Care Home: Norton Street

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What the care home does well The staff team changed very little. This meant people living at the service and staff got to know each other very well. There was some good information about people living at the service, telling staff about the support they needed and wanted. People lived in a safe and clean service. What has improved since the last inspection? Under the new owners, the service was changing for the better. New ways of helping people have more control and lead more ordinary lives were being started - with changes in how meals were organised now completed; and changes in how people had their benefits paid to them being made. Medicines were now kept in people`s bedrooms so they could be given out in private. New staff were now recruited properly, keeping people living at the service safe. What the care home could do better: New people interested in moving in needed to have a brochure about the service to help them decide if it was right for them. And the manager needed to show she had made sure the service would also be suitable for them and they would get the support they wanted. More activities needed to be provided or supported (including at weekends), so people could enjoy a meaningful and stimulating lifestyle. Major changes in people`s weight needed to be looked into quickly to help keep them well. So people lived in an attractive and safe service - the outside windows and doors of all the houses needed repainting; the gardens still needed looking after; new beds and bedding were needed; electrical safety tests needed doing; and fire doors used properly. Staff numbers needed to be looked at, as staff now had more to do with food shopping and cooking, leaving less time to give other support. All staff needed to have training in food hygiene and mental health and up to date fire safety training, so people living at the service got the right support and were kept safe. Records still needed to be clearer so such gaps could be sorted out. To check how the service was running, Deepdene Care Ltd. needed to start making regular visits. Key inspection report Care homes for adults (18-65 years) Name: Address: Norton Street 28 Norton Street Old Trafford Manchester Lancs M16 7GQ     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: Sarah Tomlinson     Date: 0 9 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: Norton Street 28 Norton Street Old Trafford Manchester Lancs M16 7GQ 01612262979/07748658277 01612270427 nortonstreet@deepdenecare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Deepdene Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of people who can be acommodated is: 30. The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. In the following premises: 17 Khartoum Street 4 service users, 13 Khartoum Street 5 service users, 15 Khartoum Street 4 service users, 39 Milner Street 5 service users, 41 Milner Street 4 service users, 24 Norton Street 4 service users, 26 Norton Street 4 service users. Whose primary care needs on admission to the service are within the following category: MD (Mental Disorder, excluding disability or dementia). Date of last inspection Brief description of the care home Norton Street is a care home registered with us (the Care Quality Commission) to provide specialist mental health care for up to 30 adults. The service is owned by Deepdene Care Ltd., which is a mental health provider with another care home and an Care Homes for Adults (18-65 years) Page 4 of 33 1 8 0 8 2 0 0 9 30 Over 65 0 Brief description of the care home independent hospital in the Manchester area, and further care homes and supported living schemes in the south of England. At Norton Street, people live in 7 small terraced houses (with staff based in an 8th house, 28 Norton Street). All houses are in very close proximity and can all be accessed via a shared, public back alley. Each of the 7 houses has 4 bedrooms, 3 on the first floor and 1 on the ground floor (2 of which have an en-suite shower). All have wash hand basins. There are 26 single and 2 double bedrooms (both currently used on a single occupancy basis). Each house has a lounge, a small kitchen/dining room, a ground floor toilet and a first floor bathroom or shower room with a second toilet. Houses have small gardens or yards at the rear, with smoking shelters (all houses are non-smoking inside). Parking is available on the street. The current weekly fee ranges from £350.00 to £950.00. A copy of our latest inspection report is kept at 28 Norton Street. Care Homes for Adults (18-65 years) Page 5 of 33 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 peterchart Poor Adequate Good Excellent How we did our inspection: Our inspection, which the service was not told about beforehand, took place over 1 day (lasting 9.5 hours). It was carried out by 1 inspector. (References to we or our in this report mean the Care Quality Commission). During our visit we met 10 people who lived at the service and spent time talking with 4 of them. We also talked with a relative and with 4 staff and the manager. We watched how staff supported people living at the service. We visited 3 houses (39 Milner Street, and 13 and 17 Khartoum Street) and looked at some paperwork. We received surveys from 2 people living at the service. Their views are also included in this report. We have also used information from an Annual Quality Assurance Assessment form Care Homes for Adults (18-65 years) Page 6 of 33 (AQAA). The home has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have improved upon since our last visit. Since our last visit the manager had changed. The previous manager, Andy Clephan, left on 29/3/2010. The deputy manager, Sonia Johnson had been promoted to manager and now ran the service. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 33 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of information meant a prospective person could not make an informed choice about moving into the service and the manager could not make an informed offer of a place. Evidence: At the time of our visit 24 people lived at the service, with 6 vacancies. One person had moved in since our last inspection. We looked at how the manager had found out about their goals and support needs. A formal assessment from Social Services had not been obtained, although comprehensive information had been received from the care service where they were living at the time. Norton Streets Statement of Purpose (which described the service and what it provided) and its AQAA described a 4 stage admission process with accompanying supporting documents completed prior to admission. However, whilst the new person confirmed they had visited before moving in, there was no evidence of this nor any other evidence to show the above admission process. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: The need for a pre admission assessment, including discussion and agreement about the prospective persons goals and needs, was particularly important as Norton Street now provided a formal rehabilitation service. Although all places were still offered on a long term, permanent basis (with no respite or emergency care provided), younger people were now moving in to receive this move-on support. The services AQAA stated Deepdene Care Ltd. has fundamentally changed the ethos and goals of Norton Street with a service focused on rehabilitation to enable our clients to move on to less supported accmmodation. New people thinking of moving in should be given information about the service (to help them decide if it is right for them). We were concerned there was no brochure (a Service Users Guide). This should be meaningful and interesting (e.g. with photographs; input from people already living there) and in a suitable format for people with severe and enduring mental health needs. It should also explain the age range of people living at the service, so a prospective person would know most people were older, e.g. in their 50s and 60s, with 3 people in their 70s and 80s). It should explain how the issue of compatibility was considered. As noted, there was a Statement of Purpose, which was a more technical document about the service (meant for us and commissioning departments, etc.). This needed several minor revisions and corrections to provide the information we require. We also found the services actual registration with us was incorrect, as 17 not 11 Khartoum Street should be registered. This will be followed up after the inspection. The new person had a contract. However, this had not been signed by them or the manager. It also needed to show which room and in which house they had chosen; confirm how and who paid their fees; and include general information about house rules (e.g. regarding smoking and alcohol) and responsibility for housekeeping tasks (particularly with the new rehabilitation focus). We looked in 2 other peoples files (who had lived at the service some time). Neither had a contract. All people living at the service should have a formal contract or statement of terms and conditions to provide both sides with clear guidelines about the rules of living at the service. Care Homes for Adults (18-65 years) Page 12 of 33 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. The care and support needs and any associated risk factors of people living at the service were well documented, ensuring staff had accurate, up to date information to guide their work. Evidence: People living at the service were generally positive about it and the staff team. Individual staff were praised, with one key worker described by a relative as going beyond the call of duty in the care they provided and was better than some previous staff who had not always seemed really interested. One person said they were really happy at the service; another said the staff looked after them. We observed staff being polite, friendly and patient. We spoke with several staff, most of whom were very knowledgeable about the care and support needs of the people they were caring for and demonstrated a caring and considered attitude to their work. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: We looked at the care files of 3 people who lived at the service. These were of a good standard, with up to date detailed and helpful information about peoples needs and associated risk issues. Decision making and capacity issues were also addressed, with agreements about any practical support needed to manage money and cigarettes. We discussed some minor improvements (e.g. identifying goals and aspirations more clearly; and using plain English consistently and including the words of the people themselves). There was also some minor duplication; some entries were also not dated or signed; and some key worker section were not completed. We also discussed files showing if a person was on the Care Programme Approach (CPA) and if so, their CPA care coordinator. There was a helpful profile of a persons life history. However, the standard of completion varied, with very little in one persons who had lived at the service for over 10 years. At our last inspection, we had found daily records detailing peoples health and welfare varied in quality. These had now improved. We discussed developing this further, by linking them more to care plans (and also not duplicating medicine administration information). In addition to the services own internal review system, we discussed external