butler as they wished. Staff told us that they thought that they had a good team and enjoyed spending team with the people who lived there. Staff spoken with showed that they had a genuinely caring attitude and wanted to proved effective support to the people living in the service. What has improved since the last inspection? At our last visit there were serious concerns regarding the management of medications. At this visit we saw that improvements had been made and medications were managed in a manner that maintained the safety of the people living in the service. What the care home could do better: Overall, despite the improvements in medications the management has not improved the quality of the service. There is no structured quality management system in place, that would help the manager to recognise areas of the service that were in need of improvement. We looked at how staff where recruited, managed and trained. We found that staff were not correctly checked before they started work, they did not have training that supported them how to meet the needs of the people living in the service. Staff do not get on-going supervision that helps them develop the skills that they need or monitors their performance. Staffing levels were not maintained at the level that the service had determined were necessary to maintain the health and welfare of people living in the service. When we reviewed how the service made sure that it protected people from harm we found that, there were significant failures in the services ability to protect people. Risk assessments were not specific to the people living in the service. In some cases the risk assessments limited peoole`s choices without a clear explanation. Training for staff in understanding and recognising potential abuse was not sufficient and as a result significant events had not been recognised or addressed. Management of people`s funds was unclear, there was no guidance for staff and records were not fully completed, all of which places people living in the service at risk. We looked at how the service managed people`s health and welfare needs. We found that one person had been admitted to the service without having their needs assessed or recognition of any potential risks. Plans of how the service was to support the person`s needs were not specific, plans did not provide staff with clear instructions and did not reflect what people`s individual needs, choices or preferences. There was limited opportunities for people to develop skills such as cooking, cleaning, laundry, money or medications management. There was no facilities or sufficient staff available for people living in the service to maintain or develop lifestyle skills. Although some people attended day centres the majority did not and as a consequence people spent their days watching television with little or no other stimulation.  Key inspection report Care homes for adults (18-65 years) Name: Address: Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE     The quality rating for this care home is:   zero star poor 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: Julie Garrity     Date: 2 5 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE 01517277877 01517277877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harold Smith Name of registered manager (if applicable) Philip David Wade Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning diability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 Date of last inspection Brief description of the care home Josephine Butler House was an older building converted for use as a care service. There were gardens to the rear and front, with a car availiable at the front of the building. The service was located in Liverpool near the Sefton Park area of Liverpool. Access to Sefton Park, Lark Lane, shops, pubs and public transport was a short five to ten minute walk. The service was registered to provide support to younger people between the ages of Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 21 0 4 0 2 2 0 1 0 Brief description of the care home 18-65 years of age that have mental health needs. Accommodation was provided on three floors with the communal areas lounge, dining room, games room and smoking area on the ground floor. All the bedrooms accommodation was provided in single bedrooms with a passenger lift to all floors. The weekly fee was 450 pounds per week. Information regarding the services was availiable on the notice board in the service. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor 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 unannounced visit was carried out over one day and took a total of nine hours. Two inspectors undertook this visit, one of whom was a specialist pharmacy inspector with expertise in determining the safe management of medications. The service was sent a self-assessment to complete before the visit. The self assessment is known as an AQAA this gave the service the opportunity to say what areas they had improved on and what plans they had to develop quality in the future. The inspectors completed the visit by looking at records such as care plans, risk assessments, care assessments, medication records, staff training records, staff files, staff recruitment, policies and procedure, services quality assurance, competency assessments of staff, supervision evidence, minutes of staff meetings and complaints records as examples. We spoke to all staff working on the day of or visit and seven people who live in the service. They gave us their opinion of what it was like to live and Care Homes for Adults (18-65 years) Page 6 of 36 work in Josephine Butler. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the service uses to support staff to promote equality and diversity. Feedback was given to two members of the management team and the opportunity was made available for them to ask any questions. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Overall, despite the improvements in medications the management has not improved the quality of the service. There is no structured quality management system in place, that would help the manager to recognise areas of the service that were in need of improvement. We looked at how staff where recruited, managed and trained. We found that staff were not correctly checked before they started work, they did not have training that supported them how to meet the needs of the people living in the service. Staff do not get on-going supervision that helps them develop the skills that they need or monitors their performance. Staffing levels were not maintained at the level that the service had determined were necessary to maintain the health and welfare of people living in the service. When we reviewed how the service made sure that it protected people from harm we found that, there were significant failures in the services ability to protect people. Risk assessments were not specific to the people living in the service. In some cases the risk assessments limited peooles choices without a clear explanation. Training for staff in understanding and recognising potential abuse was not sufficient and as a result significant events had not been recognised or addressed. Management of peoples funds was unclear, there was no guidance for staff and records were not fully completed, all of which places people living in the service at risk. We looked at how the service managed peoples health and welfare needs. We found that one person had been admitted to the service without having their needs assessed or recognition of any potential risks. Plans of how the service was to support the persons needs were not specific, plans did not provide staff with clear instructions and did not reflect what peoples individual needs, choices or preferences. There was limited opportunities for people to develop skills such as cooking, cleaning, laundry, money or medications management. There was no facilities or sufficient staff available for people living in the service to maintain or develop lifestyle skills. Although some people attended day centres the majority did not and as a consequence people spent their days watching television with little or no other stimulation. Care Homes for Adults (18-65 years) Page 8 of 36 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move into the service were not given information or had their needs reviewed prior to moving in. The lack of an assessment (review of needs) before people move into Josephine Butler places them at risk of receiving inappropriate support and places them at risk. Evidence: We looked at how people were assessed before they moved in. Three care records were reviewed, the most recently admitted persons admittance was more closely looked at. We saw that the persons pre-admission assessment (an assessment done before someone moves in to make sure that the service can meet their needs) was dated a month after they had started living in the service. The manager was unable to offer an explanation for this delay. We looked at the assessments and saw that they did not look fully at peoples equality and diversity needs. There was no review of peoples social interests, daily routines, work, education or hobbies. People need to have their full needs explored before they move into Josephine Butler in order that the manager can determine that the service can meet the persons individual needs. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: Information that helps people decide if Josephine Butler is somewhere that they would like to live was requested from the manager. The information known as the statement of purpose and a service users guide was not available. We were able to see a copy of a document that was titled summary of statement of purpose, available in the care plan of one person. Other care plans viewed did not have a copy of this available. We spoke to people living in the service and they were unable to recall if they had been given a guide or a brochure about the service. None of the people living in the home or the staff were able to remember having seen the information. One person said I think I saw a booklet once but cant remember when or what was is it. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual choices and opportunities to develop independence skills are not explored. Care records available do not have the correct information to fully support people living in the service in a manner that meets their individual needs. Evidence: We looked at three care plans and discussed these with the manager. Of the three we viewed none and been signed by the person for whom they were written for. When we spoke to people living in the service four people were not aware of what was written in their plans. Two said never seen it and no idea what its about. One person did say want nothing to do with a plan, their wishes had been respected. Of the plans viewed one was incomplete and written over ten days after the person came to live in the service. The other two plans were discussed with the manager and it was agreed by the manager that information to staff was not specific to peoples individual needs. There was no information about how staff were to support peoples self care skills or develop new independence skills. One person wishes to move out the service in 12 months and there were no plans in place that would assist staff to help them develop Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: the skills that they needed to live independently. We asked the manager when a plan would be developed to support independence and he was unable to confirm any opportunities to do so. Of the plans we viewed there was no information about peoples individual choices, how staff were to support and develop skills or details on the management of their funds. All people living in the service need to have a clear plan that gives staff accurate instructions on how to support people. Plans need to be agreed with by the person for whom it was written. There were risk assessments (what risks people needed to take and how to limit any risks identified) available for people living in the service. Risk assessments were not specific to the needs of the person. As an example two people