Care Home: Parkwood House

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What the care home does well People are supported to keep in touch with their families and friends and visitors are welcomed into the home. One relative told us they are satisfied with the service and have no complaints. They went on to say that their son looks forward to returning to Parkwood House after a stay away. Staff encourage people to make choices about what they would like to eat and drink and they are provided with nutritious meals. They make sure that people`s personal finances are dealt with properly and staff support them with their monies where needed. People go out to places in the community in the home`s minibuses. They employ a driver and some of the staff can drive a minibus too, which means that they can go out a lot. They also have places at the home where people can enjoy recreational activities, such as in the home`s indoor swimming pool, sensory room and the adjacent day care unit. People`s medicines are dealt with safely. What has improved since the last inspection? They are currently introducing a new care plan, which people will be involved in writing, so that they can say how they like things to be done. They have made sure that there is sufficient transport to enable people to participate in activities in the community. They have replaced some worn furniture to keep it homely for people. Some garden furniture and equipment has been purchased so that people can enjoy using this outdoor space. What the care home could do better: As a result of the safeguarding investigation, the providers have formulated an action plan, which they are working on to bring about the necessary improvements that have been identified. The most important thing is to have a manager in place with the necessary experience, qualifications and skills to manage the home in a way that safeguards people`s best interests and safety. They have recently appointed someone to this role. In order to make sure that they are providing the service that is specified in their statement of purpose, they need to look at the mix of people living in the home. This is necessary to check and see if it is suitable for all the people currently living there and if anything more needs to be done to make sure that they can meet the diverse needs of everyone they are providing care for. Care plans need to be more person centred to include people`s individual wishes and aspirations. They should show that people have had a say in how they want staff to support them and how they want their care to be given. This has already been recognized and they have started one plan that has been done in this way. They must make sure that risk assessments have enough detail, so that staff have the guidance they need to keep people safe, while allowing them to lead the lives they choose. They need to look at how they enable people to make choices, especially people who might need communication aids to make this happen. They must make sure that staff are properly trained to give them the skills to support people in this. People living in the home should have access to somewhere where they can make drinks and snacks for themselves without the need to ask staff to allow them entry. If this is deemed risky for some individuals, it should not mean that all people are restricted from using the kitchen. They need to provide a changing table for use when changing people that cannot stand, to maintain their dignity and ensure safety for staff. They have said they plan to add a changing table in a bathroom. A separate hand wash basin also needs to be added to this room for staff to wash their hands after they change the person and before leaving the room to safeguard people from the spread of infection. They must make sure that the home environment is properly maintained and that repairs are carried out within reasonable timescales, so that the home is a pleasant and safe place for people to live in. Tap heads must be fitted to the washbasin in the bedroom where they have been removed, as there is no reason why the person occupying this room should not have them. Action is needed to reduce the risk of burns from unguarded radiators. The swimming pool hoist either needs to be repaired or replaced, so that people who cannot walk can make use of the pool if they wish. A review of staffing levels is needed to make sure that there are enough staff on duty each shift, with the right qualifications, knowledge and skills to meet the needs of the people living in the home. They must make sure that staff have all the necessary training to enable them to support the people living in the home effectively and safely. Gaps in the mandatory training must be addressed in moving and handling, infection control and food hygiene and they should also provide any additional specialist training, for example autism. To keep people safe they should make sure that there is an appointed first aid person on duty at all times. Although they have quality monitoring systems in place, they need to make sure that these are robust enough to promptly pick up things that they need to do better. Then they need to show the people who use the service and any other people involved what they have done to improve the things that have been identified. They must make sure that they follow the fire safety procedures as specified in fire safety legislation. This includes getting their fire risk assessment approved by the fire safety officer and the regular testing of fire safety equipment. They also need to consult with the fire officer with regard to the fire exits being kept locked. The new manager also needs to ensure that all records are in place, consistently maintained and kept available for those people to see that have a right to do so. Following our visit, they have responded promptly to the requirements set in this report and have submitted a detailed improvement plan. This indicates that they are well on the way to achieving them within the timescales specified. Key inspection report Care homes for adults (18-65 years) Name: Address: Parkwood House West Street Harrietsham Maidstone Kent ME17 1JZ     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: Christine Grafton     Date: 1 5 0 7 2 0 0 9 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 39 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 39 Information about the care home Name of care home: Address: Parkwood House West Street Harrietsham Maidstone Kent ME17 1JZ 01622859710 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: parkwoodhouse@counticare.co.uk Counticare Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 13. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Parkwood House is owned by Counticare Ltd., which is a part of CareTech Community Services Ltd. It is a detached property with extensive grounds, garden (incorporating a sensory garden) and car parking for several vehicles. Also on site adjacent to the main building is a separate small day care unit, which provides activities of a more educational nature. A further facility containing a range of soft furniture and aids for relaxation is also available for use by service users. The home is situated on the outskirts of Harrietsham village lying on the main Ashford to Maidstone road. Facilities such as shops etc are within walking distance. There is good access to bus services and a main line station is situated in the village itself. Care Homes for Adults (18-65 years) Page 4 of 39 Over 65 0 13 Brief description of the care home The fees range from £1,056.81 to £1,575.16 per week. Care Homes for Adults (18-65 years) Page 5 of 39 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: This report takes account of information received since the last inspection of 6th August 2007 and included a visit to the home. We visited the home on 15th July 2009 without telling anyone we were coming so that we could see what it is like for people living there on a usual day. We arrived at 10.10 hours and stayed for most of the day leaving at 16.35 hours. We talked to the acting manager, the area manager and some of the staff on duty. We were introduced to the people living in the home and eight were involved in the inspection. We looked around the general living areas of the home and some people invited us to see their bedrooms. We observed what was going on and looked at the homes routines. At the time of our visit there were eleven people living at the home. We looked at some of the homes records. We also used the homes annual quality assurance assessment known as an AQAA for short. This is a document that all homes Care Homes for Adults (18-65 years) Page 6 of 39 have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets us know when they have completed important environmental safety checks. Information from the last inspection is also referred to. Since the last inspection, there have been some changes to the management of the home. The last registered manager left in October 2008 and a new manager took up their post in December, but left in May this year, after only five months. They have informed us since our visit that a new manager has been appointed and is due to take up their post on 3rd August 2009. During the interim periods without a manager, the deputy manager has been appointed temporarily to the post of acting manager and this is what they will be referred to throughout this report. The owning organization is known as Care Tech and their area manager has been supporting the acting manager in her role. The area manager was present from approximately 11.00 hours until the end of our visit, when we gave some initial feedback of our findings. Also, since the last inspection there has been a safeguarding vulnerable adults (SVA) investigation at the home. This means that the local social services adult protection team have had some concerns about the home. As a result, care managers and other agencies have visited the home and their findings have been shared with us and used when making judgements in this report. The management have responded positively to the investigation and have taken their own actions to make things better for the people living in the home. At the time of writing this report the safeguarding alert has been closed, but a poor practice flag remains open with the local authority. Care Homes for Adults (18-65 years) Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: As a result of the safeguarding investigation, the providers have formulated an action plan, which they are working on to bring about the necessary improvements that have been identified. The most important thing is to have a manager in place with the necessary experience, qualifications and skills to manage the home in a way that safeguards peoples best interests and safety. They have recently appointed someone to this role. In order to make sure that they are providing the service that is specified in their statement of purpose, they need to look at the mix of people living in the home. This is necessary to check and see if it is suitable for all the people currently living there and if anything more needs to be done to make sure that they can meet the diverse needs of everyone they are providing care for. Care plans need to be more person centred to include peoples individual wishes and Care Homes for Adults (18-65 years) Page 8 of 39 aspirations. They should show that people have had a say in how they want staff to support them and how they want their care to be given. This has already been recognized and they have started one plan that has been done in this way. They must make sure that risk assessments have enough detail, so that staff have the guidance they need to keep people safe, while allowing them to lead the lives they choose. They need to look at how they enable people to make choices, especially people who might need communication aids to make this happen. They must make sure that staff are properly trained to give them the skills to support people in this. People living in the home should have access to somewhere where they can make drinks and snacks for themselves without the need to ask staff to allow them entry. If this is deemed risky for some individuals, it should not mean that all people are restricted from using the kitchen. They need to provide a changing table for use when changing people that cannot stand, to maintain their dignity and ensure safety for staff. They have said they plan to add a changing table in a bathroom. A separate hand wash basin also needs to be added to this room for staff to wash their hands after they change the person and before leaving the room to safeguard people from the spread of infection. They must make sure that the home environment is properly maintained and that repairs are carried out within reasonable timescales, so that the home is a pleasant and safe place for people to live in. Tap heads must be fitted to the washbasin in the bedroom where they have been removed, as there is no reason why the person occupying this room should not have them. Action is needed to reduce the risk of burns from unguarded radiators. The swimming pool hoist either needs to be repaired or replaced, so that people who cannot walk can make use of the pool if they wish. A review of staffing levels is needed to make sure that there are enough staff on duty each shift, with the right qualifications, knowledge and skills to meet the needs of the people living in the home. They must make sure that staff have all the necessary training to enable them to support the people living in the home effectively and safely. Gaps in the mandatory training must be addressed