Care Home: Peartree House Rehabilitation Centre

What the care home does well People`s rights to privacy and dignity and privacy are respected. Service users and relatives are happy with the service they receive adding comments on surveys including `care for my relative to the standard I would hope for` adding `Peartree is always clean and staff friendly and caring. Now and again there will be a minor problem but anything I have referred to management has been dealt with ASAP`. Another relative added `extremely helpful staff - they give us the invaluable peace of mind that my relative is being well cared for even when we cannot visit as regularly as we would like`. A high number of care staff have a recognised care qualification. What has improved since the last inspection? Following the key inspection in March 2009 seven requirements were made. A random inspection was undertaken in July 2009 to assess compliance with these requirements. Only one requirement was found to have been met and subsequently a statutory requirement notice was issued concerning the remaining unmet requirements. A further two requirements were issued after the July 2009 random inspection. A further random inspection including a pharmacy inspector was undertaken in September 2009 and this found that the statutory requirement notice had been met. The remaining two requirements not covered by the statutory requirement notice were assessed during this inspection and were found to have been complied with. Throughout 2009 the service had several people managing it and has now recruited a permanent manager who was present during the inspection visit. What the care home could do better: Although the home has met all previous requirements there is a need to ensure that the improvements are sustained and embedded in practice. Three requirements were made following this key inspection. It was identified that although care staff are recording when service users refuse some aspects of personal care on a regular basis there is no evidence that this is included in the person`s care plan or measures put in place to support the person and ensure needs may be met. The responsible individual must ensure that action is taken when service users regularly refuse personal care so that they are safe and not at risk of a deterioration in their health. The home has recruited a new manager who commenced working at the home in November 2009. The manager has not yet commenced the registration process and the responsible individual must ensure that the home has a registered manager. During the unannounced inspection visit it was noted that substances hazardous to health were not stored securely placing people at risk. This was rectified during the inspection. However the responsible individual must ensure that substances hazardous to health are stored securely at all times. Key inspection report Care homes for adults (18-65 years) Name: Address: Peartree House Rehabilitation Centre 8a Peartree Avenue Bitterne Southampton Hampshire SO19 7JP     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: Janet Ktomi     Date: 2 7 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Peartree House Rehabilitation Centre 8a Peartree Avenue Bitterne Southampton Hampshire SO19 7JP 02380448168 02380434260 lesley.humphrey@peartreerehab.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Peartree House Rehabilitation Limited care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 46. The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability (PD) Date of last inspection Brief description of the care home Peartree House Rehabilitation Centre consists of an extended house, 3 two-bedroomed bungalows and four self-contained flats and a four bedroomed house within the perimeter of the grounds. The home is situated on the outskirts of Southampton city and is within easy access of Bitterne and local amenities. The home is registered with the Care Quality Commission to provide nursing care and accommodation for up to forty-six people over the age of 18 years who have physical disability. Service users who require only personal, emotional and living skills support and have no nursing needs are housed in the flats and bungalows with a dedicated Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 46 2 8 0 9 2 0 0 9 Brief description of the care home team who enable these service users to live an independent life according to to their capabilities. Service users who need nursing care are accommodated in the main house and the four bedroomed house named Wyncroft. Peartree House employs a multidisciplinary team that comprises an occupational therapy team, physiotherapy, psychology, speech and language therapist, a rehabilitation consultant, dietician, registered nurses and care staff as well as housekeeping, maintenance and administration staff. The home is owned by Peartree House Rehabilitation Limited and does not currently have a registered manager. Care Homes for Adults (18-65 years) Page 5 of 35 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 contains information gained prior to and during an unannounced visit to the home undertaken on the 27th January 2010. All core standards and a number of additional standards were assessed. The unannounced visit to the home was undertaken by one inspector and lasted approximately eight hours commencing at 9.30am and being completed at 5.30pm. The home previously had a key inspection in March 2009 and random inspections in July 2009 and September 2009. Compliance with remaining requirements from these inspections was also assessed. The inspector was able to spend time with the manager and staff on duty and was provided with free access to all areas of the home, documentation requested and people who live at the home. The manager completed the Annual Quality Assurance Care Homes for Adults (18-65 years) Page 6 of 35 Assessment (AQAA) in January 2009 and some information from this is included in this report. Comment cards were sent to the home for distribution to people who live at the home, staff and external health and social care professionals. Four completed comment cards were received from people who live at the home and four from staff. Comment cards were also received from relatives of people who live at the home and four completed comment cards were also received from relatives. No surveys were received from external health and social care professionals. Information and notifications sent to the commission by the home is also considered. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Although the home has met all previous requirements there is a need to ensure that the improvements are sustained and embedded in practice. Three requirements were made following this key inspection. It was identified that although care staff are recording when service users refuse some aspects of personal care on a regular basis there is no evidence that this is included in the persons care plan or measures put in place to support the person and ensure needs may be met. The responsible individual must ensure that action is taken when service users regularly refuse personal care so that they are safe and not at risk of a deterioration in their health. The home has recruited a new manager who commenced working at the home in November 2009. The manager has not yet commenced the registration process and the responsible individual must ensure that the home has a registered manager. During the unannounced inspection visit it was noted that substances hazardous to health were not stored securely placing people at risk. This was rectified during the inspection. However the responsible individual must ensure that substances hazardous to health are stored securely at all times. Care Homes for Adults (18-65 years) Page 8 of 35 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 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 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. The home undertakes a comprehensive pre-admission assessment to ensure that only people whose needs can be met at the home are admitted. However the home has not admitted people for in excess of six months and it is therefore not possible to fully assess how the home would now manage new admissions. People or their relatives are provided with information about the service and are able to visit the home as part of the admission process. Evidence: The homes admission process was detailed in the AQAA and the pre-admission assessments were viewed for one person due to move into the home soon after the inspection visit and others that the manager has completed. The inspector discussed new admissions with the manager and staff and viewed the homes amended service users guide. In June 2009 the responsible individual agreed to a voluntary hold on new admissions during the safeguarding investigation. A random inspection completed in September Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: 2009 found that all the requirements made during the key inspection in March 2009 had now been met and the commission informed the home that no action would be taken should they recommence admitting people. The home has since admitted one person for respite care in November 2009 and arrangements have been made for a person to be admitted to the home soon after this inspection. The AQAA completed by the homes manager detailed the homes admission procedure stating that where possible the potential service user or their family visit the home prior to admission. The AQAA stated that the home has a comprehensive assessment process including multi-disciplinary involvement. The records in respect of the person admitted for respite care were viewed along with assessments relating to the person to be admitted soon after the inspection visit. Additional assessments completed by the manager were also viewed. The assessments provided a high level of detail of the care needed by the referred person and identified issues that needed to be resolved before the person was admitted to the home. The assessments also identified equipment that would be required for when the person is admitted to the home. As no new people have been admitted to the home it was not possible to discuss admissions with new people or staff or fully assess how the home would manage new admissions. The information viewed in respect of the person admitted for respite care in November 2009 would indicate that their needs had been met during the week they were at the home. The assessments viewed with the manager contained clear information about the costs of care that would be provided and included what additional services such as physiotherapy would be provided. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans, incorporating risk assessments, are now in place for all service users and provide all the necessary information and detail necessary, and are in a format suitable to inform staff as to how peoples individual needs should be met. People are able to make decisions and dignity is promoted. Evidence: Three care plans which incorporate risk assessments were viewed and discussions were held with people who live at the home, staff and the manager. Information from surveys received is also considered as is the AQAA completed by the manager and reports following the previous key inspection and two random inspections completed in 2009. Following the inspection in March 2009 a requirement was made that the responsible person must ensure that care plans contain all the information necessary for staff to be aware of peoples current needs. The responsible individual was also required to ensure that full risk assessments are undertaken and that risk assessments are Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: reviewed and updated. The random report completed in July 2009 identified that these requirements had not been met and they were included in the statutory requirement notice issued to the home in August 2009. The random inspection completed in September 2009 found that these requirements had now been met as the home had introduced a new care planing system that incorporated risk assessments. Not all care plans were in the new format in September 2009 but those in the new format viewed were found to meet the requirements. The manager stated in the AQAA completed in January 2010 that the home has care plans that incorporate risk assessments and that given the recent changes in care plan format in the last four months, we need to ensure that their full use is anchored in practice. We looked at three care plans, one for a person who had been admitted for a short period of respite care in late 2009 and the others for people who