Care Home: Nottingham Neurodisability Service Hucknall - Rosewood

What the care home does well People`s needs are properly assessed before admission to ensure that peoples needs can be met in the home. People living in the home have their health care needs met and they receive personal support in the way that they prefer. Medication procedures are well maintained and are safe. Two staff completed surveys and they said, "The home cares very well for their clients, they go out for fresh air, shopping, they have showers regularly and have good food". What has improved since the last inspection? The new manager in post is enthusiastic about making improvements and there has also been a new quality manager employed by the service who will be responsible for looking at the systems and documentation in the home and making improvements where needed. The service is also in the process of recruiting a team leader for the unit. The manager was able to provide us with an action plan with timescales of what they were doing to address the issues raised in the Annual Service Review which triggered this visit. They also responded positively to the feedback we gave at the end of the inspection and have already started to make changes to address any areas of concern we raised. What the care home could do better: Care plans should contain evidence that the people they are written for and/or their Representative, if appropriate, are involved in their development and review. The home must have in place a system for reviewing and improving the quality of care provided, which includes the views of people using the service. The required numbers of staff should achieve or be enrolled to complete a National Vocational Award at level 2 or above. There must be a complaints procedure in place for people living in the home which is accessible, appropriate to their needs, specifies the response timescale and gives the contact details of the Commission. Key inspection report Care homes for adults (18-65 years) Name: Address: Nottingham Neurodisability Service Hucknall - Rosewood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lynda Dyer     Date: 1 2 0 1 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 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Nottingham Neurodisability Service Hucknall Rosewood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 01159680202 01159642747 ian.banks@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (Ilkeston) Ltd Name of registered manager (if applicable) Mr Ian David Banks Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Service Users accommodated at Nottingham Neurodisability Service Hucknall Rosewood shall be within category PD The maximum number of service users accommodated at Nottingham Neurodisability Service Hucknall - Rosewood is 32 Date of last inspection Brief description of the care home The Nottingham Brain Injury Centre, Rosewood Unit is a 32 bed care home for people with moderate to severe physical disabilities who need full care with nursing. The home is situated just off a main road entering the town of Hucknall, on a bus route. Within half a mile radius there are shops, superstores as well as the town centre, leisure activities, market and the parish church. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 32 2 0 1 1 2 0 0 8 Brief description of the care home All rooms are located on the ground floor. There is a designated activities room and independent living skills kitchen. There are 29 bedrooms including 3 double rooms, which the manager told us are not currently being used as double rooms. Many of the bedrooms have en-suite facilities and access to a garden area via a patio door from the rooms. The manager told us on the 12th January 2010 that the fees currently charged at the home were £130 per night with additional payments per hour for one to one monitoring. Additional payments are required for Physiotherapy services, Occupational Therapy services, Clinical Psychology services and Podiatry services. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last time we visited this service was November 20th 2008. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. One inspector carried out an unannounced site visit to the home, which took place over a period of eight hours. The manager and quality manager assisted us during the site visit to the home. Care Homes for Adults (18-65 years) Page 6 of 34 We had not planned to visit the home this year. However we conducted a planned Annual Service Review, which involves asking the manager to complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and also asking people involved with the service to complete surveys and give us their views of the service. Concerns raised during this process prompted us to carry out a visit to the service. Our concerns were about the availability of the manager and inconsistencies in information we were being given in the AQAA. We sent out 106 surveys to the service and asked them to give them to people living in the home, their relatives, staff working in the home and health professionals involved with the home. Of 106 surveys sent to the service in three batches over a three month period we received six a total of completed surveys back. We also reviewed all of the information we have received about the home since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing two people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, three members of staff and three people who use the service to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment and facilities of the home to form an opinion about the health and safety of people who live there. Care Homes for Adults (18-65 years) Page 7 of 34 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 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 8 of 34 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 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed before admission to ensure that peoples needs can be met in the home. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that each person living in the home has a full pre-admission assessment as soon as possible after initial referral and that they ensure before people decide to move into the home, they and their next of kin are given the opportunity to visit the unit, at their convenience as many times as they need and access staff to answer questions they may have. We spoke with staff and they told us that they received information about peoples needs before they were admitted to the home so that they knew how to support them. We viewed the care plans of two people living in the home and they both contained evidence that a full needs assessment had been carried out prior to them moving into the home. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: Care Homes for Adults (18-65 years) Page 11 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff members have a good understanding of peoples needs. Care records do not always show that people are supported to live as they would like and staff do not use the plans as a working document. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the introduction of a care culture based on empowerment and choice is starting to actively involve people living in the home in their care planning. We only received one survey back from a person living in the home and they told us that they could do what they liked during the day, the evening and at weekends. Care plans that we viewed contained some evidence that people were being supported to make their own decisions and the manager has put a system in place, which provides people with access to an external advocacy service. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: We looked at the care plans of two people living in the home and they contained risk assessments and support plans detailing the action staff needed to take to minimise the risks. Neither care plan held any person centred information. The plans were very task driven in nature with no information recorded of peoples likes and dislikes, what is important to them, what they are able to achieve themselves or what their goals and aspirations are. There was no evidence in the care plans that we viewed that the people they were written for had been involved in the development or review. One person we case tracked had communication difficulties. There was no evidence in their care plan that staff had tried to use any communication aids to try to improve communication. One care plan that we viewed contained an assessment from an external health professional and there had been a recommendation that this person be provided with a specialist arm chair, so that they could spend time sitting out of their wheelchair for periods of time during the day. We spoke with the staff about this chair and were told that they had not been provided with one as this person did not have the funds to purchase it. We spoke with two members of staff working in the home and they were able to demonstrate that they had a good understanding of the needs of people they were caring for, although they told us that they did not get the chance to read the care plans to keep up to date with the changing needs of people living in the home. The manager has completed the training in the Mental Capacity Act 2005 and staff are also completing the training. We observed that this act had not yet been implemented into the care planning process and there was no evidence to suggest that training has been completed in the Deprivation of Liberty safeguards. This legislation is aimed at protecting peoples rights and choices. We spoke with the manager about the care plans and they told us that the new quality manager was currently developing the care plans. Care Homes for Adults (18-65 years) Page 13 of 34 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. People living in the home are given the opportunity to participate in recreational activities and maintain social contacts. Activities provided may not support people to maintain interests they had before moving in to the home or to achieve their goals. People receive a nutritious diet but their independent living skills around nutrition is restricted. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that people living in the home are encouraged to access community services such as health care, personal care and grooming, educational and recreational. They also told us that transport is available to help them access community services or areas of interest and to go out on trips, country drives etc. The manager said that varied and specialist menus are readily available with light foods, snacks being available on the unit throughout the day. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: The home has a spacious and well equipped activities room and this was in constant use on the day of the inspection with a variety of activities taking place. We viewed the activities schedule and saw that people were being supported to attend in-house activities and also go out on trips outside the home and attend day centres. The activities schedules did not contain information detailing peoples likes, dislikes or goals and aspirations. The activities organiser has a meeting with people living in the home regularly to discuss activities and there was some evidence that the menu was discussed at these meetings with people being asked if they thought the menus needed any changes. Staff told us that they did not feel people were able to go out on trips often enough and information received in surveys also indicated trips were not as regular as people would like. When asked what the home could do better one person living there said, I would like to be more involved in day to day activities. I would like to go out, even if it is just around the estate or to the park at least three times a week. One person living in the home told us, I would really like the activities team to arrange for me to go to a football match. We saw evidence in this persons care plan that they had been a dedicated supporter of their local team before moving into the home. We asked the activities organiser if this person had been asked if they wanted to go to the football match and she said that although they (the activity organiser) did not feel going to the match would be appropriate for this person, they had not actually asked them. They agreed that they would ask this person if they would like to attend a match. We observed that there is a computer in the activities room, which is not set up to receive the Internet and two people living in the home told us that this would be beneficial to them, to be able to maintain links in the community and do research. The activities organiser said that people living in the home could have a laptop in their bedroom but they had to buy this themselves. There is a kitchen that is for people living in the home to use and the activities organiser told us, that they used the kitchen to teach and maintain peoples independent living skills around cooking and baking. We observed that the kitchen is not designed for wheelchair users, the work surfaces and cupboards are at a standard height , so activities for people who are confined to a wheelchair are restricted . The majority of the kitchen cupboard doors were locked on the day of the inspection and Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: there was a lack of utensils available. This means that the kitchen is not being used to its full potential and people living in the home are not being supported in their independence if they wish to make themselves a meal or a drink. We saw friends and relatives of people living in the home visiting throughout the day and they were made welcome by staff. We observed lunch and we saw that there were enough staff available to give the support that people needed and staff offered discreet assistance. We saw that there was a choice of meal and the menu was displayed on the dining room wall. A high number of people living in the home have specialist diets and need a high level of support with their nutrition. Despite this, care staff have not received any training in managing nutrition. One person was not supported to eat in the way their care plan specified and we have addressed this in the staffing outcome of this report. (Outcome 7) Care Homes for Adults (18-65 years) Page 16 of 34 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. People living in the home have their health care needs met and they receive personal support in the way that they prefer. Medication procedures are well maintained and are safe. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the approaches by staff that are used are based on maintaining individuality, choice and dignity when delivering or supporting care to people living in the home. They also told us that they ensure that all care plans are based on a comprehensive physical and psychological well-being assessment with care plans being developed in collaboration with people living in the home and their families or significant others in order to identify personal choices. They told us that all care plans and risk assessments are reviewed by a named nurse monthly and that people living in the home have access to specialist staff on site and are encouraged and supported to access any community based health services whenever this is necessary. One relative said, In all aspects the care provided is of a high standard. I find the staff always very willing to hear comments and act on them. The staff handle difficult Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: situations with my relative well. We received two surveys from relatives of people living in the home and they both said that the home usually gave the care and support to their relative that they had expected and agreed. We asked staff what the home did well and one said, Always meets the needs of the service users. We viewed the care plans of two people living in the home and they gave information on their health care needs, details of how their personal care should be delivered and evidence that referrals to external health professionals were made when they were needed. We received surveys from members of staff and they said that they had been given training that gave them enough knowledge about peoples health care and medication. We also spoke with the nurses who are responsible for the medication systems and they confirmed that they receive regular training in safe medication procedures. We looked at the homes medication storage and administration procedures and we found that these were being managed well by the trained nurses. The nurses spoken with were knowledgeable about the medicines and were aware of the requirements for the safe receipt, storage and disposal of medicines. We also observed the nurses administering prescribed medicines and saw that they were following safe procedures. Care Homes for Adults (18-65 years) Page 18 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service do not know how to raise concerns or make a complaint. Complaints that are made are not documented and there is evidence that suggests they have not been managed well. Staff know how to safeguard people living in the home from abuse. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that they respond sensitively to all events that may or do fall within the framework of adult protection, with rapid reporting to all relevant parties within Nottinghamshire Adult Protection procedures and staff being trained in adult protection. They also told us that they have an open culture that promotes whistle blowing and raising concerns with the complaints procedure clearly displayed and available to people living in the home, staff, external professionals and visitors. We received one survey from a relative and they told us that they did not know how to make a complaint. We received two surveys back from people living in the home and they both said that they did not know who to speak with if they were not happy and did not know how to make a complaint. We received surveys back from members of staff working in the home and they said that they knew what to do if someone told them they had some concerns. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: The home has a complaints procedure in place for visitors to the home. This was in the main entrance to the unit but was not very prominent. There is a complaints procedure in place for people living in the home but this is not in a very prominent position and it asks that if people are not happy they speak with the manager. One person said to us in a survey Who is the manager now? and What hours and days do they work?. The procedure does not tell people how the home will respond if they make a complaint, what they can do if they are not happy with the way the complaint has been managed or give details of people outside of the home that they can speak with, such as the Commission. The Commission has received one anonymous complaint about the unit since we last visited. The complainant said that there was not a manager available and there was no-one to contact in an emergency. We asked the manager to investigate this complaint and let us know the outcome. This complaint was refuted by the service but there was no evidence supplied to prove that there was appropriate management cover and they did not tell us what action they would take to prevent a similar complaint arising in the future. We asked the manager what investigation had taken place as a result of this complaint but he did not know as it had been a different manager in place at the time and the complaint had not been documented. The manager was able to evidence that staff were now aware of how to contact one of the management team if there was an emergency out of normal office hours. We looked at the complaints file and there had been one complaint made to the service since we had last visited. The complaint was from a relative raising concerns about care delivered to their relative. A letter had been written by the manager that was in place at that time stating that they would investigate the concerns but there was no evidence documented that an investigation had taken place or that a resolution had been reached. We spoke with the manager about this and asked them to contact the relative to ensure the complaint had been addressed. We have received information from the manager since the inspection to say that they have followed up this complaint with the relative and although it wasnt documented, the complaint had been concluded. The response to complaints was raised as an issue of concern in our last inspection and we made a requirement that asked that the registered person ensure that all elements relating to complaints were fully documented. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The requirement that we made when we last visited the home has not been met and the evidence that we found on this inspection means we cannot be assured that complaints are being managed effectively. The home has the local current safeguarding adults policies in place and the manager has carried out the referral training. We saw evidence that staff have attended training in safeguarding vulnerable adults and we spoke to staff who verbally demonstrated that they had a good understanding of the homes procedures to safeguard the people living there. The manager told us in the AQAA that they had made two safeguarding referrals since we last visited. Our records indicated that there had been four referrals made, two of these concerned the conduct of staff, and were investigated by Adult Social Care and Health staff and resulted in a member of staff being referred to be considered for inclusion on the Protection of Vulnerable Adults list. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean and well maintained with procedures in place to prevent the spread of infection. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the unit environment is kept clean and tidy and whenever and wherever possible odour free, with their being a recent decorating programme throughout centre. They also told us that shared toilet and bathroom facilities are well maintained through the infection control policies and procedures and that health and safety checks are maintained for equipment in use such as, passenger lifts, electrical equipment, water supply, gas checks, lifting equipment and wheelchairs etc. On the day of the inspection we found the home to be warm and welcoming. We had a partial tour of the home and we found it to be clean and bright in the areas we viewed. We looked at three bedrooms of people living in the home and we found them to be personalised and to have equipment in place to meet their needs. All of the bedrooms have en-suite facilities and there are adapted bathrooms for Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: people with a mobility impairment. The home has health and safety systems and procedures in place and staff are trained in how to put them into practice. The home also has infection control systems in place to prevent the spread of infection and staff are trained to maintain the systems. Care Homes for Adults (18-65 years) Page 23 of 34 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. Staff recruitment practices are safe. Staff are trained in areas of health and safety but some are not receiving training around care practices. Staffing levels may be affecting the outcomes for people living in the home. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that they ensure that all shifts are covered by sufficient staffing levels that take into account the needs of the people living in the home, with the unit having robust recruitment policies and procedures. They also told us that personal care and support to people living in the home is provided by suitably trained staff, with all new staff having a minimum of one weeks supernumerary time to shadow a more experienced carer or senior care assistant. The manager also told us in the AQAA that the homes training meets the National Minimum Standards but then went on to say that out of 19 care staff only 5 have a recognised qualification, called an NVQ level 2 (National Vocational Qualification) in social care. The National Minimum standards ask that a minimum of 50 of staff have this qualification. We discussed this with the manager and he told us that a further 8 staff are in the process of being registered for this qualification, although the 8 staff are spread over the three units of the service. We made a requirement for this Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Minimum Standard to be met last time we visited the home. This requirement has not been met. We looked at the files of two members of staff working in the home and they contained evidence that the required safety checks had been carried out prior to them commencing employment in the home. We received information from staff working in the home that these checks were carried out before they started working there. We looked at the staff training plans and these showed that staff were completing mandatory training. We received two surveys back from staff working in the home and they told us that they received training that was relevant to their role, helped them to understand the needs of people and kept them up to date with new ways of working. Two staff completed surveys and they both said that there are not enough staff available to meet peoples needs. When we asked how the service could improve they said, By having enough staff and giving responsibilities to staff who are able and who really know what they are doing, and more staff would be nice. Concerns were also raised about staff safety at night. Staff working in the home told us that when some bank staff (temporary staff who are brought in to cover staff shortages) are used it made it difficult to complete all the necessary tasks as some of the bank staff did not know peoples needs and so permanent staff need to keep spending time showing them. We saw an example of this during the lunch observation when a member of the bank staff was assisting a person living in the home to eat. This persons care plan showed that a nutritional assessment had been carried out by external health specialist. They had made recommendations for this persons nutrition to be managed at mealtimes by staff making sure they always ate with a tea spoon and by sitting and engaging them in conversation whilst eating. The bank staff did not observe these procedures and quietly stood and assisted them to eat with a tablespoon. A permanent member of staff saw this and took over assisting this person using the recommended practices. The last time we visited the home we recommended that the manager should make extensive efforts to recruit permanent staff for the home. Staff told us that there was not often time to read the information in peoples care plans and that the only time they got to sit and chat with people living in the home was when they were assisting people with their meal. We spoke with two members of staff working in the home and they showed a good level understanding of peoples needs and how they worked to meet them. We also Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: observed them interacting with people living in the home and we saw staff treating people kindly. One person living in the home told us, I feel I am cared for and treated well and I feel like this is my home now as the staff are friendly and I feel confident to ask for anything I need. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistent management has had an impact with some systems and records being left unmanaged and people being unclear as to who is responsible for the home. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) in September 2009 that there was a new centre manager in post. However we have since been told that this centre manager is not expected to return and a new manager is going through the registration process with the Commission. We had not planned to visit the home this year. We conducted a planned Annual Service Review, which involves asking the manager to complete the AQAA and asking people involved with the service to complete surveys and give us their views of the service. Concerns raised during this process prompted us to carry out a visit to the service. Our concerns were about the availability of the manager and inconsistencies in information we were being given in the AQAA. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: We sent out a total of 106 surveys to the service and asked them to give them to people living in the home, their relatives, staff and health professionals who visit. The surveys were sent out in three different batches over a period of three months but we only received 6 completed surveys back. In the surveys we received back from people living in the home and from staff, we received comments about the manager not being available with one member of staff saying, I have never got to speak to the manager yet. and a person living in the home saying, Who is the manager now? and What hours and days do they work?. We spoke with people living in the home and with staff on the day of the inspection and we had comments that included, Who is the manager, I think the quality manager is the manager of the home, I have seen the manager walking around but not spoken with them yet and Are you the new manager? We spoke with the manager about this and they said that they were going to take steps to make sure people were clear about the management structure. When we last visited the home there was a process in place that enabled people using the service to have a say in how it was run and to measure the quality of the service being provided. There was no evidence to suggest that this process is still being used or that there is any other way of measuring the quality of the service provided. The provider is required to visit the home at least monthly to complete an audit which includes speaking with people living in the home, staff working there, looking at record keeping and making sure the service is running well. The evidence in the home indicated that this had only been carried out once since we last visited. The last time we visited the service we asked them to make improvements. We made requirements and recommendations around safety and improving practice. The home did not respond to these requirements or recommendations and they have not been met. This being said, the new manager in post is enthusiastic about making improvements and there has also been a new quality manager employed by the service who will be responsible for looking at the systems and documentation in the home and making improvements where needed. The service is also in the process of recruiting a team leader for the unit. The manager was able to provide us with an action plan with timescales of what they were doing to address the issues raised in the Annual Service Review which triggered this visit. They also responded positively to the feedback we gave at the end of the Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: inspection and have already started to make changes to address areas of concern we raised. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R 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 1 22 22 The registered person shall ensure that all elements relating to complaints are fully documented which will include the outcome and actions resulting from complaints. 05/01/2007 Care Homes for Adults (18-65 years) Page 30 of 34 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 22 22 There must be a complaints procedure in place for people living in the home which is accessible, appropriate to their needs, specifies the response timescale and gives the contact details of the Commission. This will ensure people living in the home know how to raise concerns and make a complaint. 22/02/2010 2 39 26 The responsible individual or 08/03/2010 another person responsible for the home must complete an unannounced visit to the home at least once a month and prepare a written report of the conduct of the home. This will ensure that the home is being managed in the best interest of the people living there. Care Homes for Adults (18-65 years) Page 31 of 34 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 3 39 24 The home must have in 07/06/2010 place a system for reviewing and improving the quality of care provided, which includes the views of people using the service. This will ensure that the home includes the views of people who use the service and can measure how well it is being run. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should contain evidence that the people they are written for and/or their Representative, if appropriate, are involved in their development and review. When a recommendation for specialist equipment has been made. The recommendation should be acted on or information recorded to show why no action has been taken. Where people have communication difficulties, care plans should reflect this and show methods of communication that work best. Care plans should be made more person centred with information about what is important to people and what their goals and aspriations are and how staff will support them to acheive them. It is recommended that, where appropriate, support plans include reference to the Deprivation of Liberty safeguards and the effect it has upon peoples lives. This is to ensure that their rights and choices are protected. It is recommended that support plans include reference to the Mental Capacity Act 2005 and the effects it has upon Page 32 of 34 2 6 3 6 4 6 5 6 6 6 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations peoples lives. This is to ensure that their rights and choices are protected. 7 8 13 16 People living in the home should be offered activities in line with their likes and interests. The kitchen that is provided for the use of the service users should be made more suitable for the client group it is aimed at in order to maximise their independence. Staff should be given training in nutrition. The complaints procedure that is aimed at visitors to the home should be made more prominent. Senior staff should achieve or be enrolled to complete a National Vocational Award at level 3 or above. The required numbers of care staff should achieve or be enrolled to complete a National Vocational Award in health and social care at level 2 or above. The manager should make extensive efforts to recruit permanent staff for the home. It is recommended that staff complete training in the Deprivation of liberty safeguards. (DOLs) 9 10 11 12 17 22 32 32 13 14 33 35 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!