Care Home: Mappleton House

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What the care home does well People have been assured their needs can be met at the home, with full assessments carried out before they were admitted at the home. Support is planned to meet needs agreed through the assessment. Some people benefit from attending a day centre and staff assist them to prepare for their day. People live in clean premises and maintenance is planned and ongoing. What has improved since the last inspection? All care plans are now kept securely on the premises. Improvements in security and storage arrangements of medication have been made since the last inspection. Repeat prescriptions are checked each month for completeness and accuracy before the medicines are delivered. Each person has their own medication care plan describing their preferences and needs. Staff told us that they had started using the minibus to take people out on short trips. The acting manager had started using personal care plans using pictorial representations and photographs to help people understand and express their needs. The acting manager had designed a new accessible complaints procedure for people living in the home. This used photographs and pictures and staff reported that it was helping people to request to see the manager. Staff have received more training since the last inspection visit and they are all now trained in Safeguarding Adults. Staff recruitment practices have improved. What the care home could do better: They should encourage individuals to take part in daily housekeeping tasks with appropriate support. Staff should always offer people choices of meals and opportunities to be involved in food preparation. Staff should always follow plans to carry out procedures to monitor people`s health. Care staff should follow the home`s medication procedures at all times. All hand written entries and changes should be checked by a second carer. Carried forward quantities should be recorded on the new MARs each month. Accurate records of skin care product usage should be maintained. Opening dates should be recorded on all oral liquids and skin care product containers. They must maintain full records of all transactions concerning money held on behalf of people. This is so that people are safeguarded from financial abuse. The manager should complete training about implementing the Mental Capacity Act so that capacity tests and best interests assessments are included in care planning. The bungalow must be accessible by wheelchair users at all times. This is to ensure the premises meet people`s changing needs. They should provide an alternative pedestrian entrance to the premises so that the wide gates do not need to be opened every time someone needs to enter or leave. This would help to prevent people leaving without the support and supervision they need to keep them safe. There must be arrangements to maintain a sufficient number of staff at all times to cover staff sickness and there must always be a nominated member of staff, trained to administer medication, on duty on the premises at all times of the day and night. This to safeguard the health and well being of people in the home. More staff need to work towards achieving a National Vocational Qualification in care so that they become more competent and qualified to meet people`s needs. Managers should always obtain a reference from the previous employer as part of the recruitment process to confirm people are fit to work with vulnerable adults. Each member of staff should have regular recorded supervision meetings at least six times a year with their senior or manager in addition to regular contact on day to day practice. This is so that people benefit from well supported and supervised staff. The acting manager must complete a full application to the Commission to be assessed for registration. This is so that she can demonstrate her fitness to manage the home for the benefit of people that live there. Key inspection report Care homes for adults (18-65 years) Name: Address: Mappleton House Mappleton House 9B Chestnut Grove Mapperley Park Nottingham NG3 5AD     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: Meryl Bailey     Date: 1 3 0 4 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: Mappleton House Mappleton House 9B Chestnut Grove Mapperley Park Nottingham NG3 5AD 01159623714 01159623714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mappleton House Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Mappleton House Care Homes Limited is registered to provide accommodation and personal care for persons of both sexes whose primary care needs fall within the following category :- Learning Disability (LD) 10 Date of last inspection Brief description of the care home Mappleton House Care Homes is a care home providing long-term personal care and accommodation for a maximum of 10 younger adults who have a learning disability. The home is located in a residential area, north of Nottingham city centre and close to shops, pubs, the post office and other amenities. Mappleton House Care Homes comprises of two houses and a bungalow each with single bedrooms, bathrooms, kitchen, and shared sitting rooms. Unrestricted parking is available on the road. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 10 1 0 0 6 2 0 0 9 Brief description of the care home Information about the service is provided on request at Mappleton House. The fees for the service range from £900 - £3,200 per week depending on needs. There are additional charges for hairdressing, chiropody and toiletries. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is on outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection in June 2009. Managers of homes are now required to complete a form called an Annual Quality Assurance Assessment (AQAA) to identify from their own quality monitoring what the service does well and what they need to improve. An AQAA was returned in March 2010 and was used to plan the visit and to support judgements made in this report. We did the inspection visit with two inspectors. One of these was a specialist pharmacy inspector, who concentrated on the handling and administration of medicines in the Care Homes for Adults (18-65 years) Page 6 of 31 home. The visit was unannounced and took place on one day during the daytime. The main method of inspection we use is called case tracking which involves us choosing a sample of people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at three peoples care records and all eight peoples medication. The people living at the home have needs relating to communication and our assessment of their views has been through observations in addition to some direct responses. We had discussions with some of the staff and also received completed survey forms from other staff working there. A tour of the premises included some of the bedrooms as well as communal areas and facilities. We also looked at a sample of staff records to find out if checks were carried out before they started working at the home and if they were appropriately supervised and trained. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: They should encourage individuals to take part in daily housekeeping tasks with appropriate support. Staff should always offer people choices of meals and opportunities to be involved in food preparation. Staff should always follow plans to carry out procedures to monitor peoples health. Care staff should follow the homes medication procedures at all times. All hand written entries and changes should be checked by a second carer. Carried forward quantities should be recorded on the new MARs each month. Accurate records of skin care product usage should be maintained. Opening dates should be recorded on all oral liquids and skin care product containers. They must maintain full records of all transactions concerning money held on behalf of Care Homes for Adults (18-65 years) Page 8 of 31 people. This is so that people are safeguarded from financial abuse. The manager should complete training about implementing the Mental Capacity Act so that capacity tests and best interests assessments are included in care planning. The bungalow must be accessible by wheelchair users at all times. This is to ensure the premises meet peoples changing needs. They should provide an alternative pedestrian entrance to the premises so that the wide gates do not need to be opened every time someone needs to enter or leave. This would help to prevent people leaving without the support and supervision they need to keep them safe. There must be arrangements to maintain a sufficient number of staff at all times to cover staff sickness and there must always be a nominated member of staff, trained to administer medication, on duty on the premises at all times of the day and night. This to safeguard the health and well being of people in the home. More staff need to work towards achieving a National Vocational Qualification in care so that they become more competent and qualified to meet peoples needs. Managers should always obtain a reference from the previous employer as part of the recruitment process to confirm people are fit to work with vulnerable adults. Each member of staff should have regular recorded supervision meetings at least six times a year with their senior or manager in addition to regular contact on day to day practice. This is so that people benefit from well supported and supervised staff. The acting manager must complete a full application to the Commission to be assessed for registration. This is so that she can demonstrate her fitness to manage the home for the benefit of people that live there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate assessment procedure is in place for any new people. Evidence: No new people have moved into the home since December 2007. There were comprehensive assessments from health and social care professionals about the needs of the last person who moved in and the acting manager had previously attended meetings with professionals and family to ensure full information was obtained in order to plan the support needed to meet the persons needs. She informed us that any future assessment would be carried out jointly with family and professionals involved. There would be visits to individuals and their visits to Mappleton designed to meet their individual needs. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and support is planned to meet individual needs, but how people make their own decisions and choices is unclear, which means that peoples individual needs and preferences may not be met. Evidence: The manager told us in the Annual Quality Assurance Assessment form, Each individual service user has their own individual care plans, person centred plans, risk assessments and activity plans which are reviewed on a regular basis. We found that there were individual plans available for each of the people living there, though they were not consistent in format. There were some person centred plans that included pictures and diagrams to help clarify peoples needs and support required. Not all person centred plans had been completed and it was not clear which decisions people had made for themselves. There were some detailed risk assessments, though it was unclear how and when these were reviewed. The manager told us that they had been trying to review these Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: each month, but it was not possible to keep up with this aim. Some risks remained unchanged and did not require such frequent reviews, but others changed according to needs and behaviour. There was no clear system to ensure these were not missed. There were records of some review meetings held with professionals and family members. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are plans made to offer lifestyle and meal choices to people, but in practice choices are limited and this means that people may not always have any real choice. Evidence: The Annual Quality Assurance Assessment stated: All service users at Mappleton House have their own individual activity plan, transport timetable and sensory room timetable that allows for a variety of different activities for the service users to choose from. All service users are encouraged to access the community as much as is possible. Several service users attend day services and are involved in regular activities which are planned by the day service. We found that three of the current people living at the home attend regular day services, though one of these was unwell and stayed at home at the time of this visit. There were, then six people at the home when we visited. Two of these went out for a Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: walk with staff. One person spent most of the day at the home with a family member. We did not see any of the other three engaged in any activity. There were activity plans with suggested activities. There was a sensory room in one house and the acting manager told us it was available for use. No one used it during this inspection and we found that some furniture was temporarily stored in the room, though there was still sufficient room for sitting. Staff told us in returned surveys that they had started using the minibus to take people out on short trips, though no holidays had been offered or planned and staff felt these may be appropriate for some people. All housekeeping tasks were undertaken by staff and we did not see any attempt to involve people in these tasks. Meals menus were clear and included photographs showing a choice of two alternatives for every meal. However, in practice staff were not following this. For lunch one staff member thought she might give them spaghetti. She had not consulted the menu or the individuals concerned. Staff told us that it was not possible for people to help with food preparation due to their behaviour. From records we saw that on the previous evening everyone had minced beef casserole. Staff explained that due to storage arrangements this was cooked in one house and taken round on plates and trays. There were records of how much had been eaten, but no record of alternatives offered if meals were rejected, though some people had food supplements prescribed for them. The kitchen in the bungalow was very small and also served as a corridor. This may not be a safe area for people to be assisted and involved with preparing meals. (See further comments in the environment section.) Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support with personal care in private and healthcare needs are reviewed, but assurance is not given that all planned procedures are carried out to monitor health. Systems are in place to manage medication appropriately, but when staff do not follow the medication policy and procedures correctly, this could potentially put peoples health and safety at risk. Evidence: Support needed with personal care was clearly stated. For some people this was in personal care plans which showed they had some input in planning where possible, but not all of these had been completed. All personal care was provided in private and each person had their own bathroom facilities. There were records of health appointments and reviews. One review agreed care staff would carry out a procedure on a monthly basis, but records indicated this had only been done once. We examined all current Medicine Administration Record (MAR) sheets and those for the previous month and we found no significant gaps in recording whether or not Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: medication was given. However, we found that not all staff were following the homes medication policy and procedures correctly. For example, the quantity of medicines retained at the end of the monthly cycle was not recorded in the carried forward section of the new MAR. This meant that it was difficult to confirm whether these medicines had been used correctly and whether sufficient medicines would be available for the whole of the next month. We also found that two hand written entries on one MAR had not been checked and that they lacked a witness signature. Errors in recording the date on the MAR meant that the administration records for these two medicines suggested that the medicines might not have been given as directed. A check of the remaining medicines still to be given showed that the expected quantities were correct so we concluded that it was likely that the two medicines were given. We also found some gaps in the usage records of one dental product and one skin care product. We were told that care staff helped people to use these products in peoples own rooms as part of their personal care. It is important to show that all prescribed medicines, including skin and mouth care products, are being used correctly so that the benefits of all prescribed treatment can be accurately assessed. Medication security and storage arrangements have improved since the last inspection which has minimised the risk of any loss or diversion of peoples medicines from the home. Temperature checks of the medication refrigerator identified no concerns but no thermometer was available in the medication store room. There was no evidence to show that the store room temperature was being monitored to keep the contents safely at temperatures recommended by the manufacturer. We found that staff had omitted to record the opening dates on containers of oral liquid medicines, which means that it is possible for some of these products to be used beyond the recommended in-use period. Medication ordering, receipt, storage and disposal arrangements in the home were good, and the General Practitioners prescriptions were checked by staff each month before the medicines were delivered. This check had been put in place since the last inspection and had helped to make sure staff are aware of any prescription changes and they now know that sufficient quantities of everyones medicines have been prescribed each month. The manager has recorded information about when and how people living in the home prefer to receive their medicines in a personal medication plan accompanying each MAR. This helps staff to reduce the risk of refusals or omissions. There were some examples in care plans of instruction to staff describing the circumstances in which medicines prescribed to be taken as and when needed are to given, but not all peoples care files were up to date in this respect. Care Homes for Adults (18-65 years) Page 17 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to express their own concerns and any complaints received are taken seriously. Action is taken to safeguard people from physical harm, but the absence of accurate records does not safeguard people from financial abuse. Evidence: The acting manager had designed