Care Home: Parkcare Homes (No 2) Ltd TA The Mews - Bramley

What the care home does well Good community links were maintained and people were well integrated into the community. There was a good relationship maintained with the wider community that had a positive effect on people. The home had a good complaints procedure and a robust adult safeguarding policy. The environment was homely, and well maintained and the standard of cleanliness was good, providing a safe environment for the people that live there. Staff training was up to date including specific training. Recruitment procedures were robust protecting people who lived at the home. What has improved since the last inspection? This was the homes first inspection since it registered in September 2009. What the care home could do better: Full assessment of need, should be used when assessing perspective clients to ensure their needs can be met. A full plan of care should be generated from the needs assessment ensuring all people`s needs are identified and can be met. Risk assessments must be in place to ensure all people`s risks have been identified and can be met. Medication procedures must be improved to ensure all medication is given as prescribed to safeguarded people. Health action plans must be completed to ensure all peoples health care needs are identified and met. Key inspection report Care homes for adults (18-65 years) Name: Address: Parkcare Homes (No 2) Ltd TA The Mews - Bramley 97 - 99 Main Street Bamley Rotherham S66 2SE     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: Sarah Powell     Date: 1 5 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 25 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 25 Information about the care home Name of care home: Address: Parkcare Homes (No 2) Ltd TA The Mews Bramley 97 - 99 Main Street Bamley Rotherham S66 2SE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Sally Lovell Type of registration: Number of places registered: care home 8 Parkcare Homes (No 2) Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence learning disability physical disability sensory impairment Additional conditions: The maximum number of users who can be accommoded is 10 The registered person may provide the following category of service only Care home only To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Learning disability code LD Date of last inspection Brief description of the care home The Mews is a purpose build block of eight self contained flats. The flats are on two storeys so some are accessed by stairs. The service is situated in Bramley, Rotherham Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 0 0 0 0 0 0 8 0 0 Brief description of the care home close to shops and amenities. Each flat has its own bedroom, bathroom, kitchen and lounge diner. Access to the flats is through a locked gate with secure care parking. The service looks after people with a learning disability. Fees at the time of the visit were £1350 - £3295 per week. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star, This means that the people that use this service experience adequate quality outcomes. We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may be revised or carried forward into the report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced visit, which took place on 15th January 2010, commenced at 10:30 and finished at 15:30 hours. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from Care Homes for Adults (18-65 years) Page 6 of 25 different sources for this report. These sources include Reviewing information that has been received about the home since the last inspection. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. We spoke to the people living at The Mews, support staff, domestic staff, the administrator and the manager. At the site visit one inspector spent 5 hours at the home. During this time observation of interactions between staff and residents and care practices took place. We spent time looking at care plans, medication records, staff rotas, looking at individual flats and reviewing a selection of health and safety information, staff recruitment and training records and management. Full feed back was given to the manager during the visit and at the end of the visit full feedback was given to the administrator and the manager. The annual quality assurance assessment had not been completed this was because one had not been sent. The manager has now received one and will complete the annual quality assurance assessment (AQAA). The AQAA focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. Care Homes for Adults (18-65 years) Page 7 of 25 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 25 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 25 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. Peoples needs and aspirations were not fully assessed prior to admission and therefore could not determine if these could be met at The Mews. Evidence: We looked at two peoples assessments undertaken by the manager prior to being offered at place at the Mews. The assessments were very brief and contained very little detail on what peoples needs were. It was therefore difficult for staff to determine if the persons needs could be met at The Mews. Assessments from placing authorities were in the plans of care but not easily accessible to staff. The peoples needs identified in the placing authorise assessment were not identified on the homes assessment, this did not ensure peoples needs were met. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans did not clearly identify peoples needs or have clearly identified measures in place to determine how needs could be met. Evidence: We looked at two peoples plans of care in detail to determine if their needs were identified and met. When we looked at the assessment by the placing authority and the managers pre admission assessment of needs, these did not identify the same needs. The placing authorities assessment was very detailed yet the plans of care had not been generated from this, many needs were not identified in the plan of care. This did not ensure all peoples needs were met. One example we saw was the placing authority assessment of one person gave details of challenging behaviour and aggression, which was displayed at times. This was not identified in the plan of care, however incidents of aggression were recorded in the Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: daily records, staff had not completed a behavioural chart , a plan of care