reviews with the Community Mental Health Team/Social Services. One person we looked at had not received such input for a number of years, although they had now been allocated a community psychiatric nurse. The manager was aware of the need to now monitor this situation to ensure everybody received at least an annual external review. Care Homes for Adults (18-65 years) Page 14 of 33 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. New, positive initiatives enabled people living at the service to have more control and lead more ordinary lives. However, inadequate staffing levels and a lack of day to day activities may put this at risk. Evidence: As noted, Deepdene Care Ltd. had introduced a new rehabilitation focus, with the specific aim of supporting people to become as independent as possible, with a view, where identified, of moving onto more independent living. However, peoples level of independence and lifestyles varied. As noted, the majority of people living at the service were older (several of whom were near or over retirement age). This wide spread of ages placed demands upon the manager and staff with regard to supporting appropriate personal development and meaningul occupation. Some people organised their own time; another person went to a day Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: centre 3 times a week; one person went to the gym and an adult education class and 2 people attended a weekly support group. However, most people led unstructured lives, spending their time in the houses. None of the (younger) people living at the service were in paid or voluntary employment. At our last inspection we had recommended more work was done in identifying and meeting peoples recreational and educational needs. At this inspection we again discussed work still needed to be done in ensuring people were supported to lead meaningful and fulfilling lives. Deepdene Care Ltd. had made two major improvements. The first, regarding meal arrangements, had begun at our last inspection and was now fully in place. Previously meals were cooked off the premises and brought to 28 Norton Street before being then being sent out again to each individual house. This institutional practice had now stopped. All 7 houses now had fitted kitchens, with each house having its own flexible weekly menu. All the food shopping and cooking was now done mostly by care staff. Two people living at the service told us they were pleased meals were now made in the houses and liked the food, although another 2 people felt not all staff could cook well. We discussed the need for staff to keep a record of the main meals being served (to allow us and the manager to confirm a varied and nutritious diet, with alternatives, was provided). We also discussed about staff eating with the people (as part of their work), which they did not currently do. This would provide an opportunity to spend more time together, particularly when the shopping and preparation had been shared, and would make meals a more social and enjoyable event. The second improvement regarded people having more control over and access to their money. Welfare benefits were to be paid directly into a persons own (interest bearing) account (rather than into Deepdene Care Ltds business account), with staff providing support (where needed) for people to go out and use them. However, the impact of these (very positive) changes upon staff time was considerable, particularly regarding meal preparations. Although people living at the service were encouraged to get involved, staff were now responsible for shopping and cooking a daily main meal and also supporting breakfast and lunch in most of the 7 houses. We were concerned staff members ability to support people with other activities was consequently reduced. With regard to 1 to 1 and group activities, staff said apart from annual trips at Christmas and summer, and cinema trips twice a month, little was done on a regular day to day basis. Staff time to support people in weekend activities was limited by lower staffing levels. However, people did have regular one to one time with their keyworker (although as noted, records did not always support this). We discussed Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: developing this so key workers supported people to take part in a regular activities, either in or out of the houses. With regard to holidays, nobody had been supported to go away in the past few years. One person living at the service said holidays away would be good. People living at the service were however supported to keep in touch with families and friends, with relatives visiting and people staying at their family home on a regular basis. Good practice was also noted, as many people living at the service had been supported to be politically active and vote in the recent local and national elections. Care Homes for Adults (18-65 years) Page 17 of 33 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 physical and mental health of most people living at the service was well promoted. Evidence: People living at the service were supported to access a range of different healthcare support and facilities (e.g. GP, community psychiatric nurse, social worker, district nurse, optician, specialist hospital appointments). We discussed where routine health check ups took place, as unless people were very frail, these should take place out of the home (supporting community participation and ordinary living). We discussed the routine monitoring of peoples weight. Whilst unnecessary for most people (as it did not promote privacy and dignity nor people having control over their own lives), it may be indicated for certain health or medical reasons or if the person themself wished support to lose or gain weight. We were concerned specialist assessments had not been sought for one person when their weight chart clearly showed considerable weight loss over the past year (which was also likely having a negative impact on a separate healthcare need). Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: We discussed general health records, as it was difficult to track issues over time and confirm annual check ups. The standard of some entries was also unhelpful, e.g. a medication and some tablet did not explain what changes had been made and why. We discussed having a separate medicaton record, with details of current and past medicines would be helpful when tracking peoples responses. We also discussed how known signs and symptoms of mental ill health, possibly indicating a relapse, could also be recorded and used as a reference point to support early intervention. With regard to serious incidents and accidents, the manager was correctly informing us of these. The services accident records were also being completed appropriately (although the need to store completed records differently to meet data protection legislation was discussed). We discussed having first aid boxes in kitchens (now they were in use). Many people living at the service needed support with personal hygiene. There was a good mix of male and female staff, enabling people to receive support from a person of the same gender. We looked at how medicines were managed. Suitable arrangements were in place. All staff were trained to administer medicines, with a specimin list of their initials kept (to identify who had administered any given medicine). There was a clear audit trail of medicines entering the home, being administered and any unused medicines being returned to the pharmacist. Improvements had been made since our last inspection, with clearer guidelines in place for medicines given on an as needed (PRN) basis. We discussed the need to have information to guide staff about the correct order for inhaler administration. Medicines were stored safely. Improvements had been made, with each person now having a locked medicine storage box in their bedroom. This increased privacy as medicines were no longer given out in front of others. Good practice was noted, as several people were supported to look after their own medicines, with details in files about the practical arrangements for this. Care Homes for Adults (18-65 years) Page 19 of 33 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. Arrangements were in place to protect people living at the service from abuse or harm and for taking their concerns seriously. Evidence: A new complaints procedure was being introduced, with clear timescales for each stage of the process. The procedure was not displayed in the houses, although the manager said the right to complaint and how to do it was discussed at each house meeting (although these were not currently taking place). The people we spoke to knew who talk to if they were unhappy or had any concerns. As noted, there was no brochure currently for the service. When produced, this must include helpful information explaining what to do if a person wanted to make a complaint. No complaints had been received by us since the services last inspection. The AQAA had not provided any information about complaints received by the service, although the manager confirmed there had been none. A formal record was now in place to record any if made. We discussed finding out about local independent advocacy schemes. With regard to safeguarding alerts, although no information had been provided in the AQAA, the manager confirmed none had been made since our last inspection. Good practice was noted, as staff attended formal abuse awareness training. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: There had been two serious incidents since our last inspection, one concerning an intruder and theft and the second an assualt and theft when a person was out. Appropriate action had been taken by the manager. The service had links with the local community police officers and due to a previous intruder, had already improved house security. With regard to safeguarding peoples monies, arrangements were in place for several people to have their money looked after on a daily basis. We checked 2 of these cash balances. These were correct, with money held safely and appropriate records in place. We discussed the Deprivation of Liberty Safeguards (DOLs), which include a new legal role and responsibilities for care home managers. Good practice was noted, as the manager had attended training about this and was able to confirm no person living at the service was currently being deprived of their liberty. Care Homes for Adults (18-65 years) Page 21 of 33 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. Routine maintence was inconsistent, resulting in people living in houses that were not always well looked after or well furnished. Evidence: The interiors of the houses were bright and comfortable, with domestic style furniture, fittings and decor. However, the exteriors were poorly maintained. All windows and doors had paint peeling off, with the bare wood exposed, some of which had clearly rotten (e.g. back door at 17 Khartoum Street). The manager said windows and doors were due to be repainted over the summer. We also discussed the partially white washed ground floor windows at 28 Norton Street, which looked unattractive and drew attention to the house. At our last inspection we had found garden areas poorly maintained. There had been improvements made but some areas still looked unsightly (with lots of weeds and hanging baskets of dead plants). We found other needed maintenance work - some beds (mattresses and bases) were very stained and dirty; some pillows were very worn; and some bedding was very marked with numerous cigarette burns; and everyone did not have a comfortable easy/armchair in their bedroom. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Some settees and arm chairs also needed deep cleaning or replacing (due to heavy staining); at 17 Khartoum Street the lounge carpet needed deep cleaning or replacing and the black mould and wallpaper coming away on the kitchen ceiling (from a now fixed leak) needed addressing. With regard to aids and adaptations, the manager was aware of the need to ensure the houses continued to meet the needs of the older people living in them. Good practice was noted, as an occupational therapy assessment had been arranged for a younger person, resulting in the fitting of additional grab rails in their house. We discussed the need to arrange such an assessment for another person (regarding using the shower/negotiating steps). We discussed smoking arrangements. Deepdene Care Ltd. had decided not to permit smoking inside. There were a couple of open-sided shelters in back gardens/yards and one enclosed (but unheated) external smoking area. We discussed reviewing the policy and the smoking areas provided (e.g. how they were used in winter), as some people clearly smoked elsewhere (both in and outside the houses). We found the houses we visited smelt fresh and were tidy and clean (apart from the minor issues noted above). Two domestic staff were employed to clean communal areas, with care staff supporting people to clean their bedrooms. Good practice was noted, as hand hygiene was supported by liquid soap and paper towels in communal hand washing areas. Care Homes for Adults (18-65 years) Page 23 of 33 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. Improvements in recruitment meant people living at the service were safer. However, gaps in basic training put this at risk, and people living at the service may not benefit from the new rehabilitation focus due to inadequate staffing levels. Evidence: The staff team was stable, with little change, enabling staff and the people living at the service to get to know each other well. Staff worked set shifts, with 4 working during the week and 3 at weekends. There were 2 waking night staff. We were concerned not enough staff were on duty to meet the needs of people at the service. Firstly, only 3 staff had been working weekday mornings for several months. The manager had been helping to cover care duties but we were concerned this had carried on for several months. We discussed the managers hours in a service this size should be supernumerary to allow management duties and responsibilities to be properly carried out. We were also concerned about the adequacy of staffing levels due to layout of the service (with people living in 7 separate properties) combined with the new (and positive) rehabilitation focus. As noted, new meal arrangements placed particular demands on staff time, and more group and social activities needed to be provided Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: and/or supported (including at weekends). Communication within the staff team took place via staff meetings and by an overlapping of team leader shifts during the day. We discussed this would be further supported by a brief overlap of shifts between day and night staff, enabling a handover to take place at these times. With regard to recruitment, at our last inspection we had been concerned poor practices had put people living at the service at risk. As no new staff had been employed since, at this inspection we looked at the records of bank staff currently being recruited. Some improvements had been made - gaps in employment were now being investigated (although there was no record of this); references now appeared to be being pursued appropriately; and criminal record checks were now being requested (with the manager confirming no staff would start work until a full check was received). We confirmed all criminal record checks from staff employed after this inspection must be kept until our next visit. Recent photographs (confirming identity), were also now in place. Good practice was noted, as formal interviews had been carried out, with set questions and responses recorded and scored. The manager was aware of the new forthcoming additional legal requirement for staff to be registered with the Independent Safeguarding Authority (although the government were currrently reviewing this). Staff spoken to felt supported by the management team. Supervision arrangements were in place and the new manager had scheduled for sessions to restart next month. We discussed the shift patterns of the sevices management team, as both the manager and deputy worked the same shifts. We discussed the benefits of the 2 most experienced and skilled staff working occasional evening and weekend shifts to monitor and support staff who only worked these hours. With regard to staff training, as noted at our last inspection, we again found records unclear (although the manager provided requested inormation shortly after our visit). We discussed the need for the manager to monitor what training staff had received, when any needed updating and whether staff were attaining our expected minimum of 5 training days pro rata each year. We also discussed what mandatory training staff needed to complete to work at the service. As a specialist mental health service, we expected staff to have a good understanding of severe and enduring mental health needs, and how these effected peoples lives. Staff attended several different courses. However, no staff had attended all and 5 staff had attended none. There were also gaps in other basic training, as