have been living at the home for a longer period of time. The care plans viewed included risk assessments and were individual to the person covering all activities of daily living and rehabilitation. All care plans were in the new format, containing up to date information with older information kept in a separate file in the nurses office. Nursing and care staff spoke positively of the new care planning formats and felt that they were much easier to use than previous versions. Care plans are now produced on computers eliminating the problems of handwriting and legibility. The home has recently changed the way that staff record the care and support provided on a daily basis. This is now recorded at the front of the file rather than linking to each section in the care plan. Staff stated that this had greatly reduced the time needed for recording allowing more time to be spent with service users. There was evidence in care plans and from discussions with service users that they had been involved in the formation of care plans and that where this was not possible due to the level of the persons cognitive disabilities that relatives or representatives had agreed care plans. Care plans and risk assessments had been reviewed and people all had a named nurse responsible for their care plan. The manager stated that he audits care plans and audit forms were seen in some care plans. Care plans were seen to contain an assessment of the person capacity to make decisions and how this should be supported by the home. Discussions with people who live at the home indicated that they are able to make decisions on a day to day basis such as time they get up/go to bed and how they spend their time. People also confirmed that they can decide about meals. Surveys were received in January 2010 from four people who live at the home, three stated that they always and one usually Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: that they make decisions about what they do each day and that they can do what they want during the day, evening and at weekends. Staff surveys identified that at weekends there were fewer occupational therapy assistants on duty which could restrict peoples opportunities for choice as to their activities. We looked at how the home supports people with their personal money. Since the inspection in March 2009 the home has been trying to change the appointee ships for a number of people that the homes administrator held. The administrator stated that she is now only the appointee for one person and that others had all been transfered to family members or social services receiving officers. The administrator discussed how she is trying to transfer the remaining appointee ship to a relative. Although this has not yet occurred the situation should be completed soon either to the relative or to social services receiving officer. The home does support some people with small amounts of personal money and where this is the case records are maintained. The manager discussed how people are involved in the day to day running of the home. The home has a service users group that provides a forum for some decisions. Discussion with the manager indicated that he was considering how service users could participate more in the decisions that are made about how the home is run and in particular how staff are recruited and selected. Service users confirmed that they are involved in decisions about some aspects of the home and kept up to date about things that affect the home. A newsletter for service users and relatives was seen. Care Homes for Adults (18-65 years) Page 15 of 35 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 enjoy a varied and flexible lifestyle and are offered a healthy diet and enjoy their meals. Evidence: Discussions with people who live at the home and staff as well as information from surveys completed, information in the AQAA and care plans viewed is considered. Care plans contained a section for peoples social and leisure interests and care plan notes recorded how people had spent their time. These confirmed that the home provides a range of activities both as part of the rehabilitation programme and to meet social and emotional needs. Pre-admission assessments contained information about the service users interests and previous occupations. Four service users completed surveys and they stated that they were able to do what Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: they wanted during the day, evening and at the weekend. Four relatives also completed surveys. One identified that there was not always enough for their relative to do at weekends adding in the section what the service could do better do more things at the weekend as we often find people just sitting around over the weekend. During the unannounced inspection visit the inspector spoke with some of the people living at the home. They confirmed that they are provided with social activities and also that there is less to do at weekends. During discussions with nursing and care staff it was identified that many activities are organised by the occupational therapy assistants and that at weekends there may only be one on duty whereas during the week more are on duty. This was discussed with the manager who stated that they were aware of this issue and that duty rotas were being reorganised to ensure that there is a more equal spread of occupational therapy assistants throughout the week including the weekend. The home has two house cars suitable for the people who live at the home and these are used for rehabilitation and leisure activities. The home also has a computer room and people confirmed that they have access to computers and the Internet and have the necessary adaptations for people unable to use a standard keyboard. Other leisure/activities equipment is also available. People confirmed that they can have visitors and the inspector observed some visitors during the day of the unannounced inspection. Discussions with visitors confirmed that they are able to visit at any time, made to feel welcome and kept up to date with any relevant information. A newsletter for relatives was seen in the nurses office updating them with the latest information about events in the home. The inspector observed the main lunch time meal and spoke with people and staff about the food provided at