Care Home: Kingsfield Care Home

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What the care home does well People told us they liked living in the home. One person said that since living in the home they had gained more independence and more confidence to go out on their own. People told us "I like my friends and my bedroom", "They do everything well", and, "I do love this home". People told us they made decisions about what they wanted to do each day. They said "I like shopping with staff" and "I like going to work". There was a stable staff team at the home with a low turnover and most staff having worked at the home for several years. 5 out of 8 care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the National Minimum Standard of 50% of care staff with the qualification. What has improved since the last inspection? Requirements made at the last inspection had been met, resulting in improvements to the complaints procedure and to staff records. Information was available in the home about the Mental Capacity Act 2005 and staff had received relevant training. Building work had re-started on the extension to the rear of the home and the manager said this should be completed by the summer of 2010. What the care home could do better: Ensure there is a care plan in place for each person, produced in consultation with the person or their representative, that details how their assessed needs are to be met. Provide all staff with training in person centred care planning to ensure that people are actively involved in making decisions about their own care. Carry out individual assessment of nutritional needs on admission to the home and review these at least annually to ensure that people`s needs are fully met. Provide staff with relevant training to ensure they understand and meet people`s nutritional needs. Encourage and support people in the home to be more actively involved in menu planning, shopping for food, and preparation of meals. This will help to ensure their involvement and promote their choice and independence. Ensure that storage of medicines in the home meets the Royal Pharmaceutical Society guidance `The handling of medicines in social care`. Specifically, the storage of controlled drugs, and ensuring the medicines cupboard is not used for any other purpose such as keeping money. This will help to protect people in the home. Encourage and support people in the home to manage their own medication, where this is appropriate following capacity and risk assessments. This will help to encourage their independence and ensure their rights are recognised and promoted. Ensure that all staff have training about safeguarding vulnerable adults so that people are protected.Put into place be clear and robust procedures to ensure that the personal money of people living in the home is properly and correctly accounted for. Encourage and support people to manage their own finances, where appropriate following capacity and risk assessments. This will ensure people`s rights and independence are promoted. Ensure effective systems are in place, following current Department of Health guidance and including staff training, to ensure the prevention and spread of infection in the home. Encourage and support people to be involved in staff selection. This will help to promote their involvement and independence. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that people`s rights are promoted and upheld. Key inspection report Care homes for adults (18-65 years) Name: Address: Kingsfield Care Home 23 High Street Clay Cross Chesterfield Derbyshire S45 9DX     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: Rose Moffatt     Date: 3 0 0 3 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 32 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 32 Information about the care home Name of care home: Address: Kingsfield Care Home 23 High Street Clay Cross Chesterfield Derbyshire S45 9DX 01246861505 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingsfield Care Homes Ltd Name of registered manager (if applicable) Mr Alkesh Odedra Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Kingsfield provides personal care and accommodation for up to 9 people with learning disabilities. The home is in the village of Clay Cross, near Chesterfield, close to local shops and amenities. The home is a large, detached house with accommodation over two storeys. There are seven single bedrooms, one with an en-suite bathroom, and one shared bedroom, (currently used for single occupation). There is a large lounge and separate dining room. There are separate kitchen and laundry facilities of a domestic scale. There is a large attractive garden to the rear of the home and car parking space to the front and side of the home. 2 7 0 5 2 0 0 9 9 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Information about the home, including CSCI/CQC inspection reports, is available in the home or from the provider or manager. The fees at the home are £398.80 per week. The manager provided this information on 30th March 2010. Care Homes for Adults (18-65 years) Page 5 of 32 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 the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we Care Homes for Adults (18-65 years) Page 6 of 32 have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over 5.5 hours on 30/03/2010. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 8 surveys to people living in the home and received 6 completed responses. We sent out 10 surveys to staff employed at the home and received 5 completed responses. There were 8 people accommodated in the home of the inspection visit. People who live in the home, staff and the manager were spoken with during the visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 2 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Ensure there is a care plan in place for each person, produced in consultation with the person or their representative, that details how their assessed needs are to be met. Provide all staff with training in person centred care planning to ensure that people are actively involved in making decisions about their own care. Carry out individual assessment of nutritional needs on admission to the home and review these at least annually to ensure that peoples needs are fully met. Provide staff with relevant training to ensure they understand and meet peoples nutritional needs. Encourage and support people in the home to be more actively involved in menu planning, shopping for food, and preparation of meals. This will help to ensure their involvement and promote their choice and independence. Ensure that storage of medicines in the home meets the Royal Pharmaceutical Society guidance The