whilst all staff were now involved in food preparation, 8 staff did not have a basic food hygiene qualification. Eight staff had also not received Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: annual fire safety refresher training for at least 2 years. With regard to supplementary training, we were pleased to note staff were attending Mental Capacity Act 2005 training. We also discussed staff knowledge of relevant physical conditions (i.e. diabetes or pressure sores). Whilst information was in care files, informal training sessions in team meetings could support this. Care Homes for Adults (18-65 years) Page 26 of 33 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 living at the service and the staff team were benefiting from positive leadership, with a service that was safe and well run. Evidence: The manager of the service had recently changed. The previous manager, Andy Clepham, had left on 29th March 2010 to manage another Deepdene Care Ltd. service. The deputy manager, Sonia Johnson, who had worked at the service for 10 years and had been deputy manager for the past 4 years, had been promoted to manager. Ms Johnson was aware she needed to now apply to us to become the Registered Manager. Ms Johnson had an NVQ level 3 care award and was in the process of enrolling to do a managing care services qualification (the Leadership & Management Award). We discussed once this management qualification had been attained, we would expect her to then attain an NVQ level 4 care award or equivalant. Staff spoke positively about the new manager, feeling supported and involved. We also received positive comments from people living in the service and from a relative, who said Ms Johnson was good and knew what was what. As noted, we discussed with Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Ms Johnson the need for her hours to be supernumerary to ensure she had adequate time to carry out her duties (e.g. supervision; recruitment; monitoring and arranging training; admission assessments; and the implementation of the services new rehabilitation focus). We discussed the need for the service to assess the impact of its new rehabilitation approach and to also monitor its performance in general. Group meetings were usually held with people living at the service, enabling them to discuss issues and make comments. However, as noted, these were not currently taking place. We also discussed the need for monthly, unannounced quality assurance visits by Deepdene Care Ltd., which were also not taking place. We also discussed the need to develop other quality assurance mechanisms to gain wider feedback, e.g. surveys to relatives and stakeholders (i.e. community mental and social work teams; GPs; District Nurse teams). With regard to safe working practices, as noted, some staff needed fire safety and food hygiene training. Whilst the AQAA had confirmed most safety and maintenance checks were up to date, there was no information regarding portable electrical appliance testing. With regard to fire safety, we discussed the need to review the services own internal weekly fire safety checks as some lounge doors did not close into their rebates (this was addressed before the end of our visit) and they were also being wedged open. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 As planned, the exterior windows and doors of all 7 houses must be repaired and painted. So people live in attractive and well maintained houses. 30/09/2010 2 26 16 Marked and worn beds and bedding must be replaced. So people living at the service had good quality, comfortable, clean beds and bedding. 30/07/2010 3 37 8 As planned, the manager 30/07/2010 must make an application to become the Registered Manager. To ensure the appropriate management of the service. 4 39 26 The Responsible Individual 30/07/2010 or an appropriate person must make monthly, unannounced visits to the service (with a formal record Care Homes for Adults (18-65 years) Page 30 of 33 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 kept), interviewing the people who live there and staff, and inspecting the premises and records of events and complaints. To monitor the running of 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 2 1 3 A Service Users Guide should be developed to provide prospective people with information about the service. To support the services new rehabilitation focus, the pre admission process should include clear discussion and agreement about a prospective persons goals and needs and how these will be supported the manager and staff team. To ensure people living at the service were supported to lead meaningful and stimulating lives, a greater range of leisure, social and educational activities should be provided and/or supported. To promote peoples health, considerable changes in weight should be responded to quickly. Gardens and back yards should be well maintained, so they provide a pleasant area for people to enjoy (this was asked for at our last inspection). Staffing levels should be reviewed to make sure there are enough staff to support the services new rehabilitation focus. To keep everyone safe, all staff should complete annual fire safety refresher training, and all staff involved in food preparation should undertake food hygiene training. To enable training needs to be identified and met, the Page 31 of 33 3 13 4 5 19 28 6 33 7 35 8 35 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 system for recording staff training should be reviewed (this was asked for at our last inspection). 9 42 To keep people living at the service safe, portable electrical appliances should be regularly tested. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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