the home. Most people had their meal in the homes dining room with some having their meal in the lounge at small dining style tables. People are provided with a choice at meal times with special diets catered for. People were seen to be eating different meals and those the inspector spoke with confirmed that choice is available and if they dont like what is on offer then they can request alternatives that are provided. A requirement was made following the key inspection in March 2009 that people must be provided with a supper as there was a long gap between the evening meal at 5pm and breakfast the next day. A random inspection in July 2009 could not evidence that this requirement had been met and it was included in the statutory requirement notice Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: issued in September 2009 and found to have been compiled with at the random inspection in late September 2009. People spoken with during this inspection confirmed that supper is still provided and that they can have a range of choices including sandwiches, cereals, fruit and yoghurts. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans identify how individual peoples health and personal care needs should be met however records could not demonstrate that all personal care needs were being met. Medication is appropriately managed and administered in the home. Evidence: Information in care plans and risk assessments and other records relating to care are considered along with discussions with qualified nurses, care and other staff and the manager. Observations during the visit and information from the AQAA and surveys received is also included. People the inspector spoke with stated that they felt that their personal and health care needs were met. People looked as if their personal care needs were being met and relatives confirmed that they had no concerns about the personal care their relative received. All bedrooms are for single occupancy, some with en suite facilities, providing privacy with personal care tasks. The home has the necessary equipment within bathrooms and shower rooms. Care staff stated that they generally have sufficient time to met peoples personal care needs. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: The home maintains records of when personal care has been provided on individual forms held in a file in the nurses station. These were viewed. These showed that most people were receiving personal care such as bathing and oral/dental care. However there were several people who were repeatedly refusing some personal care such as oral hygiene/teeth cleaning. We looked at the care plans for some of these people and there was no information in the care plan that the person was repeatedly refusing care or the actions staff should take when care is refused. It is the persons right to refuse care and staff are correct to record refusal however the care plan should identify repeated refusal and consider how the persons needs could be met in alternative ways or include a risk assessment in respect of repeated refusal. This was discussed with the manager who agreed to look at how refusal of care is monitored and managed to ensure that people are not at risk. The report following the key inspection completed in March 2009 contained evidence of concerns that some peoples health needs may not be met and that records relating to health care were contained in a variety of places. The new care planning format now incorporates all information in the one care plan file. The exception being records of food, fluids and care that are recorded throughout the day and then when completed are transfered to the care plans. The previous reports recorded that there had been gaps and poor recording for fluid charts with daily totals not added up. Fluid charts including those for people receiving a PEG feed were seen to be fully completed and in most instances totaled at the end of the day. Care plans contained individual moving and handling assessments and plans which had been reviewed. Care plans also contained information about health needs and visits from GPs and involvement of other health professionals. A requirement was made following the random inspection in July 2009 that the responsible person must ensure that all health and personal care needs are met and that there is evidence to demonstrate that this is the case. The care plans and most records viewed evidence that this requirement has been met with the exception of where some people regularly refuse some personal care. This requirement is not repeated however the manager must ensure that care plans acknowledge people who regularly refuse care and how this will be managed. A requirement was made following the key inspection in March 2009 that the responsible person must ensure that medication is correctly managed, stored, safely administered and correctly disposed of within the home. The random inspection completed in July 2009 found that this requirement had not been met and medication was included in the statutory requirement notice issued in August 2009. A pharmacy Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: inspector assessed how the home manages medication at a random inspection undertaken in September 2009 at which time it was identified that the requirement in respect of medication had been met. A qualified nurse showed the inspector the storage, administration and records relating to medication. Two qualified nurses are on duty throughout the day and one undertakes the medication rounds. The nurses stated that this usually took about an hour and that should the home have additional service users then the morning medication round may be split between the two nurses if it was found that the round was taking too long to complete. The procedures used, records and storage arrangements viewed evidenced that the home is appropriately managing medication. All medication is administered by qualified nurses. The home has the necessary storage facilities for medication that must be kept at cooler temperatures and for controlled medication. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. The home has addressed safeguarding concerns and people living at the home should now be safe. Evidence: Information from the homes AQAA, comment cards received, discussions with service users, staff and the manager are considered. Also considered are records viewed and random inspections completed in 2009. The AQAA stated that the homes formal complaints procedure is displayed in the main reception area and this was seen to be the case during the unannounced inspection visit. The AQAA stated that there had been seven complaints in the past year of which six were upheld and all were resolved in twenty-eight days. The manager stated that there had been no complaints since he commenced working at the home in November 2009. Four comment cards were received from people who live at the home and four from their relatives. All stated that they knew how to make a complaint. Discussions with people who live at the home and visitors during the unannounced inspection visit identified that people knew how to make a complaint and they stated that if they had any concerns they would feel able to raise these. People did not raise any concerns or complaints to the inspector during the inspection visit. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: Three staff also completed comment cards and these stated that they knew what to do if someone had a concern about the home. The report following the key inspection completed in March 2009 identified concerns relating to the safety of people living at the home. Southampton social services undertook a safeguarding investigation at the home looking at how the home was ensuring that peoples needs were being met. This investigation has now been concluded and the safeguarding team are satisfied that the home has taken all the necessary action to ensure the safety of people living at the home. One of the concerns recorded in the previous report related to staff not being aware of safeguarding issues and therefore not identifying potential or actual abuse or reporting this so that people continued to be placed at risk. The commission undertook a random inspection in September 2009 and this concluded that the requirement made in respect of safeguarding following the key inspection in March 2009 had been met. Staff had undertaken safeguarding training and additional training related to safeguarding such as challenging behaviour and information about reporting abuse was also available around the home. Information about safeguarding was still available to staff and seen on notice boards around the home. Discussions with nursing and care staff confirmed that they had all completed safeguarding training and were clear about their responsibilities to report concerns and what may constitute abuse. The home has continued to report incidents in the home where service users have been at risk as a result of their own or other service users behaviour. The notifications have included information about the action the home has taken to prevent reoccurance and protect service users. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained home that meets their individual and collective needs. Evidence: The manager showed the inspector round the home and the inspector viewed records related to the homes environment and discussed the home with the people who live there and staff. The home comprises of a large older house that has been extended to provide a purpose built environment for the service user group accommodated at the home. At the time of the inspection all service users were accommodated in the main house. Within the homes registration there are also several houses located on the same site and accessible via the homes grounds. These were not viewed during this inspection but had previously been viewed and provide a range of single and small group living opportunities. The home has pleasant gardens to the rear and a good sized parking area to the front of the home. Most bedrooms are on the ground floor with some bedrooms on the first floor at the front of the home. There is a lift to access these rooms. The home was noted to be well maintained throughout and provides all single bedrooms, appropriate communal areas and space for therapists, nursing, ancillary Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: and administration staff. Furnishings, fittings, adaptations and equipment are good quality and are as domestic and unobtrusive and ordinary as is compatible with fulfilling their purpose. The home has a large amount of equipment as required by the people who live there, however storage for equipment is limited. All bedrooms are for single occupancy and suitable for their occupant and are fitted with a nurse call system and doors have locks. People stated they were happy with their bedrooms. People stated that the home is usually clean both during the inspection and on comment cards received. The home has specific housekeeping staff who stated that they have sufficient time and the necessary equipment to keep the home clean. Staff confirmed that they have undertaken infection control training and have the necessary infection control equipment such as disposable gloves and aprons to prevent the risk of cross infection. Whilst viewing the home it was noted that the sluice room is not locked and within this there was an unlocked cupboard containing a range of chemical cleaning products (COSHH). These present a risk to service users. An immediate requirement was not issued as this was secured by the maintenance person during the inspection with the provision of a new padlock. Certificates relating to the environment and equipment were viewed and confirmed the information on the AQAA that regular servicing has occurred. The home is fully accessible to people with a physical disability, however freedom of movement is restricted by key codes and high buttons to open some doors. Care plans contained individual assessments in relation to deprivation of liberties with one of those viewed indicating that the person was safe outside the home on their own however in order to leave the home they would have to request staff to open doors restricting their freedom of movement. The home should consider how the environment can meet the requirements of the Deprivation of Liberties Act. Care Homes for Adults (18-65 years) Page 25 of 35 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. The home employs appropriate numbers of staff who should be able to meet peoples needs. The home has appropriate recruitment procedures. Staff have completed