Care Home: Kathleen House

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What the care home does well There is an open visiting policy enabling people to visit at a time that suits them. Prior to coming to stay at the home pre-admission assessments are completed, so that staff and people considering using the service can be sure individual needs can be met appropriately. There were adequate numbers of staff on duty at the time of inspection to ensure people`s needs were met. The home was clean and generally well maintained providing people with a safe place to live. People were given a choice of meals and they stated they enjoyed them. People are able to continue with visits to centres and groups that they usually attend at home, so they receive continuity of care. Staff are available during the day and organise activities for people who do not attend centres, so they are adequately stimulated. What has improved since the last inspection? Some areas of the home had been re-decorated, so improving the environment for people to live in. Staff retention had improved, so there was a stable staff team to provide more consistency of care. What the care home could do better: The assessment process needs to be reviewed and action taken to ensure a more comprehensive assessment is undertaken and details of visits to the home are clearly recorded. This provides staff with the appropriate information to draw up a plan of care that informs them about the support people need, so needs are met effectively. Information for people considering using the service needs to be updated and provided in alternative formats, so that it is more accessible and provides up to date information, to assist people with making a decision about using the service. A review of risk assessments for bed rails should be undertaken and where staff determine people need bed rails they must ensure appropriate equipment is in place to protect people. Staff also require training in respect of the use and maintenance of bed rails, to ensure they have the knowledge to keep people safe. Action needs to be taken to ensure systems for personal care and laundering of clothing is of a satisfactory standard and meets peoples needs. The system for recording and dealing with complaints needs to be more robust to ensure accurate records are maintained and action is taken to ensure learning has occurred and re-occurrences are prevented. The systems for follow up and monitoring of accidents needs to be more robust to ensure appropriate action is taken at the time of incidents and to prevent reoccurrences. Staff require training in a number of areas to ensure they have the skills and knowledge to meet peoples needs, ensure they are safeguarded and supported with making decisions. The quality assurance systems needs to be developed further to ensure continuous improvement is achieved. Also a senior manager should undertake visits to the home at least and write a report on the conduct of the home, as part of the quality assurance process. Medication systems need to be improved, to ensure people receive the medication prescribed for them. The arrangements for handling people`s personal finances needs to be more robust, to ensure people`s money is protected. The recruitment of staff needs to be more robust, to ensure people using the service are safeguarded when new staff are employed. The manager should take appropriate action to ensure staff are not working excessive hours and have appropriate breaks between shifts, to ensure the health and safety of staff and people in the home. Some aspects in respect of the environment need to be addressed, in order to provide a pleasant place to live and reduce the risk of accidents and cross infection. Key inspection report Care homes for adults (18-65 years) Name: Address: Kathleen House 59-61 Addison Road Brierley Hill Dudley West Midlands DY5 3RR     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: Ann Farrell     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 37 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 37 Information about the care home Name of care home: Address: Kathleen House 59-61 Addison Road Brierley Hill Dudley West Midlands DY5 3RR 0138470187 0138470187 kathhouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr P Murray,Mr R Murray care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Existing service users using the service over the age of 65 years may continue to be accommodated for short respite, for as long as the home can demonstrate it can meet the service users assessed needs, with a maximum of 5 LD(E) at any one time. No service users who are wheelchair users be accommodated at 59a Addison Road. Service users to include up to 15 PD and up to 15 LD, not exceeding the total number registered for. Date of last inspection Brief description of the care home Kathleen House is a purpose built Home, opened in 1995. It provides residential care on a short-term respite basis for up to fifteen younger adults with learning/physical disabilities, at any one time. The Home comprises three self-contained bungalows, each accommodating up to five people. It is located in a residential area and it blends in well with the local communcity. There is easy access to local amenities and public transport with links to towns such as Brierley Hill, Dudley and the Merry Hill shopping Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 0 15 15 2 7 1 0 2 0 0 8 Brief description of the care home centre. Externally the property is well maintained, with car parking in the grounds. To the sides and rear of each bungalow are well-maintained gardens, with small patios, lawned areas, mature trees and shrubs. The interiors of the bungalows are domestic in style, promoting a homely environment and maintained to high standards. Beds at the Home are block purchased by Dudley Social Services Department. In excess of one hundred and forty people use the service. Information regarding fees charged for using this service is not included in the homes Statement of Purpose. Interested parties should contact the registered provider for this information. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 27th October 2008 when they were given a one star rating. This inspection found some areas that need to be addressed and they can be found in the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken by 24th November 2010. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Care Homes for Adults (18-65 years) Page 6 of 37 Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies plus concerns raised. An Annual Quality Assurance Assessment (AQAA), which is a questionnaire that is completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. The inspection was undertaken over two days by one inspector. The Manager was available for the duration of the inspection. The home did not know that we were visiting. At the time of inspection information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involved discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection two people who live in the home and two staff were spoken with. In addition, surveys were sent to relatives, staff and visiting professionals in order to gain feedback about the home. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The assessment process needs to be reviewed and action taken to ensure a more comprehensive assessment is undertaken and details of visits to the home are clearly recorded. This provides staff with the appropriate information to draw up a plan of care that informs them about the support people need, so needs are met effectively. Information for people considering using the service needs to be updated and provided in alternative formats, so that it is more accessible and provides up to date information, to assist people with making a decision about using the service. A review of risk assessments for bed rails should be undertaken and where staff determine people need bed rails they must ensure appropriate equipment is in place to protect people. Staff also require training in respect of the use and maintenance of bed rails, to ensure they have the knowledge to keep people safe. Action needs to be taken to ensure systems for personal care and laundering of clothing is of a satisfactory standard and meets peoples needs. The system for recording and dealing with complaints needs to be more robust to ensure accurate records are maintained and action is taken to ensure learning has Care Homes for Adults (18-65 years) Page 8 of 37 occurred and re-occurrences are prevented. The systems for follow up and monitoring of accidents needs to be more robust to ensure appropriate action is taken at the time of incidents and to prevent reoccurrences. Staff require training in a number of areas to ensure they have the skills and knowledge to meet peoples needs, ensure they are safeguarded and supported with making decisions. The quality assurance systems needs to be developed further to ensure continuous improvement is achieved. Also a senior manager should undertake visits to the home at least and write a report on the conduct of the home, as part of the quality assurance process. Medication systems need to be improved, to ensure people receive the medication prescribed for them. The arrangements for handling peoples personal finances needs to be more robust, to ensure peoples money is protected. The recruitment of staff needs to be more robust, to ensure people using the service are safeguarded when new staff are employed. The manager should take appropriate action to ensure staff are not working excessive hours and have appropriate breaks between shifts, to ensure the health and safety of staff and people in the home. Some aspects in respect of the environment need to be addressed, in order to provide a pleasant place to live and reduce the risk of accidents and cross infection. 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 37 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 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process should be developed further to ensure a person centred approach to care when people commence using the service. Information about the services and facilities needs updating to ensure people have up to date information, so they can make a decision about using the service. Evidence: The home provides respite care to fifteen people with a physical or learning disability in three bungalows. On entering one of the bungalows a service user guide and statement of purpose were available, which had been produced in 2007. These documents provide people with information about the services and facilities in the home, so they can make a decision about using the service. However, they required updating to ensure people had up to date information about the services and facilities available. Also consideration should be given to providing them in alternative formats, so they are accessible to people using the service. Feedback from surveys indicated people received enough information to assist them in making a decision about using the service. Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: The manager stated people were assessed before they started using the service and they visit the home at least six times for tea visits and occasionally overnight before they commence using the service. This enables them to sample the home, meet staff and other guests to determine if they wish to use the service. A sample of records were seen and it was found the assessment document (personal profile) was completed, but lacked detailed information about the support people required. The record of tea visits were on the same documents as daily records and it was difficult to distinguish them apart. It was recommended this process be reviewed, so staff obtain more comprehensive information about peoples needs and the support they require to ensure a person centered approach when they commence using the service. Also consideration should be given to an alternative format for recording tea visits to enable easier follow up and retrieval of information. Care Homes for Adults (18-65 years) Page 12 of 37 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. Care records for individuals need to be improved further to ensure staff are fully aware of peoples needs and the support they require to ensure a person centred approach to care. Evidence: Following admission to the home staff develop a summary of care. This document outlines the activities people require assistance with and the actions staff need to provide in order to support them. This process provides staff with all the relevant information in one place about the support people require. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: The summarys of care were found to be lacking in detail and were not comprehensive, as they did not include information about peoples needs found in other documents in the persons file. Therefore, it could not be guaranteed that staff were fully aware of peoples needs to ensure they were being met in a consistent and person centred manner. Bed rails were in use and the risk assessment on one file was not comprehensive and had not been reviewed. On discussion with the manager she stated the person could crawl to the end of the bed rails and get out of the bed. Also on inspecting the persons room, it was found there was only a bed rail on one side of the bed. Staff had not completed any training in the assessment, use and maintenance of bed rails. Risk assessments for anyone who uses bed rails must be reviewed on a regular basis to ensure they are being used appropriately and people are safeguarded. All risk assessments for bed rails must be reviewed prior to peoples next visit and where it is deemed necessary for people to use them the manager must ensure appropriate equipment is in place to protect people. Also staff should receive training in the use and maintenance of such equipment. The manager stated they were in the process of reviewing everyones needs and developing new summary documents, so that staff would have the information required to support people appropriately and in a consistent manner. Daily records were recorded by care staff, but the quality of the information recorded was variable and aspects of care could not be consistently followed up. It was found that there were a number of gaps as a new sheet of paper was used each day. Staff also recorded any conversations about a person on a new sheet of paper, so there were also large gaps in these records. These records should be recorded contemporaneously and if gaps are left there is the possibility that documents could be changed at a later date. The manager will need to review this practice. Whilst reviewing the accident record it was noted there had been some incidents of disruptive/challenging behaviour by one person. Records did not indicate the action taken by staff to diffuse the situations or prevent them from occurring. Also there was no evidence that the social worker had been informed of such incidents. On inspection of staff training records it was found that only a small number of staff had received training in respect of challenging behaviour. On discussion with a member of staff they were not fully aware of the persons behaviour patters and the summary/profile did not give information about it. On discussion with the manager about accident recording she stated she would audit Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: records once a year and was not aware of one of the entries in relation to concerns about bed rails. The manager must implement a more robust system for reviewing accident records and ensure audits are undertaken at least once a month, to determine if there are any trends and ensure appropriate action has been taken to safeguard people following accidents/incidents. We received three surveys from people using the service and their relatives. They told us the staff and managers treat them well, staff usually listened and acted upon what they said, but they only sometimes made decisions about what to do each day. Comments included; Keeps my daughter happy most of the time - and safe. At the last inspection it was recommended meetings should be held with people twice a year to provide opportunity for peoples involvement in decisions about the home. The manager stated meetings had not occurred. However, the manager had recently developed a feedback form which was sent to people every three months following their stay in the home. This asked questions about their stay and had been produced in picture format to make it accessible, but it did not provide space for any comments. Additionally, people who were in the home at the time of staff meetings were invited to attend them. Care Homes for Adults (18-65 years) Page 15 of 37 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 are able to participate in a range of activities that they enjoy. A choice of meals are provided that people enjoyed. Evidence: The majority of people who use the respite service continue to access their regular day care services whilst staying at the home and this was observed on the days of inspection. For people who remain at the home during the day activities are available based on their preferences and on the day of inspection two people went out to the cinema. On return they stated they really enjoyed it. Other records indicated people had been out to the pub, to the lights in Brierley Hill and shopping. We observed care practices, talked to people staying at the home, staff and examined records and found that in the main people accessing the service are supported to undertake activities that meet their individual needs and expectations. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: People were seen to wander freely around the home, from one area to another depending on their abilities. Staff were observed to be respectful towards people and used their preferred name. There was a six week rotating menu and each bungalow was on a different week of the rotating menu. This ensured there was a choice of meal available should someone not like the meal offered in the bungalow where they were staying. Breakfast usually consisted of cereals, fruit and toast, there was a light lunch and the main meal was cooked in the evening. The home does not employ separate kitchen staff; with care staff undertaking cooking responsibilities. At the last inspection it was recommended staff received training in nutrition and diet to provide them with the knowledge to meet peoples dietary needs. The manger stated a number of staff had completed the training and they were waiting for the certificates to verify this. On the day of inspection staff offered people a choice at breakfast and lunch time and provided assistance where required. People spoken to told us they enjoyed the meals. Care Homes for Adults (18-65 years) Page 17 of 37 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. The arrangements for personal care, laundry and medication need to be more robust to ensure peoples needs are met effectively and consistently in a person centred manner. Evidence: There was a mixed group of people staying at the home in respect of age, gender and ability. Summaries gave brief information about the support people required with personal care and they were dressed appropriately for their age, culture, gender and weather according to their own personal choice. Feedback from surveys indicated there were some concerns about aspects of personal care plus laundering and returning of peoples clothing. Whilst inspecting the complaint record it was noted that a number of concerns had been raised about personal care and loss of clothing, which had been upheld by the manager. The manager will need to review the systems for personal care and laundering and take appropriate action to ensure there are no further re-occurrences. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: People are registered with a General Practitioner (GP) at their permanent place of residence. However, if their own G.P. is not able to visit them in the care home a GP from a local practice will see people on a temporary basis, so that any acute conditions can be treated. Equipment was available to promote peoples independence including handrails and hoists. The majority of the staff had received training in respect of moving and handling, so they could support people to maintain their independence where necessary. The homes medication system consisted of a box system with hand written Medication Administration Record (MAR) sheets. Medication is received into the home from family and the amounts are checked by staff. However, it was found some of the records were not dated, which made auditing difficult. Also there was no system to verify the medication with the GP when people commenced using the service. Medication was stored in locked cupboards ensuring the safety of drugs. The manager stated the medication policy and photographs for medication records had not been addressed since the last inspection. On inspection of the current medication it was found to be correct for people who had been admitted and were staying for a short period. However, one person had been in the home for a longer period of time and had required a visit by the local GP. The audit for their medication indicated staff had run out of medication on one occasion. Also staff had signed to say it had been administered, but the home would have run out of the medication some days previously according to the number of tablets brought into the home. Staff stated an extra supply of medication must have been brought into the home, but there was no record of any extra medication entering the home at that time. The manager must ensure a robust medication system to include checking peoples medication with their GP when they commence using the service. A record should be kept on each subsequent visit to indicate if there has been any changes in medication and if changes have occurred it should be checked with the GP again. Also there must be robust recording procedures for any extra supplies of meditation brought into the home, so that auditing can be undertaken. Each bungalow has a medication room and the temperature of the rooms are monitored daily. It was noted the temperature in one of the medication room in bungalow 59a was above 25 degrees. The temperature of the medication fridge was not been monitored. The manager will need to ensure action is taken to maintain the Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: temperature of medication rooms below 25 degrees. Also the minimum and maximum temperature of the fridge should be recorded daily, to ensure all medication is stored at the correct temperature. Care Homes for Adults (18-65 years) Page 20 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for dealing with concerns and complaints need to be more robust to ensure people are safeguarded. Further training is required to ensure staff have the knowledge to safeguard people and support those who lack capacity to make decisions. Evidence: A complaints procedure and an easy read version of the procedure were available on entering one of the bungalows. Feedback from surveys indicated people were aware of who to speak to if they had a complaint. On inspection it was found that they were not up to date and did not advise people of their right to contact Social Services and the Care Quality Commission if they had concerns. These documents should be updated so people are aware of their rights. We have not received any complaints about the home. The home had a book to record complaints received and a separate record of the investigation/outcome and response. We found that all complaints had not been recorded in the book. A number of the complaints they had received were in respect of personal care, which the manager had upheld, but there was no evidence of systems to reduce re-occurrences. Records of investigations and responses to complainants were not comprehensive, as in some cases there was no record of an investigation or outcome, but merely a letter to the complainant. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: The manager must ensure a comprehensive register of complaints to enable auditing and follow up. Also records of complaints must include a record of the investigation, findings, outcome and the action to ensure re-occurrences are prevented plus the response to the complainant. The manager had recently made a referral under the safeguarding procedures and this was being investigated. On inspection of the Whistle Blowing procedure it did not give the contact details of the agencies where referrals could be in the event of an allegation, if staff did not feel able to raise the issue with management. Records indicated that only a small number of staff had received training in respect of safeguarding people from abuse. The manager stated training had been arranged for early next year. There was no evidence of training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards. All staff will need to undertake the training to ensure staff are aware of their responsibilities in respect of supporting people who lack capacity to make decisions. The home manages small amounts of money for people when they visit, which is deposited in the home for safekeeping. The home does not act as appointee/agent for people in the home. Individual records were maintained for people where the home held money on their behalf. On inspection of records it was found that receipts were not consistently available for items of expenditure and records did not consistently balance with the money held. Also records indicated money had been given to people directly, but they had not signed the records to demonstrate they had received the money. The systems were not sufficiently robust to demonstrate peoples money was safeguarded by staff. Care Homes for Adults (18-65 years) Page 22 of 37 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 live in a homely, clean and comfortable environment that meets their needs. Evidence: Kathleen House comprises of three separate bungalows set in well-maintained gardens, with adequate car parking facilities in the grounds. The bungalows were purpose-built to provide a comfortable, home like and safe environment for younger adults with learning and physical disabilities who require respite care. The exteriors and interiors of the home were maintained to a good standard. The home was clean and odour free with the exception of one bedroom. A small lawned area and patio were to the rear of bungalows and it was found that some of the slabs were uneven. These should be attended to in order to reduce the risk of tripping. Feedback from surveys indicated the home was clean and fresh. Comments included; The home is nice, clean and cosy. Some where nice to stay and bungalows and gardens are kept nice. A friendly atmosphere. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: We undertook a partial tour of the premises and found some of the bed rooms were quiet sparse with little or no forms of decoration. Attempts should be made to create more welcoming bedrooms by the use of pictures and decorative ornaments. Bedrooms did not have any bedside lamps and the light in the en-suite was utilized if people require any lighting during the night, which remains unchanged from the previous inspection. The manager was asked to review this area with people using the service and take appropriate action to meet their individual needs. Each bungalow has an assisted communal bathroom and communal toilets in addition to the bathing and toilet facilities in each en-suite bedroom. The bathrooms were clean, tidy and attractively decorated with stencils or seascapes. Staff hand washing facilities were available in communal facilities, but not in en-suite facilities and this will need to be addressed in order to reduce the risk of cross infection. Also the water from the showers was not regulated to 43 degrees, in order to reduce the risk of scalding. There was a separate lounge and dining room in each bungalow and they were decorated and furnished to a good standard. At previous inspections it was recommended that action be taken to repair the faulty secondary glazing in bungalow 59 and this remains outstanding. There is a separate kitchen in each bungalow and they were clean and well maintained with appropriate equipment. The kitchen in bungalow 59 was in need of replacement and the manager stated it was being addressed by the maintenance staff. There was a separate laundry in each of the three bungalows and all were appropriately equipped for the laundering of clothing. Care Homes for Adults (18-65 years) Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient staff on duty to meet peoples needs. The recruitment procedure needs to be more robust to ensure people are safeguarded. Staff would benefit from further training to ensure they are up to date with current practice and have the skills to meet peoples needs. Evidence: Each unit has a separate staff group and duty rotas indicated there were two carers in each bungalow during the day with one senior carer between all of them. Overnight there was one carer in each bungalow with a senior carer between all three bungalows, which appeared satisfactory to meet peoples needs. Care staff are responsible for all caring tasks, domestic, laundry and catering tasks. They are supported by the manager and maintenance staff. It was noted that some staff were covering extra shifts, which resulted in working long hours and in some cases insufficient breaks between shifts. The manager will need to review this area to ensure the health and safety of staff and people using the service. Comments from surveys indicated people were finding it difficult to identify staff and it was suggested name badges or T shirts with names on be used. The manager should give consideration to this suggestion. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: The staff files for three newly appointed staff were inspected. All prospective staff complete an application form and declaration of health. Interviews are held and appropriate checks are undertaken before they commence employment such as references, Protection of Vulnerable Adults (POVA) checks and Criminal Record Bureau (CRB) checks. Although these had been completed it was found that in some instances issues had been raised on CRB checks and there was no evidence that they had been followed up or risk assessments put in place. This could put people at risk. The manager stated one of them had been discussed with the member of staff, but there was no record of the discussion. She must ensure that where an issue is raised on CRB checks they are followed up appropriately and records plus risk assessments are put in place to demonstrate this process to ensure people are protected. Newly appointed staff undertake the homes induction training the the City and Guilds 3100 training to provide staff with the knowledge initially to meet peoples needs. However, it was noted that a number of staff had not completed the City and Guilds training and the manager will need to ensure this is completed by all staff, to ensure they have the knowledge and skills to meet peoples needs effectively. Since the last inspection the manager has become a trainer for first aid and manual handling and she stated she was developing training packages, so she could deliver the training to staff. There was a rolling programme of in house staff training, which covered mandatory areas such as manual handling, infection control, fire safety, food hygiene, health and safety, and safeguarding etc. The information provided indicated only eight staff had completed National Vocational Qualification (NVQ) level 2 in care. The manager stated she had arranged training in the near future for safeguarding and fire prevention. She also stated she was going to arrange training in respect of health and safety, basic food hygiene and dementia for those staff who had not received the training. Consideration will also need to be given to updating manual handling training and training in respect of challenging behaviour, epilepsy, Mental Capacity Act and The Deprivation of Liberty Safeguards to provide staff with the appropriate skills and knowledge to care for people living in the home. Care Homes for Adults (18-65 years) Page 26 of 37 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. Management systems need to be more robust to ensure the health, safety and welfare of people in the home Evidence: The manager has been in post for a number of years and is registered with us. She is currently undertaking the Registered Managers Award. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home in order to gain information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home, which would have benefited from more detailed information. The organisation has a quality assurance process that consists of an audit twice a year by another manager. The records demonstrated that only one audit had taken place in the last three years and there was no evidence of any follow up of issues that had been identified as needing improvement. Surveys are sent out to people for feedback about the service annually. The manager has recently commenced sending out Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: questionnaires every three months to gain feedback from people who have used the service. There was no evidence of any meetings with relatives or people who use the service occurred. The manager stated people could attend staff meeting if they were staying in the home when they were held. The quality assurance process needs to be developed further to ensure continuous improvement. Records of visits by a senior manger indicated they were not occurring every month as required under the regulations, in order to monitor the quality of the home. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was safe and in full working order. These were found to the satisfactory. Checks were completed on the fire system regularly ensuring people would be safe in the event of a fire. However, there were no individual fire evacuation plans for people who use the service. The manager is advised to contact the West Midlands Fire Brigade for further information. Care Homes for Adults (18-65 years) Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 37 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 9 13 Risk assessments in respect 25/12/2009 of the use of bed rails must be reviewed and updated for everyone who is currently using them. To determine if they are the most appropriate method of safeguarding people. 2 9 13 Where it is determined bed rails are required suitable equipment must be put in place. To ensure people are protected appropriately. 25/12/2009 3 20 13 The minimum, maximum 25/12/2009 and current temperature of the medication fridge must be recorded on a daily basis. To ensure medication is stored at the correct temperature Care Homes for Adults (18-65 years) Page 30 of 37 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 4 20 13 Systems must be in place 25/12/2009 for recording the receipt and disposal of all medication. To ensure people receive their medication and auditing can be undertaken 5 20 13 Systems must be in place to 25/12/2009 ensure there are adequate stocks of medication in the home at all times. To ensure people receive the medication prescribed to them. Medication rooms must be 25/12/2009 maintained at a temperature of 25 degrees or below. To ensure medication is stored correctly in line with the manufacturers guidelines. Robust systems must be in 25/12/2009 place for the correct administration and recording of medication. To ensure everyone receives the medication prescribed for them. 6 20 13 7 20 13 8 20 13 Effective systems must be in 25/12/2009 place for checking peoples medication with the GP when they commence usign the service and if there are any changes. Care Homes for Adults (18-65 years) Page 31 of 37 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 To ensure the correct medication is administered. 9 23 12 The manager must ensure there are robust procedures for managing peoples money with receipts for all withdrawals and comprehensive records. 25/12/2009 To ensure peoples money is safeguarded. 10 24 13 Action should be taken ensure the water from all hot water outlets does not exceed 43 degrees. To reduce the risk of scalding 11 24 13 Action must be taken to ensure the paving slabs on patio areas are even. To reduce the risk of accidents. 12 34 19 There must be robust recruitment procedures in the home with follow up of issues identified on CRB checks and records to demonstrate the action taken. 25/12/2009 25/02/2010 25/12/2009 Care Homes for Adults (18-65 years) Page 32 of 37 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 To ensure people are safeguarded with the recruitment of new staff. 