handling of medicines in social care. Specifically, the storage of controlled drugs, and ensuring the medicines cupboard is not used for any other purpose such as keeping money. This will help to protect people in the home. Encourage and support people in the home to manage their own medication, where this is appropriate following capacity and risk assessments. This will help to encourage their independence and ensure their rights are recognised and promoted. Ensure that all staff have training about safeguarding vulnerable adults so that people are protected. Care Homes for Adults (18-65 years) Page 8 of 32 Put into place be clear and robust procedures to ensure that the personal money of people living in the home is properly and correctly accounted for. Encourage and support people to manage their own finances, where appropriate following capacity and risk assessments. This will ensure peoples rights and independence are promoted. Ensure effective systems are in place, following current Department of Health guidance and including staff training, to ensure the prevention and spread of infection in the home. Encourage and support people to be involved in staff selection. This will help to promote their involvement and independence. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were fully assessed before moving to the home so they were confident their needs could be met. Evidence: People told us they liked living in the home. One person said that since living in the home they had gained more independence and more confidence to go out on their own. People told us I like my friends and my bedroom, They do everything well, and, I do love this home. No-one had been admitted to the home since the last inspection in May 2009. We looked at the care records of 2 people living in the home. We found that both had detailed assessments of their needs carried out by social workers before admission to the home. Staff told us that people wanting to move to the home were able to visit first. The Annual Quality Assurance Assessment (AQAA) had no detail of how peoples needs were assessed, or of the arrangements for people to visit the home before admission. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The AQAA said the home could improve by having person centred planning and by providing more activities and days out for people in the home. The AQAA said the religion/faith and sexual orientation of people in the home was not known. Care Homes for Adults (18-65 years) Page 12 of 32 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 plans were not sufficiently detailed or person centred and people were not actively involved in the development of care plans. The care plans did not consistently reflect the care being delivered. Evidence: People told us they made decisions about what they wanted to do each day. They said I like shopping with staff and I like going to work. People we spoke with knew who their keyworker was. One of the care records we looked at did not have sufficient information in the care plan about how the persons needs were to be met by staff. There were also gaps where some of the persons assessed needs had not been included in the care plan. There was a document entitled person centred care plan which had been partly completed. However, the information recorded showed a lack of understanding by staff of the principles of person centred planning. The manager was aware this was an area where improvement was needed and said that staff were to have training in Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: person centred planning. The other care record we looked at had a care plan with good details of how the persons needs were to be met. However, we found that significant changes in the persons needs were not reflected in the care plan. Information was recorded elsewhere in the care records about the persons changing needs, but this had not been used to update the care plan. One care record had a risk assessment in place about an aspect of the persons behaviour. This was dated 04/03/2009 and there was no evidence that it had been reviewed. There were no other risk assessments in place for this person. The other care record had risk assessments in place about the environment of the home and associated hazards. These risk assessments had been reviewed annually. People in the home had regular meetings to discuss all aspects of life in the home. They also had meetings with a local advocacy service. We observed that people were encouraged by staff to make choices in their daily lives, such as buying new clothes, choice of meals, and going on holiday. We were told that 2 people in the home managed their own money and had bank accounts. There were no assessments of the capacity of other people in the home to manage their own money. One person was potentially able to manage their medication with support from staff but their capacity to do this had not been assessed. The AQAA said that people were encouraged by staff to participate in voluntary work. The AQAA said the home planned to improve by encouraging staff to enable service users to take responsible risks within the homes risk assessment and risk management framework. Care Homes for Adults (18-65 years) Page 14 of 32 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 were supported to take part in appropriate activities both within and outside the home. A lack of staff training and awareness combined with an unstructured approach to menu planning meant that the nutritional needs of people in the home were not always well met. Evidence: Most people in the home attended day centres during the week. One person was involved in voluntary work and said they enjoyed this. One person said they liked meeting friends in a local cafe. One person said there were Nice meals in the home and another said they would like to get out for more walks. All of the people in the home had a key for their bedroom door, and some people had a key for the front door. Routines in the home appeared reasonably flexible: people told us they could get up and go to bed when they wanted to and we observed people Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: following their preferred routines during the day. We found that people could choose to spend time alone in their rooms if they wanted to. The main meal of the day was served at teatime and was prepared by the staff. People in the home told us they sometimes helped with meal preparation but there did not appear to be any structured approach to this. There was no menu displayed and we were told there were no set menus. It was decided each day what the main meal would be depending on the choice of people in the home, what people were doing, and