had their cigarettes managed by staff. All staff thought that this was to prevent them smoking them all in one go. When we looked at their risk assessments there was no explanation as to why this action had been taken. Records in the service such as plans, assessments and risk assessments made no mention of mental capacity and the opportunity to determine that the person was offered an informed choice on their lifestyles was not in place. We looked at how people managed their own funds. There were no details available that informed individuals about what funds they were entitled to. Several peoples monies were paid directly to the provider who then forwarded these to the service, where it was recorded and given to people living in the service when they asked. The manager told us that peoples access to their own money was limited as only himself or the deputy had access to the safe. As such if they were not on duty people could not access their own money. There were no policies and procedures shown to us that showed how the service managed peoples money and of the three care files there was no information that showed how they were supported to manage their own money. Care Homes for Adults (18-65 years) Page 14 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service are not enabled to have opportunities to maintain and develop social, emotional, communication and independent living skills. Evidence: There was a lack of information available in the service about the activities that people living there wished and needed to do. The service had no plans or opportunities in place for people to develop lifestyle skills such as cooking, cleaning or laundry. There were no separate cooking facilities available for the people living in the service to undertake their own meal preparation and cooking. We asked how people were supported to develop life skills such as ironing and were told they are not allowed. The owner of the service said that people living in the service were allowed but that they dont want too anymore. Five of the people living in Josephine Butler attend day services that majority do not. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: One person undertakes a cooking class and was very please with the pie they had made on the day of our visit. People living in the service can come and go as they please. The people living at Josephine Butler had not had a holiday in several years and there were no plans available for a holiday in the future. People who live in the service are offered choices in various ways, such as in the time they get up or go to bed, what they wear or by deciding what they do each day. This gives people some control over their own lives and helps them maintain some independence. We looked at the records about peoples choices and found very little information it was not possible to determine in the records what daily activities people liked to do, what skills they needed support to develop, how they liked to spend their days or what food items they particularly liked. Menus did not show a choice or indicate which were vegetarian diets or diabetic diets. The cook stated that he had no training in diabetic diets but would like the opportunity to learn. There are less cooking hours available on a Sunday and the manager was not able to offer an explanation for this. The cook said that orders for the food are taken daily and cooked to request from the menus. Menus available in the service did not show that there was a choice of food. We where shown copies of minutes in which we were told choices of food were discussed. When we read the minutes they were not an open discuss of peoples choices and there was no record of what people thought of the food or how they would like the kitchen to operate. One person told us that I never have lunch there was no monitoring system in place to make sure that this individual was checked to maintain their nutrition. Menu boards were completed but staff stated that they are difficult to read from the back of the room. People living in the service and staff said that they thought the gap between meals was too short. The cook works five days a week and had ideas regarding running a cafe like lunch and tea time menu were people could help themselves as they do at breakfast. This would be very good practise and maintain peoples choices if put into place. Care Homes for Adults (18-65 years) Page 16 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not support in a manner that makes sure that their needs are consistently met. Evidence: Discussions with people living in the home showed that most of them will accept assistance offered by members of staff with regard to personal hygiene. All the care plans viewed had a section regarding health and hygiene whether the person needed this support or not. There was very few specific details such as if they preferred a bath or a shower. Of those plans viewed each was the same from one person to the next showing that peoples support needs were not assessed or supported on an individual basis. Comments from people living in the service were positive and included good staff, very helpful and always happy to help. We looked at records in the service about peoples health and welfare these were unclear. Two people had diabetes which needed to be monitored and a special diet required. One person need to have a test done daily know as blood monitoring (BM). There was no information about what the normal range of this test was for the person or what actions should be taken if the persons BM was not within their normal Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: range. The BM needed to be recorded daily we asked to view the BM records but they were unavailable. People live in the service as they have mental health needs. Of the records viewed there was no details about how to support each persons specific mental health needs, how they presented or what staff needed to do in specific circumstances. Staff spoken with told us that they relied on verbal communication between themselves as apposed to written records on how to meet peoples