Care Home: Norfolk House

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What the care home does well People take part in regular activities that they enjoy.People are supported with their health and physical care needs the way they like to be.People`s medicines are looked after safely.The flat is homely, comfortable and safe.People have nice bedrooms with lots of their own things.The staff team is small so people get to know the staff well.Proper checks are made on people who want to work at the home.The daily routines are relaxed and people can spend time doing things they like at home.They are being protected from harm and abuse. What has improved since the last inspection? People have their needs and wishes written more clearly in their care plans.The home now has a registered full time manager. What the care home could do better: People living in the home should not have to share their home with new people without a trial to see if they all get on.Communication aids could be used more to help people understand things better and make more choices.The owners should check the quality of the service every month. Key inspection report Care homes for adults (18-65 years) Name: Address: Norfolk House Etnam Street Leominster Herefordshire HR6 8AQ The quality rating for this care home is: two star good 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: Jean Littler Date: 1 7 1 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Norfolk House Etnam Street Leominster Herefordshire HR6 8AQ 01568610663 01568610663 wilhelmina.tymensen@midlandheart.org.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Midland Heart Limited Name of registered manager (if applicable) Mrs Marie Ann Davies Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 4 Date of last inspection 2 4 0 2 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home The Home is close to the centre of Leominster where there are pubs, local shops, a supermarket and post office near by. The Home is one of a group of services managed by Midland Heart Limited. The home is for four people over the age of fifty five who have a learning disability. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 Care Homes for Adults (18-65 years) Page 6 of 36 How we did our inspection: This is what the inspector did when they were at the care home We, the Commission, carried out this inspection over 5 hours on December 17th. The manager was on duty and helped with the process. We looked around the flat and spoke with two of the staff. One of the residents let us look at his bedroom and all three filled out surveys to give their views about the home. We looked at some records such as care plans and medication. The manager sent information about the Home to us before the visit. We were helped to do the inspection by Steven Proctor. He is an Expert by Experience, who uses his experience of Learning Disability support services to judge this service. His views have been put into this report. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well People take part in regular activities that they enjoy. People are supported with their health and physical care needs the way they like to be. Peoples medicines are looked after safely. The flat is homely, comfortable and safe. People have nice bedrooms with lots of their own things. Care Homes for Adults (18-65 years) Page 8 of 36 The staff team is small so people get to know the staff well. Proper checks are made on people who want to work at the home. The daily routines are relaxed and people can spend time doing things they like at home. They are being protected from harm and abuse. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 9 of 36 People have their needs and wishes written more clearly in their care plans. The home now has a registered full time manager. What the care home could do better People living in the home should not have to share their home with new people without a trial to see if they all get on. Care Homes for Adults (18-65 years) Page 10 of 36 Communication aids could be used more to help people understand things better and make more choices. The owners should check the quality of the service every month. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jean Littler 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT Care Homes for Adults (18-65 years) Page 11 of 36 01216005300 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 set out 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 12 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People interested in the home have access to information but this has not been developed into accessible formats. People will have their needs assessed and they will be offered the opportunity to trial the service. Emergency admissions do not give existing residents the chance to decide who they live with. Evidence: The manager reported that the Statement of Purpose and Service Users Guide have been updated recently. The Statement of Purpose is detailed and included the complaints procedure. The manager said in the AQAA that she plans to develop the User Guide into more accessible formats such as a CD or DVD. The Guide does not include full information about the fees and extras people will have to pay for. This should be included so people have clear financial information before they move in. Two new people have moved in during the last year. Both at very short notice when social workers had failed to find alternative accommodation when their placements broke down and they were at risk of being homeless. The manager showed evidence that an assessment of their needs was completed and assessment information was also provided by the social workers. The new people did not have families involved. Both people were Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: invited to visit the service before moving in. One accepted this and came for lunch the day before she moved in. The other was unable to cope with a visit and was brought by ambulance on the day she moved in. Fortunately for the resident who has lived in the home for 17 years staff said there have not been any compatibility issues. One of the new ladies is now a permanent resident, alternative accommodation is being sought for the other one. The manager said she is aware that his rights were compromised by the quick admissions as he was not given the opportunity to get to know the ladies to see if he wanted to share his home with them. They in turn did not have time to assess if the service could meet their needs. The Statement of Purpose does not cover emergency admissions. Two people said in their surveys that they did not choose to come and live there, but they have found the service to be good. One said, it is lovely here. Although care has been taken to ensure these admissions have been as successful as possible the providers should be mindful that