available food. There was a food diary with the main meal recorded each day. This showed a reasonable variety of meals, though full details of all meals were not recorded. People told us they had discussed meals at their meetings and said that staff had responded to requests for more variety, and more fresh fruit and vegetables. A member of staff had recently held an information and discussion session about healthy eating for people in the home. Although there was good information available about healthy eating, we found that this was not always put into practice by staff. For example, people trying to lose weight were offered crisps, and there was regular use of convenience foods which are often high in salt and fat. Most of the food shopping was ordered online by the manager or the responsible individual and people in the home were not involved in this. Some people in the home were regularly involved in food shopping locally when fresh supplies were needed. The nutritional needs of people were not routinely assessed at the home. One of the care plans seen did not include any information about the persons nutritional needs. The other care plan seen had some information about the persons nutritional needs but had not been updated to reflect recent changes in their needs. Staff had not received any training about nutrition and how to meet individual needs. The AQAA said that people in the home were actively supported and help staff to cook desserts and prepare the table. They planned to improve by encouraging people in the home to be a lot more actively involved in duties other than just cooking or cleaning. For example, maintaining gardens and growing vegetables in the garden which they could then use. Care Homes for Adults (18-65 years) Page 16 of 32 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. There was a lack of detail in care plans and a lack of support for people to manage their own medication so it was not clear that people were provided with care and support to meet their needs and preferences. Evidence: People told us they were looked after well at the home. Most people said staff always listened to them and acted on what they said. One of the care plans we looked at did not have sufficient detail of the persons preferences regarding personal support. The other care plan had good details of the persons preferences. Staff observed and spoken with showed good awareness of peoples needs and preferences regarding personal care. One person had records of the input of healthcare professionals, such as GP, District Nurse, and Speech and Language Therapist. This person had also been referred appropriately for other healthcare support due to their changing needs. Staff at the home had recorded all the necessary information following the visits of the GP, District Nurse, and so on, but this information had not been used to update the persons care Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: plan. One person only had records of GP visits, no other healthcare had been recorded. Information from a visit to the GP regarding a change in this persons needs was recorded, but again had not been used to update their care plan. Medication was stored in a locked, built-in wooden cupboard in the office. The deputy manager told us that it was planned to obtain a metal cabinet in line with current requirements for storage of medicines in care homes. The deputy manager said that it was also planned to obtain a separate cupboard for storage of external preparations. These were currently stored in the same cupboard as all other medicines. The medicines cupboard was also used for the storage of petty cash and the personal money of people in the home. There was a new policy/procedure in place for the safe-handling and administration of medicines in the home. This had been obtained from the local authority adult care services and so was relevant to their care services. There were parts of this policy/procedure that were not relevant to the home. The old medication policy/procedure was still in the homes policy folder, potentially confusing for staff looking for guidance. The home had obtained a copy of the Royal Pharmaceutical Society guidance for managing medicines safely in care homes. There had been a recent medication error that had been reported to adult social care services and to CQC as required. Appropriate action was taken by the home to reduce the risk of recurrence of the error, including training for staff. No-one in the home had been assessed to see if they were able to self-administer their medication. The AQAA said that people in the home had access to local healthcare and specialist services.They planned to improve by supporting people to choose their own GP regards to gender and have more input from residents to make their own decisions about their own health care/treatment. Care Homes for Adults (18-65 years) Page 18 of 32 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. Complaints were effectively dealt with and people in the home had confidence in staff to sort out any problems. People were potentially at risk due to unclear procedures for managing their personal money, and lack of staff training in safeguarding vulnerable adults. Evidence: Most people in the home said they knew who to speak to informally if they were unhappy, and how to make a formal complaint. People said they were able to talk about any problems at regular meetings and they had confidence in staff to take appropriate action. There were 2 complaints procedures displayed in the home, 1 of these did not have the correct contact details for CQC. Records seen of complaints showed that they were dealt with appropriately and promptly. The records included details of the action taken and the outcome of the complaint. People spoken with said they could raise any concerns at the regular meetings, or would go to staff. There were policies/procedures in place for responding to suspicion or evidence of abuse or neglect, including whistle blowing. A recent incident in the home had initially not been correctly dealt with by staff, but had been properly responded to when brought to the attention of the management. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Staff training records showed that staff had not had training in safeguarding vulnerable adults since 2007, and 1 member of staff employed since then had not received any training about safeguarding. The procedures for dealing with peoples personal money in the home were not clear. It appeared that 4 people in the home did not receive their personal allowances every week and did not have their own accounts for this money to be paid into. The records of personal money for these people were not correct as they showed money had been received when it had not. We generally found that personal money was used appropriately, although we found 2 items on 1 persons records that should have come out of the homes budget, rather than the persons own money. The AQAA said there were relevant policies and procedures in place. The AQAA said they had improved in the last 12 months by ensuring all relevant incidents were notified to CQC. They planned to improve by having separate complaints books for people in the home and staff. Care Homes for Adults (18-65 years) Page 20 of 32 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 home was generally comfortable and sufficiently maintained so that people lived in a homely and pleasant environment. All reasonable steps had not been taken to protect people living in the home and staff from acquiring infections in the home. Evidence: People told us the home was always clean and fresh. People said they were pleased the extension was nearly finished and they were looking forward to seeing it completed. They said they liked their bedrooms. 2 people told us they would like one of the lounge settees replacing as it was too low for them to use easily. The manager told us the extension should be completed in the next 6 weeks, providing 2 ground floor en-suite bedrooms. The building rubble had been cleared away from outside the lounge window so this was more pleasant for people to look out and there were no obstacles to them using the garden. The lounge and dining room appeared clean and homely. One of the settees in the lounge was quite low and staff told us that some people in the home had difficulty in getting up from it. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Although 1 bedroom could be used as a double room, all the people in the home had a room to themselves. All the rooms had a wash basin and 1 room had an en-suite bathroom. The bedrooms seen were well personalised and people told us they were able to choose the decor. Some items had been stored in 1 bedroom that did not belong to the person, including a mattress, a folding bed, a wardrobe and a bedside cabinet. People were encouraged to keep their own rooms clean and tidy, with support from staff. The main bathroom on the first floor had a separate shower cubicle that staff told us was used by most people in the home. There was a grab rail in the shower but no seat. Staff told us a seat would be useful for some people in the home. The blind and window sills in this bathroom appeared very dusty. There were 2 ceiling panels missing and the area above was very dusty. The home appeared generally clean and was free from offensive odours. The exterior of the windows appeared dirty, particularly on the first floor. The laundry floor had been replaced since the last inspection. There were cracked and missing tiles on the laundry walls. There were 2 washing machines and 1 tumble dryer, all domestic style. There was information available in the home about prevention and control of infection, including posters about effective handwashing. Staff had not received specific training about infection control, though some areas had been covered in health and safety training. Staff observed and spoken with were generally aware of procedures to follow, such as frequent and effective handwashing, use of disposable gloves and aprons, and correct disposal of waste. However, staff told us that faecally contaminated laundry was manually sluiced and soaked which is contrary to the current guidance from the Department of Health. The AQAA said they had improved in the last 12 months by making progress with the extension, replacing old furniture, and by having robust cleaning charts. Their plan for improvement was to complete the extension. The answers given in the AQAA to questions about infection control in the home indicated that this was considered not applicable. Care Homes for Adults (18-65 years) Page 22 of 32 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 were usually enough staff to meet the basic needs of people in the home, although individual choices of activities and routines may be restricted by staffing levels. Staff had received most of the training necessary to help them to understand and meet the needs of people in the home. However, there were some gaps in training that could put people at risk. Evidence: People told us staff were usually available when needed. People said that staff always treated them well. We looked at the records of 2 staff, 1 recruited very recently. Both had all the required documents in place, such as a Criminal records Bureau disclosure and 2 written references. The latest member of staff recruited had not provided a full employment history. This person had not actually worked any shifts at the home and the manager said the full employment history would be obtained before the person commenced work. We found no evidence that people in the home were involved in staff recruitment, Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: although the AQAA said that they were. Staff had completed an induction to Skills For Care standards. Most staff were up to date with all required training, except for safeguarding vulnerable adults. As noted earlier in this report, staff had not received training about meeting the nutritional needs of people in the home. There were individual staff training records. There were 8 care staff in total and 5 of these had already achieved a relevant National Vocational Qualification (NVQ) at level 2. 2 of these staff were working towards NVQ level 3. The staff rotas showed there were 2 care assistants on duty until 10am, after 4pm, and all day at weekends. During the week there was usually 1 care assistant on duty between 10am and 4pm as most people were out of the home. At night there was 1 care assistant sleeping in. In addition to the care assistants, the manager and the responsible individual were at the home for 2 or 3 days each per week. Staff told us there were usually enough staff on duty to meet the needs of people in the home. Staff said the staffing levels did not allow much scope for individual activities, particularly outside of the home. Staff told us they would like to see a cleaner employed to relieve them of some cleaning duties so they could spend more time with people in the home. The AQAA said that the home had a stable staff team with low turnover and no use of agency staff. The AQAA said the home had improved in the last 12 months by having more structured and regular staff supervision, and by supporting staff to work towards NVQ level 3.They planned to improve by providing equal opportunities training for staff. Care Homes for Adults (18-65 years) Page 24 of 32 