health needs. This practice runs the risk of staff not delivering the correct support in line with the choices of the people they support. The manager told us that people had their medications reviewed every three months by their doctor. We were unable to find any records regarding the doctors review visits or what changes had been made. When we looked at the medication records (MARs) we noticed that for one person medications had changed but these changes had not been updated with the persons care records. We looked at records regarding other external professionals such as dentists, opticians, consultants and social workers. Where these visits had taken place they were difficult to locate as no separate record was kept. What records that we were able to see did not give a clear account of the visits or any actions that needed to be taken by the staff or the people living in the service to met their Healthcare needs. We looked at how people were supported to manage their own medications. One person managed their own medications out of seventeen people living in the service. We asked the manager if there was any reason why the other people living in the service were not able to be supported to manage some or all of their own medications. The manager was unable to offer an explanation. The one person who did manage their own medications did not have risk management plans in place to make sure that staff were able to monitor that the person was managing their medications safely. We looked at how the service managed the medications for people that they are responsible for. At our last visits a statutory requirement notice was issued regarding unsafe management of medications. A statutory requirement notice is a legal notice that informs the service of their responsibilities and sets timescales that must be achieved in order to meet the notice. At this visit we noticed that there had been significant improvements around the majority of medication management. The service had instructions for staff on medications that need to be given as needed. Staff had received update training for medications and clear records were kept on the medications given to people. The service has started audits, checking on medications. Where this had highlighted issues there was no evidence to indicate that any appropriate action had been taken. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: Issues identified from audits need to be actioned in order for the audits to be effective. Staff were being assessed for competency. This was a peer assessment with one member of staff assessing another. Peer assessments are not an indicator of good practice as they depend on the capability of the person undertaking the assessment to determine that staff are following the procedure. The medication procedure had been updated to give staff clearer guidance on managing medications Care Homes for Adults (18-65 years) Page 19 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service are not protected from potential harm. Evidence: We spoke to people living in the service who told us that if they had any concerns that they felt happy, living in Josephine Butler and thought staff would listen to any problems. None of the five people spoken with had seen a complaints procedure and were not aware of how to raise a formal concern. The AQAA for the service told us that they keep a complaints book were all complaints were logged. We looked at the complaints logs and saw that there were no entries in the book. A review of the care records showed that one person had raised a concern of a serious nature. This had not been logged in the complaints book or referred as a potential abuse (safeguarding) issue to social services. The manager was unable to offer an explanation as to why neither of these actions had been taken. We looked at staff training for dealing with any potential abuse. We saw that staff training records did not record that staff had received this training. The manager said that staff saw a video and wrote an essay following the video. He confirmed the essays were not marked, that not all staff on the duty rota (details what staff work in the service) had seen the video . The manager also confirmed that the training did not include the homes own safeguarding policy or that of social services. We spoke to staff about their understanding of recognising and dealing with abuse. The actions that staff Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: detailed to us did not follow best practice and may result in people living in the service not being fully protected. The policy and procedure available in the service was gave no guidance on how to deal with potential abuse allegations. We discussed with the manager their training and found that there was no record that the manager had training in safeguarding. Without proper training staff will not be able to recognise or deal with issues of this nature in a manner that protects the people living in the home. Josephine Butler is a service for people with a mental health need. We asked the manager had he or any of his staff received training in mental capacity of deprivation of liberty he told us that no staff had received this vital training. Without this training staff would not be fully able respect or make sure that people living in the homes rights were always supported. Records regarding peoples personal funds were looked at. We could not find a record of what money people were entitled to and the manager was unaware of exactly what money people were entitled to. We were not shown a policy that dealt with how staff were to access, manage and support people with their own funds. We were told by the manager that only the manager and the deputy manager were able to access people funds. This meant that if the neither of these people were available then peoples funds could not be accessed by them. When we looked at the records we noticed that one person had a record stating that on two occasions funds had been removed and signed for by only one member of staff. All other records viewed showed two signatures one of