mandatory and service specific training however they are not at present all receiving regular supervision. Evidence: Information from discussions with staff, the manager and people who live at the home, recruitment and training records and information from surveys from service users, staff and visitors is considered. All comments from people who live at the home were positive about the homes staff. People felt that they received the care and support that they required and that there was generally enough staff and that they were available when they need them. Service users stated that staff listen and act on what they say most of the time. Comment cards were also received from four relatives who all felt that staff have the right skills and experience to look after people properly. One added some additional comments about the homes staff writing extremely helpful staff - they give us the invaluable peace of mind that our relative is being well cared for, even when we cannot visit as regularly as we like. They have always done their very best to cater for his and our needs. Another adding staff friendly and caring. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: Three staff completed comment cards stating they have received training relevant to their role and that they feel supported. They also added additional comments including staff here are very committed to caring for residents and another training programme is good. One person who works at the home added on their survey that there has been a high staff turnover and that there is a lot of anxiety for staff due to the changes over the previous year which is difficult for service users. This was discussed with the manager who stated that due to changes within the service and a reduction in service user numbers during a period in 2009 when the home was not admitting new people, the number of staff employed at the home has reduced, however with the exception of one new staff member and the manager no new staff have been employed since July 2009. Therefore most staff have worked at the home for a prolonged period of time. The homes duty rotas were viewed in the nurses office and evidenced that at least two qualified nurses are provided throughout the day and one at night with sufficient care staff to meet peoples needs. In addition to nursing and care staff the home also employs appropriate numbers of cleaning, administration, maintenance and kitchen staff. The home has its own occupational and physiotherapy staff and assistants. Speech therapy, dietitian and rehabilitation medical staff are also available. Staff stated to the inspector and on comment cards that they generally had enough time to meet peoples needs and that agency staff are not used. During the inspection visit there appeared to be sufficient staff on duty to meet peoples needs. The AQAA completed by the manager stated that the home has thirty-five care staff of whom twenty-eight have an NVQ. This equates to approximately eighty percent of staff with a care qualification. Discussions with care staff on duty at the time of the inspection indicated that most had an NVQ. The manager stated that the home has arranged for a new NVQ training provider to work with the home to ensure that staff currently without an NVQ have the opportunity to gain a care qualification. The key inspection in March 2009 identified that staff had not undertaken all mandatory training such as fire awareness, moving and handling, safeguarding, infection control, health and safety or training to give them the skills to meet the specific needs of the people living at the home. A requirement was made that all staff must receive mandatory and service specific training. The random inspection in July 2009 established that staff had not received all the necessary training and this was included in the statutory requirement notice issued in September 2009. A random Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: inspection in late September 2009 established that all staff had completed the required training and the requirement complied with. Staff also stated that they have completed all mandatory training and service specific training and that they are not asked to do anything for which they have not been trained. The manager showed the inspector the homes training matrix which showed that staff have now completed all training and certificates were seen in staff files viewed. The training matrix does not show when staff would require refresher and update training which for some courses is yearly and others less frequent. The manager stated that they are looking at how this information can be incorporated on the training matrix. A requirement was also made concerning the homes recruitment procedures in March 2009 as not all pre-employment checks had been completed prior to people commencing working at the home. This was found to have been complied with during the first random inspection in July 2009. The home has only recruited one new staff member since July 2009. The recruitment and induction records for this person were viewed and evidenced that all the necessary procedures had been followed to ensure that the person was suitable to work with vulnerable adults before they commenced working at the home. Although staff stated on comment cards that they felt they received support they stated during the inspection visit that they had not received regular supervision. The manager stated on the AQAA that staff receive regular supervision and during the inspection visit showed the inspector the supervision plan that is based on a cascade system. Staff files viewed could not evidence that staff have received regular supervision and the manager stated that this has not yet commenced and that this should be in place once the new head nurse is appointed and in place. The manager stated that he has undertaken some supervisions with senior staff and is in the process of organizing for all staff to receive appraisals. A requirement is not made in relation to supervision as the manager has already initiated this which will be reassessed during the next inspection. Care Homes for Adults (18-65 years) Page 28 of 35 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. The home has not had a registered manager since December 2008 and has been managed in the interim time by several