Care Home: Purbeck Care

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What the care home does well People have been well supported to move in to the new bungalows. Some people have care plans with pictures and photos that they have been involved in. People who live at the home are given support to enjoy their leisure time and do things in the community. People are more involved in their own houses. There are now managers for the houses and a general manager. Some information has pictures to make it easier to understand. Staff have pictures with them so they can understand people easier. Staff are caring and like to work with people who live at the home. What has improved since the last inspection? There has been very good progress on making the houses safer places to live, to improve the care and support people have, and the training and support to staff. People and the staff now know on what or if any basis under the Mental Health Act they are staying at the home. People are now given support to be occupied during the day and develop their social skills, and their skills around the house. People now have ordinary crockery and cutlery. Staff now respect people`s privacy and dignity. Staff now support people to follow what health workers say, to make sure that they stay well. If a doctor says that someone needs medication staff are now trained to do this. Medication is now kept in Garden Cottage. There are now records kept about complaints that shows how it was looked into, what happened after to try and stop it happening again and the feedback to the person who made the complaint. There are now records and care plans for when when staff physically stop people from hurting others or themselves or leaving the home. The manager has told us about it. Staff have been trained on what is abuse, how to report it and how to keep people safe.The manager has told us and Dorset Social Services when people hurt each other, leave the home without telling anyone or hurt themselves. The manager now writes down when people have been harmed, why it happened, what they have done about it and what they have done to try and stop it happening again. One person now has mattress on their bed and a new toilet. The windows are now safe in the houses. The home has done what the fire officers told them to do so that the home is safe from fire. There is now a new kitchen in Stable Cottage and the tops of the toilets have been made safe so to try and stop infections spreading. There are now more staff on duty at times to meet people`s needs. Staff have been trained in how to care for and support the people who live at the home. Staff now have support meetings with their manager. The management of Purbeck Care has improved to make sure that people are safe and live and benefit from a well run home. The management has looked at how staff support and work with people so that people are well cared for and supported. What the care home could do better: People must be involved and have an assessment that includes all of the important information about them. Care plans must include all the information about people, be kept up to date so that staff know what care and support people need. Risks to people need to be reviewed and plans kept up to date so staff know what to do so they can keep people safe. People need to have support with their communication so that staff and other people can understand them. People who communicate differently need to be given choices about food. The downstairs bathroom in East Stoke House needs to have a new bath seat and cleaned so that it doesn`t smell. The needs to be a staff rota that shows who has worked and in what house. There are lots of good practice recommendations that should be done to keep up the improvements made so far and to continue to improve the home. New staff who have not been fully checked need to have a senior staff member who is working with them. This is to make sure staff are safe to work with people. Key inspection report Care homes for adults (18-65 years) Name: Address: Purbeck Care Binnegar Hall East Stoke Wareham Dorset BH20 6AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jo Johnson     Date: 2 0 0 4 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 37 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 37 Information about the care home Name of care home: Address: Purbeck Care Binnegar Hall East Stoke Wareham Dorset BH20 6AT 01929552201 01929556441 Purbeck@bmlhealthcare.co.uk www.purbeckcare.com Purbeck Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 52. The registered person may provide the following category of service only: Care Home only - Code 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 - Code LD - maximum number of places 52. Date of last inspection Brief description of the care home Purbeck Care Ltd is registered to provide a residential service for up to 52 people with Learning Disabilities. The accommodation is provided in five separate living units. The main house is divided into two separate houses, East Stoke House provides care and support to both older and younger people and has 15 bedrooms, 4 of which are on the ground floor. Harmony House is for people whose behaviour may be both complex and challenging to the services. There are 9 bedrooms available. Garden Cottage is for Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 52 1 6 1 0 2 0 0 9 Brief description of the care home people who have a higher level of self-determination and independence. There are 5 bedrooms each with en suite facilities. Stable Cottage provides care and support to people whose behaviour has been identified as falling within an autistic spectrum. All 7 bedrooms have en suite facilities. The four Bungalows have been specifically designed to provide a safe and secure environment for up to two people in each bungalow. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced (we did not let the home know we were coming) on 19th and 20th April 2010. Two inspectors came on each day. The inspectors looked around the houses. The inspectors talked and makaton signed with people who live at the home. The inspectors looked at care plans. The inspectors looked at some of the paperwork about the home and the staff. The inspectors talked to staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 37 We sent surveys to people. We have put what people said in the report. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? There has been very good progress on making the houses safer places to live, to improve the care and support people have, and the training and support to staff. People and the staff now know on what or if any basis under the Mental Health Act they are staying at the home. People are now given support to be occupied during the day and develop their social skills, and their skills around the house. People now have ordinary crockery and cutlery. Staff now respect peoples privacy and dignity. Staff now support people to follow what health workers say, to make sure that they stay well. If a doctor says that someone needs medication staff are now trained to do this. Medication is now kept in Garden Cottage. There are now records kept about complaints that shows how it was looked into, what happened after to try and stop it happening again and the feedback to the person who made the complaint. There are now records and care plans for when when staff physically stop people from hurting others or themselves or leaving the home. The manager has told us about it. Staff have been trained on what is abuse, how to report it and how to keep people safe. Care Homes for Adults (18-65 years) Page 8 of 37 The manager has told us and Dorset Social Services when people hurt each other, leave the home without telling anyone or hurt themselves. The manager now writes down when people have been harmed, why it happened, what they have done about it and what they have done to try and stop it happening again. One person now has mattress