which was usually the person themselves. There was no explanation available as to how the individual had been able to access the funds or why there was not a second witness signature. We looked at how staff were recruited to work or volunteer in the service and found that staff had not had the proper checks in place before they started working. The lack of proper checks on staffs fitness to work in the service place the people living in the service at risk. Care Homes for Adults (18-65 years) Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The facilities available in the building do not always meet the independence skills of people living in the service. The majority of space available in the service is a homely and comfortable environment. Evidence: The home employs a maintenance person who has recently painted bedroom areas and worked on improvement to the bathroom and toilet facilities. There are a large amount of bathrooms in the service that helps people to be able to access washing and toilet facilities as needed. Three of the bathrooms were marked as out of order, no plan swere availiable as to when these bathrooms would be repaired. The maintenance man was decorating one of the bathrooms and investigating a water leak at our visit. People living the service said that they thought that there bedrooms were very nice and there was lots of facilities for them. The service has a games room, lounge, dinning room and large smoking room. There are also gardens to the front and the rear of the building. People living in the home said they are encouraged to personalise their bedroom so as to make it as homely as possible. The majority of bedroom doors are kept locked with people living in the service having a key to their bedrooms. There is a master key available with staff members. On the day of our visit one of the staff Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: members had misplaced this key and the manager had to lend them his master key copy. On our arrival to the home the front door was not locked and allowed access to the building easily we were unchallenged and able to walk around the home until we located the managers office. The misplacing of a key and ease of access to the building does not help maintain the security of peoples personal space. There are no facilities available in the service for people living there to do their own cooking, cleaning, laundry or ironing. There is a flat equipped in this manner on the second floor of the building but this is kept locked. We were told that the flat has been rented out in the past. The owner told us that this was inaccurate and the flat had not been rented out. There was no explanation available as to why people living in the service were not supported to use this facility to learn lifestyle skills. When we looked around the building we saw that it was large building that was generally maintained by the maintenance man. We saw that three of the fire doors did not close correctly. We spoke to the handyman who addressed this and corrected the doors before we left. Bathrooms had liquid soap and disposable hand towels that helped prevent the spread of infection. Staff used protective equipment such as disposable aprons and gloves appropriately. The duty rota showed that fifteen staff worked in the service of these four had received training in infection control, the most recent of which was over a year ago. Staff needs to be kept up to date in order that they can maintain good infection control Care Homes for Adults (18-65 years) Page 23 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. lack of appropriate staff recruitment, training and support places the people living in the service at risk of harm. Evidence: At the time of the inspection the home manager was on duty with two carers a cook and a member of the domestic staff. The manager told us that they had determined that they need three carers from 8am till 2pm , two carers from 2pm till 8pm and 1 carer overnight. They also had a qualified nurse for twenty four hours a day. Examination of the duty rota (showing what staff worked when) revealed that there were a number of occasions over the last few weeks where their had been reduced staff numbers. In the last three weeks there has been fourteen separate occasions in which these staffing levels were not maintained. One on occasion there was only one member of staff available for 1hr and 20 minutes. This issue was mentioned at the last report but the reduction in staff continues to be in place. We spoke to staff, manager and people living in the service. All confirmed that there have been staff shortages that can impact on the quality of the service. Discussions with people living in the home said they were left to their own devices when staffing levels were low and they felt that they had to just sit and watch television or sit in their rooms of staff did not have the time to spare to give them support. The lack of activity was noted during the inspecting visit and people were observed to be sitting watching television, Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: smoking or going to local shops on their own. The management said that the ability to fully cover the staffing rota was very limited due to the home budget and all requests to cover for staff who were off ill or on leave had to be authorised by the home owner. It was said that agency staff are not allowed to be used and as a consequence staffing levels are inconsistent. We looked at the recruitment of the most recent staff. Neither of these people had full checks in place. One person did not have a police check and another had not had a police check until they had been working in the service for six days. Neither person had a last working reference. Both people had received an induction, the records for this showed that they had completed the anticipated 6 weeks induction over 1 day. There was no evidence available that either person were supervised until their full recruitment checks had been received. We saw that three other people worked or were given full access in the service. All were