a new accessible complaints procedure for people living in the home. We saw it on the wall in each building. It was clear to understand and staff reported that people pointed to the photograph of the manager if they wanted to express concern about something. There was a file of records about complaints received and how these were dealt with. Staff told us about training in Safeguarding adults and there were copies on staff files of certificates for attendance at training sessions. The manager had commenced training about the Mental Capacity Act, but had not completed the full training to include Deprivation of Liberty Safeguards. She was pursuing this. There were no records of assessments of peoples mental capacity. There was evidence on staff files that staff were checked before they commenced at the home to make sure it was safe for them to work with vulnerable adults. However, see staffing section regarding a recommendation about staff references. Family members managed some peoples money, but most peoples finances were Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: managed by the provider company and there was an individual bank account held for each person. There were no assessments of peoples capacity to have involvement or knowledge of their finances. Two senior managers were the signatories for the individual accounts. Cash was withdrawn and brought to the home to be held in a safe on the premises so that it was available for use by staff on behalf of people as needed. We checked the records of transactions and found that staff had not completed them for the last four weeks. The amounts held for each person were in separate plastic wallets. On counting the money in each wallet there was considerably less than the amounts recorded. There were receipts in other places that had not been entered in the record book, but there were insufficient receipts to cover the amount missing. On discovering this, the acting manager informed the police and referred the matter to the local authority Safeguarding Adults Team for further investigation. Care Homes for Adults (18-65 years) Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean premises and most areas are well maintained, but not all parts of the premises are appropriate to meeting peoples needs. Evidence: The home is made up of two houses and a bungalow. We looked inside each building, but did not see every bedroom. The sizes of rooms varied between the three buildings, but three bedrooms we saw were clean and pleasantly decorated. Kitchen refurbishment was planned for one house and worktops for this were stored in the dining area of the bungalow. Two ensuite facilities in the bungalow had been improved since the last inspection, though new flooring was still needed for these. The kitchen was smaller as a result of providing a larger ensuite shower room. New flooring had been fitted in the main lounge and dining area. We found that access to the bungalow had remained via a door leading through the narrow galley kitchen. Although level, the entrance was not spacious enough to bring a wheelchair inside. At the last inspection, a senior manager told us of plans to create another entrance in place of the lounge window. This was intended to provide a wide entrance suitable for wheelchair users. We found that a further door had been fitted, but it was only available as a fire exit. Therefore, the usual entrance and exit to the building remains via the kitchen. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: There are electronically operated main gates to the premises. A code was needed to open them. They opened wide enough for vehicles to pass through and there was no alternative pedestrian gate. We had been notified of two occasions when people had left the premises via the gates, without staff being aware, since the last inspection. The risk of people leaving the premises unsupervised had been assessed and an alarm was fitted to one house. Further action had also been take to shorten the delay with the automatic closure of the main gates. Staff had been reminded to check that the gates were closed before moving away. However, we observed two occasions during the visit when staff did not wait for the gates to close. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A sufficient number of trained and competent staff are usually, but not always available to meet individual needs at all times. Relevant training is arranged for staff to be able to meet peoples needs, but staff are not fully supported and supervised in their work. Evidence: Staffing rotas showed a sufficient number of staff on duty so that most people had one to one attention and one person was allocated two staff, in accordance with the plan of care. However, one person was unable to attend a day centre due to illness and the additional member of staff that had been arranged for care of this person was not available for work. No other arrangements had been made. We found this person in the lounge of one building, one staff was with another person close by, so there was some supervision. The manager told us that there was no agreement to contact agencies when they were short staffed and she often covered the work herself. There was a staff member for each building at night, but on checking training, we found that for three nights none of these staff had medication training. We were told that at least one person may need medication urgently and the arrangements were that staff would need to contact the manager at home, who would then come to administer the medication. However, the delay caused by this could have severe Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: effect. One person needed medication within 3 minutes. We immediately required the manager to arrange appropriate staff to cover the next three nights. Subsequent nights appeared covered on the rota for the current week. Full staffing records were securely held on the premises. We looked at the records of five staff including two that had commenced during 2010. There was evidence that checks had been pursued for new staff through the Criminal Records Bureau. There were two references for each person, but many of these were from colleagues or friends and there was not always a reference from the previous employer. The