in moving and handling, infection control and food hygiene and they should also provide any additional specialist training, for example autism. To keep people safe they should make sure that there is an appointed first aid person on duty at all times. Although they have quality monitoring systems in place, they need to make sure that Care Homes for Adults (18-65 years) Page 9 of 39 these are robust enough to promptly pick up things that they need to do better. Then they need to show the people who use the service and any other people involved what they have done to improve the things that have been identified. They must make sure that they follow the fire safety procedures as specified in fire safety legislation. This includes getting their fire risk assessment approved by the fire safety officer and the regular testing of fire safety equipment. They also need to consult with the fire officer with regard to the fire exits being kept locked. The new manager also needs to ensure that all records are in place, consistently maintained and kept available for those people to see that have a right to do so. Following our visit, they have responded promptly to the requirements set in this report and have submitted a detailed improvement plan. This indicates that they are well on the way to achieving them within the timescales specified. 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 10 of 39 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 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home can learn about it in a way that helps them decide if it is right for them. They have an assessment that tells staff about them and the support they need. However, there is a mix of people living in the home that have diverse needs, some people with very complex needs. They need to make sure that they provide enough staff that individually and collectively have the skills to deliver the services and care needed by all the people living in the home. Evidence: The home provides people with a booklet known as the service users guide to let them learn about it. There is also more detail in the statement of purpose. Together these tell people all about the home so that they know what to expect when they move in. The statement of purpose was recently updated and covers all the things that it should. The service users guide is simply written with pictures to help people understand it. This is currently being looked at to see if they need to add any different symbols or pictures to make sure that it is right for each individual. Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: We looked at two assessments, including one for the last person to move into the home. Both contained lots of detail, including assessments by care managers and health consultants. The home carries out its own assessment and uses all the information to write a care plan. Parents are fully involved in this process, so they can speak on behalf of people who might not be able to say for themselves what they want. Both assessments showed what support the people needed to live their lives and what staff should do to keep them safe. However, the care plans that were written when the people moved in did not show their involvement in the assessment process. The plans mainly looked at the tasks that staff needed to do, rather the persons individual wishes and choices about how they wanted things to be done. The management have already recognised this and are working to change the assessments and care plans to make them more centred around what the person wants. People living in the home have very different needs. As there have been two changes in management of the home in the last year, we were unable to establish how they had decided who should move into the home. The acting manager said that some people had initially come to live at the home with the idea of moving on to more independent living, but this has not happened yet. Others need a lot of support from staff to lead their lives and might not be able to move on. We feel that they need to look at this mix of people living in the home to make sure that they can meet all of their diverse needs. Care Homes for Adults (18-65 years) Page 13 of 39 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. People benefit from having their own plan of care that shows their assessed needs. However people have not all been fully involved in their care planning and the decisions about how they are supported. They need to make sure that each persons wishes are known and taken into account when planning their care and that risks are managed in the least restrictive way for individuals. Evidence: We wanted to see if people are involved in decisions about their lives and take an active part in the planning of their care and support that they receive. We have looked at information from the recent safeguarding vulnerable adults investigation carried out by social services care management. As a result of this, some care managers have reviewed the needs of some of the people living at the home and looked at their care plans. Under the safeguarding protocols, their findings have been Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: shared with us. We looked at two care plans during our visit. The care plans we saw cover things like peoples abilities, their daily routines and what they can and cannot do for themselves. They show the sort of help people need from staff, for example, if they need assistance dealing with their personal hygiene, bathing, going to the toilet, moving around and eating and drinking. For the majority of people living in the home, their care plans have been in place for quite a while, depending how long they have lived there. Those existing care plans have been written in a way that is not particularly individual to the person, mainly looking at the tasks that staff need to do around personal care needs and keeping people safe. Care plans have not always looked at the wishes and aspirations of the person, or how they are going to be supported to achieve their goals. They are currently changing the way they write the care plans and plan to introduce a new format called My Plan that will be written with each person in their own words. They have almost completed one care plan like this and we saw that the person was taking a more active part in the planning of their care and decisions being made, with the involvement of their nearest relative. We saw staff encouraging people to make decisions during the day. This included asking individuals what they wanted to do, what they would like to drink and eat and whether they wanted to help with the food shopping. We saw a support worker encouraging a person to tidy some of their own things in their room. This was done in a patient way that enabled the person to do the work for them self in