related to the owner but were not the registered provider. None had received any checks that they were suitable to work in the service. The manager and the owners representative were unable to provide an explanation for the missing checks. Without making sure that staff are suitable to work in the service, people living there are placed at risk. Staff files were reviewed with regards to staff training these showed gaps in staff training. The manager told s that there in no dedicated training budget and as such it was sometimes difficult to plan training. Of particular concerns was no evidence of training for all staff in safeguarding, fire training, health and safety, food hygiene, infection control and mental capacity. There was also no evidence that staff had received training specific to the assessed needs of the people that they support. Staff spoken with said they were content working in the home and whilst they were always very busy they tried hard to meet the needs of all the people living in the service. They said that staff shortages did impact unfavourably upon staff and people who used the service.. Staff said they received some in house training and were encouraged to complete national vocational qualifications. Staff files showed that one to one supervision and support sessions do not take place on a regular basis and the manager acknowledged that this shortfall. .It is essential that staff have the support and skills they need to carry out their job roles Care Homes for Adults (18-65 years) Page 25 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service do not get the right support to meet their needs. Their individual rights, health and welfare are not protected. The quality of the service has not increased good practice is not sustained and a lack of effective management places people living in the service at risk. Evidence: The manager of the service is registered with CQC. He has been the manager of the home for several years and has suitable qualifications for his role. We saw from the duty rotas that manager was allocated six hours a week to undertake his role. He told us that in recent months he had fond being the manager increasingly difficult and would like to consider stepping down from the role should a suitable alternative be fond. During the day we observed people who lived in the service and staff frequently accessed the manager and on all occasions he was kind and willing to assist. . The home arranges residents meetings and provides surveys and questionnaires. Surveys are done six monthly those returned were positive in response. Minutes of residents meetings are not circulated to residents and did not include any direct comments from the people who live in the service. The registered provider completed a monthly audit Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: and produced a report for the manager as part of an overall quality process in the home. People living in the service were consulted with and some of their comments included. No other checks on quality were available such as the quality of care, records, staff training or recruitment. Checks on quality had been commenced and had resulted in an improvement. The audits had identified issues that had not been addressed. As a result the service has not improved the quality of its service and people living in the service were placed at risk. Records in the service and discussions with staff show that, recruitment, training, development and supervision of staff is inconsistent. Staff have not received the training and guidance that they need in order to provide a quality service to the people they support in the service. Policies and procedures were not reviewed or kept up to date several of these were last dated 2008. The AQAA for the service was incomplete and gave no dates those policies and procedures were up to date. When we looked at this in detail we saw that the manager told us that there was areas that need to be improved but there was little information as to how the service intended to improve. The AQAA was very brief and demonstrated very little understanding of equality, diversity and quality. After our last visit the manager submitted an improvement plan. This plan stated that the manager would make sure all staff received supervision every 8 weeks, staffing levels will be maintained, medications management would be improved, all staff would receive up to date training. Of the areas that the manager stated would be improved none but improvements in medications had been successfully put into place. Care Homes for Adults (18-65 years) Page 27 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 17 All care plans need to be up 31/05/2010 to date, specific to the individual and accurately reflect how the staff are to meet peoples individual needs. All changes to the persons needs and condition need to update the care plan rapidly. Without clear records staff will be all able to meet peoples needs. 2 20 13 Medication must be stored securely at all times in order to prevent it from being misused or mishandled 31/05/2010 3 23 13(6) All management and staff 30/04/2009 must have training in the management and awareness of abuse so that people livibg in the home can be assured of being fully protected from any potential risk of abuse. ( Previous requirement date of 1/10/08 not met) There must be an effective 01/05/2009 staff team with sufficient numbers as previoulsy determined by the manager to support peoples assessed needs at all times. This will ensure that people who live Page 28 of 36 4 33 18(1)a Care Homes for Adults (18-65 years) 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 in the homes needs can be met. 5 36 6 Staff supervision must be in place at least six times a year to ensure staff can be monitored ,supported and training needs identified. Staff supervision must be in place to enable staff development. 