it is not best practice to provide temporary placement in someones home and the Statement of Purpose does not explain how these two services will be managed. The Expert by Experience reported the following, I asked how the male resident gets on with two female residents. Staff said it is fine but the man does spend a lot of time in the dining room on his own listening to music. I thought it was difficult to tell if people were happy living together. Care Homes for Adults (18-65 years) Page 15 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs detailed in their care plans and these are being kept under review. People are being enabled to take reasonable risks in order to enjoy their lives. They are being supported to make decisions and participate in the life of the Home. Better developed Person Centred Planning systems would help ensure peoples future needs and wishes are being actively planned for. Evidence: Care plans are in place for all three residents. The company has introduced a new format for care not yet presented in a format that would be easily accessible to most people with a learning disability. Two were sampled on this occasion. One was looked at in relation to the assessment of a new persons needs, as mentioned above. The other was looked at to see how the needs of the resident who has lived in the home for many years were being met. This contained relevant and detailed information to guide staff, including risk assessments. The information had been kept under review. The risk assessments seen showed that reasonable judgements were being made about the balance between safety and quality of life. The daily notes indicated that appropriate support was being given and staff discussions confirmed that they knew him well including his likes, dislikes and Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: methods of communication. The manager is due to attend training on the Mental Capacity Act in February. Following this she should develop the care plans to better show what each persons capacity to make decisions is, and how they will be helped to be as involved as possible in decisions that affect them. A professional involved in the service reported, The service, in my opinion, has strived to be person centred and meet individuals needs. There is an excellent staff team who will take on the challenge, explore alternative options for people and always put their wishes and needs first. The physical aspect of the building lets the service down. Many of the staff put themselves out to give people a fulfilling and happy home life. They genuinely care for their service users it is not just a job to them. The manager reported in the AQAA that the two permanent residents have had Person Centred Planning (PCP) meetings held with them and their external representatives. However these only focused on whether it would be in their best interest to move to a building with better facilities, rather than on an overall PCP for all areas of their life. All residents have two keyworkers to support them. It would be positive if their role included holding PCP meetings and developing clear action points for the next six months. Review meetings should be held at least every six months to keep the planning and reviewing process active. The staff on duty were observed to offer the resident who was at home choices during his daily routine. They responded positively to signs given by him as a means of communication, for example, when indicating he wanted a drink. One worker gave examples of how people are involved in the life of the home such as going food shopping. She confirmed that choices are offered whenever possible. The manager said they aim to improve how information is offered by making it more accessible. This is much easier now IT and digital cameras can be used. Each person does have a communication profile in their care plan to inform staff about how best to communicate wit them. The Expert by Experience reported the following, Staff told me they had recently had some communication training using art. They said this training was useful and it would help them to communicate better with people living in the home. Staff said they are going to be making some new menu cards for people living in the home. The new cards will be colourful and have pictures and will help the residents to choose what they want. I think it is a good idea and great staff recognise the importance of things being accessible. This should be put in place as soon as possible. Staff then showed me a folder called a customer involvement folder. This was a folder showing things people have chosen to do and some information about the person. I did not find the folder very accessible and I did not really understand what was written inside it. I did not see a care plan but I hope that the care plans for people are more detailed and easier to understand. Page 17 of 36 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 18 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are accessing activities and holidays they enjoy and they have relaxed routines when at home. Their rights are being respected. A balanced diet is being provided and mealtimes are relaxed and flexible. Evidence: The one person at home during the inspection seemed very relaxed and content in the Home. Routines and activities are arranged in a flexible way giving consideration to the persons age, preferences and health. Some form part of a weekly activity plan and others are arranged when opportunities and community events arise. There is a modern people carrier to enable community access. Two people have bus passes and one enjoys going into town on the bus. The two new people attend different day services five days a week. People who wish to are supported to attend church regularly. Records indicated that people are being offered regular outings. Staff reported that one person who has never had a holiday went on a short break that was very successful. Another person has been on three short breaks during the year. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: The Expert by Experience reported the following, I arrived and met the three staff on duty. One was the manager. She told me that two ladies and one gentleman live in the home. The two ladies had gone to day centres for the day so, I would not get chance to meet them or speak to them. It would have been nice to speak to everyone, but I was pleased that the ladies were out. The manager told me about the day centres the ladies attend. One lady travels to Hereford every day which is good because she gets out of the house and involved in the community. One day centre offers lots of opportunities to work within the community. They have shops run by people with Learning Disabilities and a market stall run by people with Learning Disabilities. I thought this was good to hear as people should not be in the centre all day with nothing to do. There was one gentleman at home. The man did not communicate verbally much so, I asked staff to support in answering some questions about what the gentleman does during the day. The gentleman likes to have a massage. Once every two weeks a man comes to the home to give him a massage. I think it is great that this happens, but it may be better if the man was able to go out somewhere for his massage. The gentleman also likes aeroplanes. There is an airfield local to the home which he often visits to watch planes take off and land. The gentleman has also had two flights from the airfield. I thought it was brilliant he was supported to do this. In the summer the man had visited Cardiff for a weekend away. It was nice to hear he had been on a holiday. I asked staff what people would be doing next week as many of the normal activities people do like go to the day centre would not be on offer. I was pleased to hear staff had already got some things planned including visiting some local Christmas lights, and a shopping trip. People do not have relatives involved in their lives. The manager should consider increasing links with advocacy services to see if an advocate can be found for each person. The food is purchased locally and staff prepare the meals as needed each day. Records showed a balanced and varied diet is being offered. There are no set times for meals and drinks, and snacks are available throughout the day. Peoples general preferences are known and these are considered when meals are prepared. Care Homes for Adults (18-65 years) Page 20 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are receiving personal support in the way they prefer. Their health needs are being met and their medication is being safely managed. Evidence: The care plan sampled contained clear information about peoples preferred daily routines and personal care support. Records and observations confirmed that the staff team continue to treat people with respect and engage with them in a pleasant manner. The daily routines are flexible taking account of their individual needs and where possible they are given choices about their daily routines. The current staffing arrangements do not allow same gender personal care to be given to the one male resident, but he seems at ease with the female staff he knows well. Findings confirmed that independence is being promoted where possible. The manager reported in the AQAA that there has been no increase in any negative behaviours which indicate that people are having their emotional health needs met. People are being supported to access health checks and medical appointments, and consultants are appropriately involved for specific health needs. The records seen confirmed this, for example a continence nurse has been involved to help one person. One person moved in while being treated for a serious health condition. Staff supported the person to attend treatment appointments and cope with the side effects. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: Care plans include health information to guide staff. There are not separate preventative Health Action Plans that can easily be taken to the doctors, however the manager said people would be enabled to take the whole care plan with them if they left the service. The staff team has a good history of supporting people sensitively as their health needs increase with age or during hospital stays. They have attended relevant training such as dementia and epilepsy. A thank you card was seen from the relative of a previous resident who moved into a nursing home. Staff also dealt well with a long term residents unexpected death during the year. Peoples wishes about the end of their life have been recorded in a specific care plan. Peoples medication is being securely stored. A medication profile is included in their care plans. Records showed that doses had been given as prescribed and no gaps in the recording systems were seen. One recommendation was made to improve the audit trail. New staff are being given appropriate instruction before they administer medications and accredited training is also being provided. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel their views are listened to and they are able to raise complaints. A framework is in place to help protect residents from abuse. Evidence: The manager said she has now set up a complaints folder containing the complaints procedure. A version of this in a format appropriate for people with a learning disability was not seen. A complaints return is sent into the company head office each month. There have not been any complaints about the service in the last year. No complaints have been received by the Commission either. The manager reported that efforts are made to help people express their views and staff need to be aware of changes in peoples behaviours as these will change if they are unhappy. People said in their surveys that staff do listen to them. The company has a protection policy in place, which reflects the local multi-agency Safeguarding Adults guidelines. The manager reported that one concern had been referred to the local authority under this procedure. This was not directly in relation to service. The manager reported that all staff have attended specific abuse awareness training and that she has attended the training run by the local authority for home managers. Staff confirmed that the manager is approachable and they are aware of what they would need to report to her. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: The service has a good record of responding sensitively when residents present behaviours such as agitation or aggression. Staff have attended training on dementia and in responding to behaviours in a positive way. There have not been any significant incidents with the current residents. Care Homes for Adults (18-65 years) Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are being provided with a clean and comfortable environment that is homely. Their bedrooms have been personalised and specialist equipment has been provided to promote independence. Some aspects of the building are not ideal for the residents. Evidence: The Home is situated in the centre of Leominster town and close to the local amenities. The flat is part of a large sheltered housing complex. It has level access with wide corridors and doorways throughout. The house is homely, comfortable and attractive. There are four single bedrooms with sinks. Communal facilities consist of a kitchen, lounge, dining room and two level access shower rooms. The kitchen is very small and this does not allow the residents to easily access the area to enjoy this part of home life. The lounge is also small and is not suitable for people who use wheelchairs or other mobility equipment. The residents bedrooms are individually decorated and furnished. They are fitted out with personalised items to help people feel comfortable. The laundry facilities are in the main communal laundry room, but the Home has their own machines within it. The dining area has patio doors but they open onto a communal walkway around the building and are adjacent to the car park. There is a communal garden area but this is not near to the flat. The repairs service provided by the landlord can be slow. The manager said they have agreed to replace the floor in one shower room. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: There are plans to make both shower rooms more homely. The Home is being kept clean by the care staff. This arrangement seems to be effective at the moment but should be reviewed if a fourth person is admitted. The manager reported that systems to reduce the risk of cross infection are in place and that all staff have been on infection control training. The Expert by Experience reported the following, Norfolk House is a small flat within a large warden controlled block of flats for the elderly. Three people live there at the moment but the flat does have four beds. A male staff member showed me around the home. I thought it was tidy but some of the furniture was a little old and stained. I told the staff member I do not look in a persons bedroom unless they give permission. The home is very small and I think it would be difficult if all four beds were being used. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being well supported by an effective and competent staff team who are being supervised and suitably trained. They are being protected by the staff recruitment procedure. Evidence: Two staff are usually on duty during the waking day. Staff reported that as the people currently living in the home have no mobility restrictions they can support them safely alone if a colleague is off sick at short notice. They felt the current staffing arrangements were suitable. The manager said no agency or bank staff have been used for three months. Waking night staff were provided between October 2008 to July 2009. The need for this ended when a man with dementia moved to a nursing home. Now one worker sleeps in and is on call if someone is unwell or if there is a fire. A senior member of staff within the organisation is on call. Some of the staff team have worked in the home for a significant amount of time. They are clear about their role and have been observed over several inspections to consistently provide support in a very respectful and enabling manner. The residents said in their surveys that staff always treat them well. Professionals were also positive about staff attitude and skills. The Expert by Experience report, I spoke to staff about their work. One member of staff Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: always sleeps in the home at night. One staff member told me they would be working from 7.30am until 3pm the following day as they were doing that evenings sleep in duty. I think this is a very long time to expect anyone to work and I felt this could affect the level of support given to people in the home. Only two workers have left since the last inspection and one has been recruited. This persons recruitment record was checked. This showed that satisfactory background checks had been received. The workers start date was not on the file and had to be found elsewhere. There was no date on one reference and there was no evidence that it had been obtained before the worker took up post but the manager was sure it would have been. A check list should be used to provide a clear audit trail of dates and information for each new applicant. This worker had an induction document on file showing dates certain information and policies were explained to her. The design of the induction does not meet the requirements of Skills for Care work sector induction standards. The format does not provide any evidence of the detail covered or of the workers understanding of each area. The manager explained that there have been difficulties accessing company training as this is run out of Birmingham. She has now made arrangement to use local training providers, for example five places have been booked on a dementia course locally. All the existing staff have attended courses several times so they just need periodic refreshers. The new worker had been supported to access all core training, for example, Food Hygiene, Fire Safety and Moving and Handling. The manager said the company does not provide Equalities and Values training about how people with Learning Disabilities should be supported. This should be considered to ensure all staff are working to the same standards. It is positive that places have been arranged for staff to start the Learning Disability Qualification through an on line provider. Staff spoken with said the team works well together and that morale is good. The manager has been providing regular supervisions since June 09. The new worker had been offered two of these since she started in June. These were not frequent enough to fit in six a year, which is the National Minimum Standard. The worker had not done this type of work before so supervisions should have been given more often to ensure she was well supported and monitored. Regular staff meetings are being held. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from a well run home and their health, safety and welfare are being promoted. The owners have not yet fully addressed all the areas they are responsible for. They need to monitor the service more closely and ensure the management structures are robust. Evidence: The management arrangements have not been stable since Midland Heart took over the service in 2008. There was a temporary manager and then the service was supported by the registered manager of two other local care homes. Ms Davies then became manager but was based in the local company office and was only involved with Norfolk House on a part time basis. In June 2009 she became the full time manager and she was registered following the inspection, on January 11th 2010. She has ten years relevant experience with the client group, but has not been a registered manager before and needs to gain a professional and management qualification, which she has started work towards. She says she feels supported by the company, even though she has only been provided with two supervision sessions by a line manager. Shortly after the inspection the company arranged for the manager to cover the Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: management of another service for six weeks when the manager of this service became incapacitated. One of the care workers at Norfolk House has been acting up as a senior to provide additional management support. This arrangement is due to end soon. If