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 of the home was not sufficiently proactive to ensure that peoples choices and independence were effectively promoted. Evidence: The manager was suitably qualified and experienced to run the home. He came into the home on 2 or 3 days per week and the responsible individual also came in for 2 or 3 days. The manager was supported by a deputy manager. People told us they had confidence in the management to address any concerns or problems. Staff told us they lacked confidence in the management to take prompt and appropriate action when issues were raised. For example, staff felt that some staff disciplinary issues were not dealt with effectively, and also that they were not always given correct information about employment terms and conditions. There was a quality assurance system in place that included annual surveys completed by people in the home and/or their representatives, and a report compiled from the findings. The responsible individual made monthly visits and reports as required under regulation 26. There were regular meetings for people in the home to express their Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: views, and they also had access to a local advocacy service. The AQAA was completed by the manager. The self assessment section had brief details of the current situation in the home with minimal evidence to support the claims made. There were gaps and inconsistencies in the data section. There was information available in the home about the Mental Capacity Act 2005 and the relevant codes of practice were also available. Staff had received training about the Act and the implications for their role in supporting and caring for people in the home. The Mental Capacity Act had not yet been applied to the homes policies and procedures, or put into use in assessing the capacity of people in the home. The AQAA showed that relevant policies and procedures were in place and indicated that all had been reviewed in February 2010. We looked at the infection control policy and found this had been signed as being reviewed annually, but contained details that were several years out of date. There was no evidence that people in the home and staff were involved in the formulation of policies and procedures. We looked at accident records and found these were generally satisfactory, although one record did not include all the required details. As noted at the previous inspection, accident records were not kept in line with current data protection guidance. Care Homes for Adults (18-65 years) Page 26 of 32 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 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 There must be a care plan in 03/04/2010 place for each person, produced in consultation with the person or their representative, that details how their assessed needs are to be met. This will help to ensure that peoples needs are fully met in the way they prefer and require. 2 23 13 There must be clear and 30/04/2010 robust procedures in place to ensure that the personal money of people living in the home is properly and correctly accounted for. This will help to protect people in the home. 3 23 13 All staff must have training about safeguarding vulnerable adults. This will help to protect people living in the home. 31/07/2010 Care Homes for Adults (18-65 years) Page 28 of 32 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 24 23 The premises of the home 31/05/2010 must be kept in a good state of repair and suitable provision made for storage. Specifically: -the damaged and missing wall tiles in the laundry must be repaired or replaced -the missing ceiling panels in the bathroom must be replaced -the identified items stored in a bedroom must be removed This will help to ensure a better maintained and more pleasant environment for people living in the home. 5 30 13 There must be effective systems in place, following current Department of Health guidance and including staff training, to ensure the prevention and spread of infection in the home. This will help to protect people in the home and staff from acquiring infections. 31/08/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 6 All staff should have training in person centred care planning to ensure that people are actively involved in making decisions about their own care. People in the home should be encouraged and supported to be more actively involved in menu planning, shopping for food, and preparation of meals. This will help to ensure their involvement and promote their choice and independence. Individual assessment of nutritional needs should be carried out on admission to the home and reviewed at least annually to ensure that peoples needs are fully met. Staff should have relevant training to ensure they understand and meet peoples nutritional needs. People in the home should be actively encouraged and supported to manage their own medication, where this is appropriate following capacity and risk assessments. This will help to encourage their independence and ensure their rights are recognised and promoted. Storage of medicines in the home should meet the Royal Pharmaceutical Society guidance The handling of medicines in social care. Specifically, the storage of controlled drugs, and ensuring the medicines cupboard is not used for any other purpose such as keeping money. This will help to protect people in the home. People should be supported and encouraged to manage their own finances, where appropriate following capacity and risk assessments. This will ensure peoples rights and independence are promoted. To ensure peoples needs and preferences are met, a shower seat should be provided in the shower cubicle, and the low settee in the lounge should be replaced with furniture that is easier for people to use. People living in the home should be actively encouraged and supported to be involved in staff selection. This will help to promote their involvement and independence. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles Page 30 of 32 2 17 3 17 4 20 5 20 6 23 7 24 8 34 9 39 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 and responsibilities. This will ensure that peoples rights are promoted and upheld. 10 40 The homes policies and procedures should be fully reviewed and updated annually, or when there are any changes. This will help to ensure that peoples rights and best interests are safeguarded and supported. Accident records should include all the information asked for on the forms and should be stored in accordance with data protection legislation. This will help to protect people living in the home. 11 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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