23/03/2010 6 42 23(d) All staff must receive updates in fire safety and this must be recorded. This is to ensure all staff are aware of fire safety and can maintain safety in this area. 01/06/2009 Care Homes for Adults (18-65 years) Page 29 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 Information known as the 30/09/2010 statement of purpose and service users guide needs to be written and made available to both people using the service and the staff. In order to make sure that people living in the service are aware of their rights and staff can support them to make sure that peoples choices are supported. 2 14 All people moving into the service need to have their needs assessed by someone competent to do so before the individual moves in. For the manager to determine that the service can meet their needs before they move into the home. 14/07/2010 3 6 15 The service needs carry out consultation with people living in Josephine Butler 30/07/2010 Care Homes for Adults (18-65 years) Page 30 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and prepare a written plan as to how their needs are to be met. The plan needs to be made available to the individual and kept up to date with changes in their needs. In order the correct and most appropriate support can be in place, that meets individual needs and choices. 4 9 13 Individual risk assessments related to activities in which people living the service are involved are so far as reasonably practicable free from avoidable risks. Any unnecessary risks to the health or safety of people are identified and risk management plans put into place. In order to provide people with the opportunities to manage their lives as safely as possible. 5 11 16 The manager needs to be made to make sure that people are consulted with about their social interests, and arrangements made to enable them to engage in local, social and community 27/08/2010 30/07/2010 Care Homes for Adults (18-65 years) Page 31 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action activities work and training. Consult people about the programme of individual daily activities arranged by or on behalf of the service for people. Provide facilities for recreation including, having regard to the needs of individuals activities in relation to recreation and fitness. Lifestyle choices can then be made available to meet their personal preferences. 6 16 16 The manage needs to 27/07/2010 provide adequate facilities for people living in the home to prepare their own food and make sure that such facilities are safe for use by them. In order that people can have the opportunity to develop individual skills. 7 19 13 Arrangements need to be in 23/07/2010 place to make sure that people living in the service receive where necessary, treatment, advice and other services from any health care professional. Records of any medical interventions need to be clear, accurate, Care Homes for Adults (18-65 years) Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action up to date and included in any care plans. In order to make sure that peoples health and welfare needs are meet and their wishes are respected. 8 23 13 Arrangements to support 30/07/2010 people living in the service to manage their funds safely and for staff who manage peoples funds are aware of how to support them correctly. In order to protect people living in the service. 9 23 13 All complaints need to 30/07/2010 recognised and dealt with. If the issue is safeguarding then this needs to be actioned by the manager in a manner that protects both the people living in the service and the staff. This needs to be done in order for the people living in the service are fully protected and any issues regarding potential abuse are recognised and actioned. 10 34 19 All people working or volunteering to work in the service must have two suitable, verified references and POVA first check before 20/08/2010 Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action they start working. If staff start before a police check has been received they can not work unsupervised until this is received. In order to make sure that staff are suitable to work in the home. 11 35 18 All staff working in the service need training that is suitable to their job role. In order that they have the correct skills to enable them to correctly support the people living in the service. 12 39 35 A quality assurance system that identifies good practice and areas that need to be improved needs to be in place. All staff need to have the facility to make sure that they can work towards supplying a good quality service to the people they support. 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 20/08/2010 31/08/2010 1 20 All findings in audits in the service need to be recognised and actioned, in order to maintain the safety of people Care Homes for Adults (18-65 years) Page 34 of 36 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 living in the service. 2 20 People living in the service need to be supported to manage all or part of their medication. Where people do manage their medication risk management plans need to be in place in order to support them to do this safely. Policies and procedures for managing peoples funds need to be put into place in order that people are fully protected. The policy and procedure for the protection of vulnerable adults needs to be updated in line with Liverpool Social Services. Staff inductions need to be reviewed in order that they receive an induction that meets their needs and gives them sufficient understanding as to how to meet the skills of people that they support. All staff need to have supervision and intervals at no less than three months in order to provide them with the skills that they need to undertake their specific job roles. The manager needs to make sure that the AQAA is completed fully and is robust in the information that it provides. Policies and procedures that support staff in their job roles need to be updated and provide staff with good practice guidance. All risk assessments in the service regarding the general environment and safe working practices need to be reviewed and updated. Including areas sch as fire risk assessments. 3 4 23 23 5 35 6 36 7 37 8 40 9 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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