the company is going to expect managers to be flexible then they should consider keeping a senior or deputy post so the management arrangements are more robust. Staff gave positive feedback about the manager and feel the home is very well organised and running smoothly. One said, We provide a good standard of care to all our customers and the staff team works well together. The only improvement would be to provide a garden for customers. We are all sorry that the temporary senior post will end in February. The manager explained that the company sends in a quality assurance assessor once a year to complete a full audit. This process was carried out at Norfolk House in September 2009. It resulted in an action plan that the manager expected to have completed in the near future. Residents and representatives are being consulted through reviews, meetings and surveys. The providers have not been fully carrying out their legal duty to visit the Home monthly and report to the directors on the conduct of the Home. Prior to June these visits were not taking place and this was raised in the February inspection. Since June two months have been missed. A requirement has therefore been made, so enforcement action can be considered if monthly visits are not undertaken. This monitoring is an essential part of the arrangements to safeguard people using the service, particularly as quality assurance assessments are only completed annually. The AQAA showed that the company has yet to develop policies in all areas relevant to the management of this type of service. For example, Values Dignity and Respect; Smoking and Use of Alcohol by staff; Service Users Sexuality and Relationships. This work should be prioritised by the Company as policies form a framework to guide staff and this helps protect people using the service. Staff said some of the company policies had not fitted with the service provided at Norfolk House, for example, they assumed everyone had full mental capacity and could easily be consulted. Some have been changed to reflect this. The Expert by Experience reported the following, When talking to staff they called the people living in the home customers. I have not heard this word used before. I understand that this word may be used by the home provider, but I would still like to hear the word people used as customer sounds very impersonal. It would be good to find out what the people living in the home prefer to be called or just refer to them as people. The manager has reported incidents and events appropriately to us, in line with regulation 37. Records are being stored securely and those seen were being used to demonstrate the way the service is being managed and to safeguard people in the home. One persons financial records were sampled. These showed only appropriate purchases were being made and receipts kept. There is no activities budget so most personal expenditure is in this area. Cash balances are made regularly so accountability between Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: staff is clear. Peoples money tins are held in the office. This is an institutional practice and the manager agreed to consider if more person centred arrangements can be made. It is positive that the company are paying for vehicle costs, whereas in the past residents have had to pay these. Systems are in place to manage health and safety matters such as routine checks on fridge and water temperatures. The manager provided information confirming that equipment has been routinely serviced. Risk assessments are in place and staff are provided with safety training in their induction. The fire risk assessment was reviewed in December 2009 and the manager and another worker have been on a fire marshal course. A fire drill had been held during the August staff meeting. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action 1 39 26 The registered providers must carry out monthly monitoring visits at the service. 31/01/2010 This is to help protect people using the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should make it clear how emergency admissions will be managed if the owners are going to continue to accept people in these circumstances. Clear information about fees and extra charges should be included in the Service Users Guide. Develop accessible information about the home. 2 4 Stop the practice of taking emergency admissions and ensure current residents are fully consulted about who Page 33 of 36 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 moves into their home. 3 6 Person Centred Plans should be developed, in consultation with the person and their representatives that consider how all aspects of the persons life can be enhanced. Develop care planning to better reflect the requirements of the Mental Capacity Act. Develop accessible information, including accessible care plans, to promote effective communication. Increasing links with advocacy services to see if an advocate can be found for each person. Develop separate health action plans so people can take their plans with them if they leave the service. (In line with the recommendations of Valuing People). Develop a bring forward system for medicines in stock that are outside of the Monitored Dose pre packed system. Develop complaints information in a format more accessible to people with a learning disability. Pursue plans to provide alternative accommodation for the service. Provide a comfortable chair in the dining area for the resident who spends time in there relaxing, or consider consider not filling the fourth bed and having a second communal area. Replace any stained or tatty furniture. 12 32 Introduce a different style of induction that meets the Skills for Care guidance and provides evidence that the new worker has understood the information and acquired the knowledge needed. Provide core values training for all staff. 4 5 7 8 6 7 16 19 8 20 9 10 11 22 24 28 Care Homes for Adults (18-65 years) Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 13 14 15 33 36 37 Keep the practice of staff working long hours to a minimum. Provide staff with supervision at least six times a year. The company should provide the manager with supervision at least six times a year to demonstrate clear lines of accountability. The company should provide the manager with time to complete the required qualifications relevant to her role within the next year. 16 38 Keep a senior care worker post or create a deputy post to make the management arrangements more robust. The company should prioritise completing the remaining policies and procedures needed for the effective management of the service. 17 40 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or 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 © (2010) 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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