or risk assessment for challenging behaviour or aggression. This did not ensure the persons needs were met. Some risk assessments were in place, however not all peoples risks had been identified or appropriate risk management procedures in place, to ensure people were protected. One example was a person had seven incidents of aggression documented on a behaviour chart for October and November, however there was no recording since. A risk assessment was not in place for challenging behaviour and their behaviour had not been reviewed. The manager told us his behaviour had improved yet this was not evident from looking at the care plan. It was therefore not possible to determine if their needs were met. Health action plans had not been completed, these identify peoples health care needs so not all peoples health care needs were met. The Manager told us she was aware the plans of care required work and intended to complete these to ensure all peoples need were documented. This would ensure staff understand peoples needs and are able to meet them. Another care plan we looked at was a person who had moved from another home in the group. The care plan was transfered with him, it had not been reviewed since he had moved in to The Mews. This would have identified any changing needs due to the move, to ensure all his needs were identified and met. The daily record kept by staff were detailed and comprehensive, it showed what the person had done each day, what they had eaten, what activities they had taken part in and if they had been out. This showed people were given choices and participated in what they wanted to do. People told us, Staff are good they help me. I choose what I want to do and the manager is always there to listen to me. Staff told us they supported people to make decisions, gave people choices and that people were supported to take risks to be able to live an independent lifestyle. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make decisions and choices about their lifestyle and are supported by staff to develop new skills. Evidence: The Mews is an activity focused home, enabling people to access the local community when they wished and take part in valued and fulfilling activities of their choice. People told us they take part in many activities they are able to choose what they want to do and were supported by staff to do this. People told us that they liked the new home and the staff were very nice and looked after them very well. People told us they saw their family and friend regularly, staff went with then so they could visit family and keep in touch with friends. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: The manger told us that any person that wanted to attend collage or find a job, would be supported to do this to ensure their needs were met. People told us they had not lived at The Mews for long, but were settling in and getting to know everyone. They all said they could talk to the manager if they had any problems and she would get it sorted. Each person had a self contained flat with their own kitchen. They did their own shopping with a support worker, had their meals when they wanted to and were supported by staff to prepare and cook meals. This ensured peoples needs were met. Records of what people ate were kept, we looked at some records. The meals were varied and healthy ensuring people ate a balanced diet. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mostly people receive support in the way they prefer but this is not always clearly documented in plans of care, which means their needs may not always be met. Medication procedures did not always protect people. Evidence: People who lived at The Mews were able to maintain their own personal care with support from the staff. People were also able within their capabilities, to choose their own clothes and hairstyles to reflect their personality. Staff we observed provided sensitive and flexible personal support and peoples privacy and dignity was maintained. The plans of care we looked at did not have completed health action plans in place so not all peoples health care needs were identified. This meant they may not always be met as staff were not aware of all peoples needs. The manager told us peoples healthcare needs were met, professional advice and Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: referrals were made when required. However this was not clearly documented in care plans. The manager told us she was aware these needed completing and had intended to do this by the end of February 2010 to ensure peoples needs were met. We looked at medication administration records these were clearly signed when medication was given, protocols were in with records to ensure staff understood medication policies and procedures. However when we case tracked one person the medication that had been administered and what was left did not tally. We looked at disposal records and saw that some had been returned to the pharmacy. This still did not tally with what was left. We counted the tablets that had a record of administration and the ones that had been returned. There still was still 16 tablets unaccounted for. Records did not show people had received the medication they were prescribed. The manager also looked into this during the visit and the discrepancies could not be resolved. The manager agreed to carry out a full medication audit and implement better methods of recording disposal. This would then ensure people received the medication as prescribed and were safeguarded. When we looked at medication in one persons flat, a liquid medication had been poured into a plastic pot and had been left in the locked cupboard. The administration record had been signed for but it appeared the person had not taken the medication. The manager gave this to the person while we were there, this is not good practise. The administration record was not checked so could not know when it had been poured out or if it had been given or not. If a person refused medication it should be recorded correctly on the administration record and the medication disposed of, this will safeguard people. Since this visit the manager has informed us that she has introduced new procedures regarding medication. This will ensure errors do not occur. One member of staff is responsible for ordering medication and checking all medication on receipt. Audits are carried out monthly to ensure peoples safety and that medication is given as prescribed. Care Homes for Adults (18-65 years) Page 