a fun way. It was clear that the person had made the decision to do this activity for them self and they seemed to be enjoying it. Most of the people living at the home can either say only simple words, or have no verbal communication. Some people use Makaton signs to communicate. They have put a poster with some of these signs on the notice board in the entrance hall, for staff and visitors to see to help with communication. Other people might use picture cards, symbols and objects and for some it might be facial expression, or body language that indicates their mood and wants. The current care plans do not all contain enough information about the various communication aids and methods used, but we were told that this is being addressed within the new care plans being drawn up. The acting manager says she hopes to have them completed within the next two to three months. We looked at how peoples personal finances are dealt with. They are currently setting Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: up individual bank accounts for each person living in the home. We saw that there are sound financial systems in place to support individuals with their finances. Staff can access the money on a persons behalf and records are kept of each transaction, which are signed by two people and audited by the acting manager. Spot checks are also carried out by the area manager during their monthly visits. We were told that people are encouraged to lead independent lifestyles within their capabilities and that risk assessments are in place. Some people use wheelchairs to get about and need the use of some restrictive items, such as lap belts and harnesses to keep them safe when they move about. The care plans tell staff about this and what has been agreed, including the help they need when they go out. In some cases it has been identified that it is not safe to allow the person to go out alone, or have access to places that have been assessed as too risky, such as the kitchen, unless a staff member is present. Other things that might harm a person have been identified in their care plan, where different forms of restraint might be necessary. As a result of the recent safeguarding meetings with care management, they have recognised that some of their risk assessments have not been detailed enough to ensure that all staff will know the right way of doing things to keep individuals safe, whilst supporting their independence. They are currently working to improve this within the new care plans being drawn up and the training provided for staff. Care Homes for Adults (18-65 years) Page 16 of 39 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 supported to experience various activities in the home and in the community. However, more needs to be done to make sure that activities are planned around peoples individual interests, wishes, diverse needs and capabilities. Some people would also benefit from being more involved in the homes daily routines to develop their life skills. People are supported to keep in touch with their families and friends. They are provided with a nourishing and balanced diet. However, action taken to reduce risks within the home has resulted in all people being restricted from access to the kitchen without staff support, whether or not this is in their best interests. Some people would benefit from having more choice to make their own drinks and snacks. Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: Most people were at home when we arrived. During the day some people went out in small groups on minibus trips to the community. Others were seen relaxing in the lounge at various times, or doing activities with staff. These were either in the home, or in the separate day care unit attached to the home, which has a range of craft and drawing materials. One person was excited about to going to stay with their family for a short break later in the day. We were told that none of the people living in the home currently access any college courses. They do attend the day care facility in a nearby town that the Care Tech organization runs, known as the Martello Centre. People are taken to this on various different days, where they can pursue a range of activities there and meet other people. People can also use the homes own sensory room that is separate from the main house and kept locked when not in use. This is well equipped with a range of sensory equipment, including bubble lights, balls, mats, large bean bags, a vibrating mat, starry sky, toys and a range of other sensory objects. There is always a staff member present for safety reasons and a record is kept showing the dates and times that individuals have used this facility. The home also has its own indoor heated swimming pool, but the hoist is currently broken, so only people who can get in unaided are able to use it at the moment. Staff say they also take people out to swimming pools in the local community. We saw details of activities in the care plans and the staff also told us of some of the things that people do. These include, horse riding, trampolining, bowling, shopping and discos. People are usually taken out into the community in small groups, using the homes own minibuses. We were told that the minibus hoist is in working condition and regularly used to enable wheelchairs to be lifted into the bus. We did not see anything in the care plans promoting the use of public transport and this is something they might look at within the new care plans for some individuals. Care plans currently do not include enough about each persons wishes, so we cannot be sure that the planning of activities is based around what individuals want to do. People are supported to maintain contact with their families and friends. The names of people who are important to them are written in their care plans. The new My Plan that we looked at for one person had photographs of these people and pictures of places where they live. This makes it more meaningful for them. We saw that visitors are made welcome in the home and all family visits are recorded in the care plan. The Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: people who live in the home also keep in contact with their relatives and friends by telephone. People can have keys to their bedroom doors if they can use them. We saw two people using a coded key lock to their bedroom. The front door has this type of lock too, but not everyone is able to use it so they would rely on staff support to go out. Some people help with the cleaning of their own bedrooms. The housekeeper mainly cleans the communal areas. We were told that only two people are involved in doing their own laundry. The kitchen remains locked and the people who live in the home can only access drinks and food if they ask a member of staff. This does not promote choice and