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 1 It is recommended the service user guide and statement of purpose is updated to reflect the current arrangements in the home to assist people with making a decision about using the service. Also consideration should be given to provididng them in alternative formats, so they are accessible to people using the service. Consideration should be given to the method of recording tea visits to enable easier retrieval of information. The assessment process should be more comprehensive, so staff obtain sufficient information about peoples needs and the support they require in order to provide a person centred approach. Arrangements for recording communication and daily events should be reviewed to ensure records are contemporaneous and changes cannot be made at a leter date. Staff should be provided with training in respect of record keeping to ensure accurate and comprehensive records are maintained to enable follow up of peoples care and to determine if appropriate interventions have been implemented. All summary documents must be reviewed and updated at least once a year or when there are any changes in peoples condition/needs to ensure staff have up to date information about the support people require. Page 33 of 37 2 2 3 2 4 6 5 6 6 6 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 6 The summary document should provide comprehensive information about the support people require. Also systems must be put in place to ensure the information is communicated to staff, so they are fully aware of peoples needs to ensure a consistent and person centred approach to care. Staff should receive training in respect of managing challenging behaviour, so they have the skills to safeguard people effectively. The manger should implement robust systems for monitoring and follow up of all accidents to ensure appropriate action is taken to prevent re-occurrences. Also accident records should be audited on a monthly basis to determine if there are any trends. Staff should receive training in respect of the assessment, use and maintenance of bed rails to ensure the equipment is used appropriately and it is fit for use to protect people. Robust systems must be in place to ensure the effective and appropriate laundering of peoples clothing and they are returned in a timely manner. All admission and discharge sheets should be dated, to enable follow up of peoples care. Systems must be put in place to ensure people receive effective personal care that meets their needs and prevents complications from arising. It is recommended that photographs are held with each persons medication to ensure the safe administration of medication. The medication policies and procedures must be reviewed and updated to reflect current practice in the home. The complaints procedure should be updated to ensure everyone is aware of the procedure to make a complaint and the agencies where complaints can be referred. The record of complaints should include the investigation, findings, outcome and strategies to reduce further occurrences in addition to the response to the complainant to demonstrate complaints are dealt with effectively. 8 9 9 9 10 9 11 18 12 13 18 18 14 20 15 16 20 22 17 22 Care Homes for Adults (18-65 years) Page 34 of 37 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 18 22 The manager should ensure the complaints register includes a comprehensive record of all complaints, so they can be audited effectively. All staff should be provided with training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with their position in the home, so people who lack capacity to make decisions are supported appropriately. The Whistle Blowing procedure should include the contact details of all agencies where referrals of abuse/poor practice can be made. All staff should undertake training in respect of safeguarding to ensure they have the knowledge to safeguard people effectively. Replace/repair units in kitchen units in bungalow 59 to ensure kitchen hygiene standards are maintained. Efforts should be made to ensure all bedrooms are decorated and furnished in a way that creates a more homely feel. A review of bedside lighting should be undertaken with appropriate action to ensure peoples needs are met when in their bedrooms. The faulty secondary glazing in bungalow 59 should be repaired in order that the building continues to be maintained to a good standard. Take action to ensure all areas of the home are odour free to provide a pleasant environment for people to live. Provide staff hand washing facilities in bedrooms where personal care is provide to people, to reduce the risk of cross infection. The manager should review staff working patterns and take appropriate action to ensure they are not working excessive hours without sufficient breaks to ensure the health and safety of staff and people using the service Systems must be in place to ensure all staff complete the City and Guilds induction training to ensure they have the 19 23 20 23 21 23 22 23 24 24 24 24 25 24 26 27 30 30 28 32 29 35 Care Homes for Adults (18-65 years) Page 35 of 37 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 knowledge to meet peoples needs. 30 35 It is recommended all staff are provided with up to date training to ensure the have the knowledge and skills to meet peoples needs. At least 50 of staff should be trained to NVQ level 2 in care to ensure staff have the appropriate knowledge and skills to meet peoples needs. A senior manager should visit the home once a month and write a report about the conduct of the home and copies should be available in the home for inspection. The quality assurance system needs to be developed further to ensure effective feedback and monitoring with action to address areas of improvement, in order to achieve continuous improvement. It is recommended that the manager contact West Midlands Fire Service regarding individual fire evacuation plans for people staying at the home, to ensure they are safe in the event of a fire. 31 35 32 39 33 39 34 42 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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