manager told us that 7 of the staff had completed an National Vocational Qualification at level 2, though three of those were waiting for certificates. New staff had an induction within the home in the first three days and then attended a full induction course with Rushcliffe Care within two months of starting. There were certificates of other training on staff files and a training plan was visible and clear on the office wall. Training received since the last inspection included Record Keeping, Food Safety, Cultural Awareness, Safeguarding Adults, Managing Challenging Behaviour and specific training provided by the Autistic Society. Those staff with responsibility for administering Medication had completed training on the subject and further specific training was planned. Care Homes for Adults (18-65 years) Page 23 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are being developed to monitor the quality of the service to ensure it is run in the interests of people living there. Evidence: Since the last inspection there has been a change in management and the current acting manager had commenced the process to apply for registration with the Commission The acting manager sent us the Annual Quality Assurance Assessment in March 2010. In this she told us: Residents/relatives questionnaires are sent out yearly. We have an open door policy within the home where residents and relatives can express their views. We are planning to have relatives meetings on a regular basis so that they have a regular opportunity to express their views on the home and any improvements they may wish to see. There was a system for a representative of the company to visit each month to review the quality of the service, though the last reported visit was in February 2010. Senior Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: managers had visited on a regular basis for various reasons and one visited during this inspection. Following the concerns we raised about money another senior manager visited two days after the inspection to ensure appropriate immediate action was taken. We found from information in the AQAA that all servicing of equipment had been carried out within the last year and the five yearly full service of electrical circuits was carried out in February 2007. There were systems in place to provide staff with training in health and safety topics. Care Homes for Adults (18-65 years) Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 33 18 Ensure appropriate staff, trained to administer medication, are on duty and awake on the premises at night. This to safeguard the health and well being of people in the home. 13/04/2010 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 23 17 Maintain full records of all transactions concerning money held on behalf of people. This is so that people are safeguarded from financial abuse. 30/04/2010 2 24 23 Make the bungalow accessible by wheelchair users at all times. This is to ensure the premises meet peoples changing needs. 30/06/2010 3 33 18 Ensure there is a nominated member of staff, trained to administer medication, on duty on the premises at all times of the day and night. 28/05/2010 Care Homes for Adults (18-65 years) Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This to safeguard the health and well being of people in the home. 4 33 18 Ensure there are arrangements to maintain a sufficient number of staff at all times to cover staff sickness. This to safeguard the health and well being of people in the home. 5 37 9 The acting manager must complete a full application to the Commission to be assessed for registration. This is so that she can demonstrate her fitness to manage the home for the benefit of people that live there. 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 28/05/2010 30/06/2010 1 2 6 9 Complete person centred planning, involving people in the process of planning the support they need to reach goals. Establish clear review dates for each risk assessment so that risks and actions needed are always kept under review. Encourage individuals to take part in daily housekeeping tasks with appropriate support. Page 28 of 31 3 16 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 4 5 6 7 17 19 20 20 Ensure staff always offer people choices of meals and opportunities to be involved in food preparation. Staff should always follow plans to carry out procedures to monitor peoples health. Opening dates should be recorded on all oral liquids and skin care product containers. Accurate records of skin care product usage should be maintained by the staff who assist people in using these products. Carried forward quantities should be recorded on the new Medicine Administration Records each month to allow checks of medicines available to be made. All hand written entries and changes should be checked for accuracy and completeness by a second carer. The homes medication policy and procedure documents should be fully upheld by staff at all times to ensure current best practice is always followed. The manager should complete training about implementing the Mental Capacity Act so that capacity tests and best interests assessments are included in care planning. Provide an alternative pedestrian entrance to the premises. Encourage and support all staff to work towards achieving a National Vocational Qualification in care so that they become more competent and qualified to meet peoples needs. Always obtain a reference from the previous employer as part of the recruitment process to confirm people are fit to work with vulnerable adults. Each member of staff should have regular recorded supervision meetings at least six times a year with their senior or manager in addition to regular contact on day to day practice. Meetings should cover understanding the philosophy and aims of the work, monitoring work with individuals, support and professional guidance and identification of developmental needs. This is so that people benefit from well supported and supervised staff. Develop a clear system to continually monitor the quality of the service including the views of people living within the Page 29 of 31 8 20 9 10 20 20 11 23 12 13 24 32 14 34 15 36 16 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 home. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!