the home must review this issue in line with the deprivation of liberty legislation. The people living in the home should be able to access any area of their choice unless there is a reason why they should be restricted due to their safety or best interests. These issues have been raised by social services and the home is currently reviewing this situation. During the visit the support workers were cooking the lunch and the people who live in the home were observed going into the kitchen and generally discussing the meal to be provided. The people who live in the home discuss menu choices at their resident meetings. The acting manager told us that the home is in the process of introducing pictures of food to enable the people to have a wider choice. Some of the people who live in the home help with the weekly shopping for the home. At the time of the visit the people were getting ready to go to the supermarket and told us that they go to different places to buy the food. Two people said the food was good and they had a chance to choose what they wanted for breakfast. Care Homes for Adults (18-65 years) Page 19 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff in meeting their health and personal care needs. However more staff need to be trained in some specific conditions that people have, to make sure that all the diverse needs of people living in the home are met. They are protected by the homes policies and procedures for dealing with medicines. Evidence: Care plans contain details of how people are to be supported with their personal care. Some people have continence problems and need to be regularly changed by staff. A changing mat is used on the bedroom floor to change one person and we discussed that this is not very dignified for them. The moving and handling risk for staff also needs to be considered. We were told that they are considering changing a bathroom to make space for a changing table, which will be better for everyone involved. People are supported to access healthcare services. We were told that the home has a good relationship with the local GPs (general practitioners) and surgery. People have their own health action plans that are to be changed to the new style format, which will make them more user friendly. These are taken with them when they see their Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: doctor, or go to their hospital appointments. We saw records of contacts with specialists such as, psychiatrists, psychologists and speech and language therapists and where they have provided guidance, this is being followed. Care plans cover nutrition and contain records of peoples weight. Some people have conditions such as autism and epilepsy and we saw records in the care plans of how these are monitored by the GP and specialists. However, although the majority of staff have received epilepsy training, only four staff have received autism training. It is important that staff have this training to make sure that peoples needs are being met. We saw that medicines are safely stored and staff keep records showing the medicines that have been given to each person. Staff confirmed that only trained staff administer the medications and that they have read the homes medication policies and procedures. They have clear procedures for medicines to be given when necessary and there is a booking out procedure that is followed when people go home to stay with their families. The acting manager says she checks the medicines weekly, but does not keep a record of this. We discussed doing a more formal monthly medication audit as a measure of good practice. Currently none of the people living in the home can manage their own medicines, so they have their medicine given to them by staff. We were told that they are considering putting individual medicine cabinets in peoples bedrooms. Care Homes for Adults (18-65 years) Page 21 of 39 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 can be confident that the homes complaints procedure ensures that their concerns will be listened to and sorted out. Staff try to work in a way that protects people from harm. However, recent staffing inconsistencies has meant that people could not be sure that they would be protected from abuse. Evidence: The homes complaints procedure is displayed in the hallway. When a person first moves in, they are given their own copy that is written in pictures, signs and symbols. This is explained to them by staff and kept at the front of their care plan file. However, as the majority of people have little verbal communication skills, it is unclear if they have fully understood it. In practice it is more likely to be the persons representative that would use the procedure. We were told that people have regular contact with their families and the AQAA indicates that families sometimes raise concerns on their behalf and all complaints are recorded. The AQAA also indicates that staff always go over the complaints procedure at the weekly house meetings and staff confirmed this. All staff have attended safeguarding training. A conversation with the housekeeper confirmed that they were clear of what to do if they suspected that anything was Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: amiss with any of the people living in the home. The area manager has held a recent whistle blowing exercise that has confirmed staffs understanding of this and has not raised any issues of concern. The acting manager told us she had recently attended training on the deprivation of liberties safeguards. There are some people living in the home whose behaviour might sometimes pose a risk to either their own, or other peoples safety. Their care plans contain guidance for staff on how to manage this safely. Care plans also show where a form of restraint maybe needed and that agreement has been obtained from relevant parties. They usually let us know about any incidents that have occurred. Staff spoken to say that sometimes more staff are needed to give people all the attention that they need, for example, when they are displaying certain behaviours. Since our last inspection, there has been a safeguarding alert raised concerning the home. Care managers and the local authority contracting officers have visited the home and have been working with them to make sure people are safe. The manager left during this period and the acting manager and area manager have been dealing with the issues raised. There have also been a number of staff changes that have had an impact (see Staffing Section). The area manager has been working with staff around behaviour management issues. At the time of writing this report the safeguarding alert has been closed, but the local authority poor practice flag remains in place. Care Homes for Adults (18-65 years) Page 23 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is