different people. The home has now complied with the requirements made in March 2009 although this was not done within the timescales and after a statutory requirement notice. The home must now ensure that the improvements in the service are sustained and embed in practice and that the home is run in the best interests of the people who live there. The home must ensure that all substances hazardous to health are secure at all times. Evidence: Information from the homes AQAA, discussions with the manager, service users and staff as well as records viewed during the inspection visit are considered. The home does not currently have a registered manager. The previous registered manager left the home following promotion within the provider company in December 2008. At the time of the inspection in March 2009 there was a manager appointed for the home but they had not commenced the registration process. This person left the Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: homes employment before applying to the commission to become the homes registered manager. Following the random inspection in July 2009 and statutory requirement notice being issued the responsible individual contracted for a project manager to manage the home and address issues. The project manager managed the home until October 2009. The person managing the home at the time of the unannounced inspection on the 27th January 2010 had commenced work at the home in November 2009 but had not commenced the registration process with the commission at the time of the January inspection. The responsible individual for the home also changed in August 2009. The commission was kept informed about the various changes in the homes management throughout 2009. The manager was on duty on the day of the inspection and provided information about their qualifications and previous experience. The manager has a nursing and management qualification and has previously managed a health unit. The manager stated that they were intending on undertaking some training in relation to acquired brain injury. The manager stated that although they had managed the home for two months they had not undertaken the CRB with the commission which is the first part of applying for registration. With the changes in the homes management over 2009 and the changes that have been introduced to meet requirements made and comply with regulations there is a need for the home to now ensure that these improvements are sustained and embedded in practice under the new manager who must register with the commission. The AQAA was completed by the manager and contained most of the information that was required giving a reasonable picture of the current situation. Some sections asking how the home had improved did not fully reflect the changes the home has undertaken over the past year and some of the sections asking what the home could do better had been left blank. The data section of the AQAA was completed although there were some inconsistencies such as the staffing section which stated that the home employed a total of forty-eight nursing and care staff and another section of the staff dataset recorded that forty-three staff were employed. The manager informed the inspector that the responsible individual has appointed a person to undertake the monthly visits to the home to assess the quality of the service being provided. These are called Regulation 26 visits and are a legal requirement where the responsible individual is not in day to day charge of the home. The person that has been appointed to do these has not not commenced the Regulation 26 visits so a relative of the responsible individual has been completing these in the interim. The inspector requested copies of the reports following regulation Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: 26 visits. The manager showed the inspector the report for November 2009 but could not find reports for December 2009. The manager stated that a regulation 26 visit had occurred a few days before the unannounced inspection in January 2010 but that they had not yet received a report for that visit. The manager discussed other quality assurance work that has been undertaken. The manager stated that they are undertaking care plan audits and each care plan should be audited by the manager at least monthly. Copies of care plan audit forms were seen in some care plans viewed. The service has a service user charter group that meets to raise issues and the manager stated that when issues are raised they are expected to address these issues. Discussions with service users confirmed that they felt able to raise issues with the manager. There have also been staff meetings held and the inspector viewed a copy of the minutes from these. Following the key and random inspections undertaken throughout 2009 issues were raised in respect of record keeping and a requirement was made in July 2009 that full and accurate records must be maintained. Overall the quality of record keeping in the home viewed on this inspection was much improved. As identified there is a need to ensure that when staff record repeated refusal in respect of some personal care that action is taken to ensure that records maintained by staff are used to inform and influence care. Whilst viewing the home it was noted that substances hazardous to health were not all stored securely. During the inspection a new lock was fitted to the cupboard that these chemicals are stored in. The responsible individual must ensure that all substances hazardous to health are stored securely. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 18 13 The responsible person must 01/04/2010 ensure that if service users regularly refuse some personal care that this is recorded and considered as part of their care plans. So that people are safe and have their needs met. 2 37 9 The responsible individual 01/06/2010 must ensure that a manager is registered with the commission for the home. To comply with the law. 3 42 13 The responsible person must 01/03/2010 ensure that all substances hazardous to health are stored securely at all times. So that people are safe. Care Homes for Adults (18-65 years) Page 33 of 35 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 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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