16 of 25 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. There was a good complaints procedure and safeguarding policy, which protected people. Evidence: There was a clear and effective complaints procedure, which included set timescales. The complaints procedure was also in an easy read format to enable people with a learning disability to understand. The home has a good safeguarding policy, which clearly defined different types of abuse, and staff we spoke to were aware of different types of abuse, they also told us about the importance of whistle blowing to ensure people were protected. Care Homes for Adults (18-65 years) Page 17 of 25 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. Standard of cleanliness and environmental standards were good providing a homely, comfortable environment for the people that lived there. Evidence: The Mews is a new care home it comprises of eight individual self contained flats, each flat has its own kitchen, bathroom, bedroom, lounge and dining area. Some flats are bigger and would accommodate two people, however the people living in these want to live alone, the manager told us no one would move in with them. This ensures their choices are respected. The standard of cleanliness throughout the flats was good, there were designated cleaning staff employed. These staff do the majority of the cleaning to ensure the standards are maintained. A maintenance person was employed who carried out all the routine maintenance to ensure the environment was safe for people who lived there. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were appropriately trained, the recruitment procedures were robust ensuring people were in safe hands at all times, had their needs met and were protected. Evidence: Since The Mews opened in October the manager has employed 20 new staff, four members of staff transfered from another home. The four that transfered all have NVQ level 2 and 3. The new staff will all be enrolled on the NVQ level 2 when they have completed the induction training. This will ensure people are supported by a competent and qualified staff team. We looked at three staff files all training was up to date. Staff had also received training specific to the service, including autism and speech signs and symbols. This ensured staff were able to meet peoples needs. We looked at recruitment procedures for three staff. There was a thorough recruitment procedure, each file looked at contained two references, a Criminal record check, any gaps in employment were explored and a completed application form. These robust procedures protected people. Care Homes for Adults (18-65 years) Page 19 of 25 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. Management and administration safeguards people, good health and safety policies and procedures were in place ensuring the safety of people in the home. Evidence: The manager is competent and experienced to run the home, she registered with the Commission when the home registered in September 2009. However she has been a registered manager of another service for a number of years. The manger has completed her registered managers award to ensure the home is run in the best interests of the people that live there. The manager told us she has struggled on her own with the volume of work since the home opened in October 2009. She had employed 20 new support staff. A deputy was appointed but did not take the job. An administrator has been working a few days to try to help, however this is not a permanent arrangement. The manager has requested a full time administrator rather than a deputy as this would meet the needs of this service. The administrator had assisted the manager in a Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: number of areas, if they were appointed full time this could continue. This would enable the manager time to concentrate on improving the outcomes for people living at The Mews. This would include the developing of plans of care to determine peoples needs were identified and met, staff induction and supervision. The company have good quality monitoring systems in place, however not all were being implemented at the time of the visit. The monitoring systems that seek the view of the people and their relatives have not been undertaken since the home opened, this does not give people the opportunity to share their views. The manager told us she intends to start this within the next four weeks to ensure people are listened to. Quality monitoring audits are carried out within the home to ensure standards are maintained. There was a comprehensive health and safety policy and procedure in place to protect people. All maintenance checks were carried out and up to date ensuring the safety of the people who live at The Mews. The manger told us she was in the process of updating fire procedures and putting in place individual risk assessments for all the people at The Mews to safeguard them. Care Homes for Adults (18-65 years) Page 21 of 25 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 22 of 25 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 2 14 The assessments of needs must detail all peoples needs. This ensures the service are able to meet the persons needs. 01/03/2101 2 6 15 Every person must have a written plan of care in respect to their health and welfare. This will ensure peoples needs are met. 01/04/2010 3 9 13 All peoples risks must be identified and risk management procedures in place. This will ensure people are protected. 01/04/2010 4 19 12 Peoples health care needs 01/04/2010 must be identified and documented in plans of care. Care Homes for Adults (18-65 years) Page 23 of 25 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 To ensure their needs are met 5 20 13 Arrangements must be in place for the recording, handling, safekeeping, safe administration and disposal of medication received into the care home. This ensures people receive medication as prescribed and their needs are met. 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 01/03/2010 1 2 32 39 All staff once completed the induction training to be enrolled on NVQ level 2. The quality monitoring questionnaires should be sent out to people and their relatives to seek their views on the service. The fire procedures that were being developed by the manager are completed to ensure peoples safety. 3 42 Care Homes for Adults (18-65 years) Page 24 of 25 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). 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