spacious, clean and comfortable. However, there are some maintenance things that need to be done to ensure they provide people with a homely and suitably safe environment to live in. Evidence: We looked round the main living areas of the home and saw that it is decorated and furnished to make it homely for the people living there. We saw people relaxing on the sofas in the lounge, moving about between the living rooms and going to their rooms. There is a smaller quiet lounge with bean bags, where people can go if they want to be away from other people. We were told that the dining tables had been replaced since our last visit, but the new ones that were provided from the organizations maintenance department proved to be unsuitable, so they have brought the old ones back into use. They are going to order a different type of table and try it out first, before replacing all of them. The home does not have its own dedicated maintenance person but instead has to put in a requisition to the companys maintenance team for repairs and work that needs to be done. We were told that this sometimes results in delays for things to get done. There are some maintenance things that need attention, for example, the wall by the Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: front door is cracked and needs repairing. A bathroom on the first floor is out of use and kept locked and not available for people to use. The Acting manager told us that the bath was condemned in November 2005. This is overdue for refurbishment and something needs to be done about it, as the person in the bedroom next door has to go a long way down the corridor to access the nearest washbasin. The washbasin in that bedroom has had the tap tops removed and we were told that this was for the person who occupied the room beforehand. Following our visit, they have informed us on 27th August that they plan to refurbish this bathroom facility by 25th September 2009 and while the bath is still out of action, the bathroom is now unlocked, enabling the person referred to above to use the hand wash basin. Four people showed us their bedrooms and we saw that they were clean and personalized, with such things as their own pictures, posters, televisions and music centres. They told us that they like their rooms and have arranged them the way they want. There is one shared bedroom and we spoke to one of the occupants who indicated that they get on well with the other person sharing the room. The room has been arranged with a partition separating the two sides that provides some privacy. Radiators in some communal areas have been guarded to reduce the risk of burns. Bedroom radiators in the rooms that we saw have not been guarded and also there was an unguarded radiator in a toilet that poses a safety hazard that needs addressing. Some fire doors are being kept locked. A fire risk assessment has been completed and we saw that staff carry star keys with them. They need to consult with the Fire and Rescue service to make sure that this is safe. We observed good hygiene procedures, including the use of pump liquid soap dispensers and paper hand towels to reduce the risk of cross infection. There is a separate laundry that has dual access from the ground floor hallway and general office. This is well equipped with commercial washing and drying equipment. It has to be accessed down two steep steps, so cannot be used by people in wheelchairs. There is a small day care unit attached to the main building and a separate sensory room that is kept locked when not in use. There is an indoor heated swimming pool that has an overhead hoist that is broken at the moment. This means that only people that can get themselves into the pool unaided can use it. The acting manager said they are looking at getting a different type of hoist to replace it. The AQAA states that Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: some new garden furniture and equipment has been provided for people to use. At our last inspection the garden had been well maintained. However, this is not the case now. They do not have a gardener and we were told that the lawn has only been mowed two or thee times this year. The lawn is covered in mole hills and beds are overgrown. There is a large pond in the grounds that is not protected and could pose a safety risk. We were told that there are three people that have been assessed as able to go out into the garden on their own. Other people do not access the garden unless staff are with them. However, if this risk is properly assessed and any action taken to make it safe, some of those people might also be able to use the garden on their own. Care Homes for Adults (18-65 years) Page 26 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels will make sure that there are sufficient staff on duty to fully meet the needs and choices of the people who live in the home. The people who use the service are protected by the sound recruitment procedures. Improvements are required in the training programme to make sure that all staff have the skills and competencies to do their job well. Evidence: There were eleven people living at the home when we visited. Staffing in the day time consists of the acting manager, team leader and five support workers in the morning and the team leader and four support workers in the afternoon. There is also one housekeeper, one driver and two waking night staff. Staff told us that some of the people require 1:1 assistance in the home and when going out and some require 2:1. There is no cook employed therefore the support workers are also responsible for cooking all meals and providing snacks and drinks to the people living in the home. Staff also said that there used to be an additional support worker but staffing levels were reviewed in April and reduced to the current level. They told us that this has had an impact on the staff available for activities and Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: in particular can restrict some evening activities. Several of the people living in the home have high personal care needs and other complex needs. It is therefore necessary that a review of staffing levels takes place. In order to fully meet the needs of the people living in the home there should be sufficient numbers of staff with qualifications, knowledge, skills and experience on duty at all times. The staff rota shows that at weekends it is common practice for staff to work fourteen hour shifts. One weekend shows four permanent support workers and two agency staff all working a fourteen hour day. Staff told us that it can be very tiring working long hours. It is not good practice for the staff to work such long hours especially with people who have high dependency needs. There is also no allocated hand over time for staff. Staff told us that they come in early for a handover but are not paid for this time. The area manager told us that these issues will be included in the review to improve staff working hours. The acting manager told us that there is a vacancy for a team leader and full time support worker. They are using agency staff and request staff who have already been to the home to provide some consistency of care to the people living in the home. During the visit staff were seen working well with the people in the home. They were supporting them to achieve tasks and make their own decisions. Currently only four of the seventeen staff have achieved their National Vocational Qualification (NVQ) level 2 in care or above. There are five members of staff completing the award. Three new members of staff have completed learning disability training and will now commence their NVQ level 2 in Health and Social Care. There is a training matrix for staff which has been compiled recently; however, the acting manager told us that this was not fully up to date. Improvements are required in the management of the training records and certificates. These were not easily accessible at the time of the visit with the documentation being in different places and in some cases difficult to find. There are also shortfalls in some mandatory training for example, five members of staff have not received updated moving and handling training, twelve require infection control training and nine in food hygiene. There are several people living in the home who have high dependency personal care needs and it is essential that all staff receive infection control training to prevent the risk of infection. The support workers are also cooking meals for the people in the home without receiving any food and hygiene training. Improvements are therefore required to ensure that all staff receive the training required to do their jobs efficiently. Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: The home has not made suitable arrangements for there to be an appointed first aid person on duty at all times. The night staff are required to receive this training to ensure that a trained appointed first aider is available at all times so that the people living in the home and staff are safe. The area manager told us that the training programme will include the Mental Capacity Act and Equality and Diversity Training and all staff will be required to complete the courses. Additional specialist training for example autism training is required for all staff to make sure they have a good understanding of how to support the people. Only four members of staff have received this training. The majority of staff have received epilepsy training. Although the organisation provides ongoing mandatory training, the acting manager could not provide us with the information relating to the training plan. This is necessary to identify all areas of training required to support the specialist needs of the people living in the home. It was therefore difficult to evidence what future planning is to be provided. Following our visit, the area manager has provided us with information indicating that there is a programme of training available for all staff. There is an induction training programme in place for new staff. Staff told us that they are inducted over a two week period and shadowed staff. They also looked at the policies and procedures of the company. Staff induction books are in place; however those seen were not fully completed, for example, in one case, the records of learning supervision sections one to five were blank. There were also gaps on the documentation where the inductee and supervisor sign to say they have completed each section. Improvements are therefore required to make sure that staff have a full understanding of their role when completing the induction training. There are good recruitment procedures in place, ensuring that a full employment history is obtained, two satisfactory written references, a protection of vulnerable adults (POVA) register first check and a criminal records bureau (CRB) check prior to commencing employment. Three staff files were seen and contained pro forma regarding staff information with details of employment and relevant documentation. This evidence confirms that all checks are made on the staff to ensure they are safe to provide the service. Full documentation and staff files are kept at the Head Office. Included in the pro forma is a page to record training for each person however in all three cases this was not completed. Each person should have an individual training Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: record to identify and develop their skills. The acting manager told us that she has been working hard to bring the supervision of all staff up to date. She acknowledges that there are shortfalls in this area due to the registered manager and senior staff leaving the service. Some staff had received supervision and appraisal and these records were on file. The senior staff providing supervision has received training to do so. The lack of a formal supervision programme does not give staff the opportunity to identify their training needs and discuss their skills to do their jobs well. Staff told us that in general they feel supported by the management team. There are regular staff meetings being held. Care Homes for Adults (18-65 years) Page 30 of 39 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. Improvements are required in the mangement of the home to ensure that it is run in the best interests of the people who live there. The outcome of the quality assurance surveys does not inform the people who live in the home of the issues or actions raised to make them feel they are contributing to the development of the service. There are shortfalls in the recording of safety checks and testing of the fire system, therefore the people who live in the home are not fully protected by the health and saftey procedures in the home. Evidence: There have been changes in the management of this home over the past eight months. The registered manager left the service and the deputy manager at that time is now the acting manager in the home. She is being supported by the local area manager until a new manager is in place. The area manager told us that a new person has been appointed as the manager and since our visit we have been informed of the Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: planned start date. The changes in the management of the home and safeguarding issues have had an impact on the service being provided and staff. Some staff have left the service and there are currently two vacancies. The safeguarding issues resulted in the home working towards an action plan to improve the service. It is acknowledged that the home is making progress but there are still improvements to be made. There are shortfalls in the care planning, training of staff and maintenance of the home. The home must provide the service as per the Statement of Purpose to ensure that staff receive appropriate training to meet the complex needs of the people who live there. Record keeping is not consistent and improvements are required in care planning, staff training and fire records. The area manager told us that the quality assurance programme is carried out by the head office. Questionnaires were given out in April 2008, however, the outcomes or actions required to be taken from the information have not been summarised for the home. The information does not provide the people who live there, relatives or other stakeholders a summary of the outcomes. Outcomes of the quality assurance should form part of the development plan for the home. It is therefore recommended that improvements are made when carrying out the homes quality assurance programme to make sure that the people who use the service, relatives and stakeholders are informed of the outcome of the quality assurance. There was evidence at the time of the visit that residents meetings have been held in April, May and June. The home was visited by the area manager in February, which resulted in a quality and performance report development plan being implemented. This plan identifies many areas that have been raised in this report with timescales for completion and the home is endeavouring to meet these deadlines. Regular monthly visits (Regulation 26) have been carried out; this makes sure that the organisation is aware of what is happening in the home. It is therefore acknowledged that the home is working towards the improvements. The last entry in the fire book for the weekly fire test was 22nd June 2009. It was clear that the tests had not been carried out since that date, a period of three weeks. The area manager told the staff to carry out a fire test and this happened during the visit. They must make sure that the fire call points are tested weekly to ensure that the fire system is working correctly. A requirement will be made in this report. The fire risk assessment carried out by the previous manager had not been approved by the Fire and Rescue Service. The area manager told us that this will be reviewed and sent to the Fire Service. They also need to consult with the fire office with regard to the fire exits being kept locked. Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: As previously mentioned in this report the mandatory, induction and specialist training is not fully up to date. On some night duties there is no appointed first aid person on duty and the area manager told us that the training would be arranged as soon as possible. On a partial tour of the home it was noted that the parker bath was due to be serviced in March 2009. Although the acting manager told us that this had been carried out no evidence to confirm this was available at the time of the visit. This also applied to the portable appliance testing. It was clear from the stickers on the appliances that this had been completed, however, the relevant documentation could not be found at the time of the visit. Subsequent to our visit they sent us confirmation regarding this. However, improvements are still needed to ensure that all records are in place and available for inspection. Care Homes for Adults (18-65 years) Page 33 of 39 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 34 of 39 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 6 15 That care plans contain all 30/09/2009 the information to meet the individual needs and wishes of the service users and that these are kept under review and updated as needs change. Complete the total review of all service users care plans as started. To make sure that all the needs of the service users are identified and met. 2 16 12 That the daily routines and house rules promote independence, individual choice and freedom of movement as far as possible. To encourage and support people to make decisions about their lives. 30/09/2009 3 18 12 That any equipment is provided to ensure that 30/10/2009 Care Homes for Adults (18-65 years) Page 35 of 39 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 personal support is carried out in a way that promotes dignity. For example, a changing trolley. This specifically relates to the use of a changing mat on the floor for a service user. So that personal support can be provided in a way that maintains dignity for the service user and is safe for staff. 4 24 23 That the home is kept well maintained and safe for people to live and work in. All outstanding repairs to be completed without delay. This relates to the first floor bathroom and swimming pool hoist that have been out of action for some time. Taps to be fitted in the bedroom referred to in the report. A plan to be submitted stating actual dates when this work is to be completed plus any other repairs identified as being needed. 30/09/2009 Care Homes for Adults (18-65 years) Page 36 of 39 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 provide the service users with a safe, well maintined and comfortable home in which to live. 5 33 18 To review the dependency needs of the service users against the numbers of support staff on duty during the day. Provide enough staff and make sure they have the necessary skills to meet service users needs, promoting their choice of activities. To make sure that there is enough staff on duty at all times to support and care for service users in a person centred way that suits them best. 6 35 18 To make sure that staff have 30/10/2009 received the necessary training to undertake their roles safely and effectively. Shortfalls identified in this report in mandatory training of moving and handling, infection control and food hygiene are to be addressed. To make sure that specialist training is provided, for example, autism. 30/10/2009 Care Homes for Adults (18-65 years) Page 37 of 39 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 Action plan with dates planned and completed to be provided. To ensure that service users are supported and cared for by staff with the necessary knowledge and skills. 7 42 23 To consult with the fire safey 30/10/2009 officer and seek approval for the homes fire safety risk assessment. To ensure that the requirements of the fire safety legislation are complied with. This specifically relates to fire exit doors being kept locked, making sure that fire safety equipment is regularly tested and records are kept up to date. To make sure that people are protected from the risk of fire in the home. 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 Care Homes for Adults (18-65 years) Page 38 of 39 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. 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