on their bed and a new toilet. The windows are now safe in the houses. The home has done what the fire officers told them to do so that the home is safe from fire. There is now a new kitchen in Stable Cottage and the tops of the toilets have been made safe so to try and stop infections spreading. There are now more staff on duty at times to meet peoples needs. Staff have been trained in how to care for and support the people who live at the home. Staff now have support meetings with their manager. The management of Purbeck Care has improved to make sure that people are safe and live and benefit from a well run home. The management has looked at how staff support and work with people so that people are well cared for and supported. What they could do better: People must be involved and have an assessment that includes all of the important information about them. Care plans must include all the information about people, be kept up to date so that staff know what care and support people need. Risks to people need to be reviewed and plans kept up to date so staff know what to do so they can keep people safe. People need to have support with their communication so that staff and other people can understand them. People who communicate differently need to be given choices about food. The downstairs bathroom in East Stoke House needs to have a new bath seat and cleaned so that it doesnt smell. The needs to be a staff rota that shows who has worked and in what house. There are lots of good practice recommendations that should be done to keep up the improvements made so far and to continue to improve the home. Care Homes for Adults (18-65 years) Page 9 of 37 New staff who have not been fully checked need to have a senior staff member who is working with them. This is to make sure staff are safe to work with people. 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 37 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 37 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. Information about the home is up to date and accessible for some people who may choose to live at one of the houses or bungalows. Evidence: The statement of purpose have been reviewed since the last inspection. They detail the needs of people that the home can meet and includes more photos and pictures. This means it is easier for people to follow. There have been no new admissions into the home since the last inspection. We have carried the requirement from the last inspection forward as we were not able to assess this. One person is currently in hospital. The general manager and home manager told us that they will complete a full reassessments of their needs when they are ready to discharged. As this persons needs have changed they will need a downstairs bedroom. There has been a good piece of work completed with the individual whilst they are in hospital about them moving rooms. They have used photographs of their Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: old bedroom, decorated their new room the same and furnished it with their furniture and taken photos of their old room empty. Since the last inspection, the new bungalows have now been completed. Two people have moved from other houses in to two separate bungalows. One person has 24 hour support and the other receives a domiciliary care type service. We looked at the the reassessments completed for these two people. These reassessments covered all of their areas of need and care plans and risk management plans have been developed. The status of people under the Mental Health Act has now been established. Staff have now received training in Mental health so they are better able to understand peoples mental health needs. Care Homes for Adults (18-65 years) Page 13 of 37 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. Person centred care plans and risk assessments are not yet fully completed for all areas identified in assessments to ensure that peoples specific needs and risks are identified and met. Evidence: We looked at the care records for five people. One person from each of the houses and bungalows. There are plans to introduce person centred plans using an easy to use computer programme. It is very user friendly and the people living in Garden cottage have started to use it with staff support. The person centred planning tracker includes goal setting and monitoring. We have carried forward the requirement relating to people being provided with suitable communication support to make their views and wishes known in their care plans. This is so people can contribute to their plans and their views are recorded. We acknowledge that work has started on person centred plans for people and that this may take longer that the original timescale given. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Recommendations have also been carried forward. Each person has a care plan, risk assessments and daily records. Incident records are made that detail the circumstances before and during the incident, staff involved and what worked. Body maps are also completed following any incidents of self harm, physical intervention or harm from other people. Overall there has been an improvement in the quality and content of peoples care plans and risk management assessment and plans. Further work is still required to ensure that there are full descriptions of how people present and how and when staff need to intervene with them. One persons risk assessment and management plan needs to be updated as it was originally written with Dorset Healthcare Foundation trust in 2004. It refers to escorting the individual and it is not clear whether this is a technique that staff have been trained in. Staff should make sure that when they review peoples plans they should change any references to the previous house names. Where people have restrictions or limitations placed on them this is now based and evidenced in their best interests by their own agreement or under the Mental Capacity Act or where necessary by a Deprivation of Liberty application. People are now involved in both the daily recording and their monthly reviews. The general and house managers have identified that further work is needed with staff on how daily records are written. This is to make sure that the records reflect how a person has been, the personal care and support provided and how they have spent their time and to eliminate the need for separate records. Overall the standard of recording has improved and is starting to be more person centred. There are still a number of separate records in East Stoke house about people and this information has the potential to be missed during reviews. We also found a communication book that included information about peoples personal care that was not recording in the daily records. We discussed this with the new assistant manager who immediately stopped this use of this book. Further action must be taken to ensure that there is not any personal information recorded about individuals in any staff communication books in any of the houses or bungalows. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: During the two days of inspection we did not hear any breaches of confidentiality over the walky talkies. Care Homes for Adults (18-65 years) Page 16 of 37 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 participate in a range of social, leisure, and educational and occupational opportunities. People are starting to have opportunities to develop their social, emotional, communication and independent living skills. Evidence: Since the last inspection there has been a change in focus from activities that were held in the on site activities centre to more community based activities. Two new vehicles have been purchased to support people going into the community more. One of these vehicles arrived during the inspection. The lack of vehicles was a theme in the surveys that we received from people. Internet access is now being installed in each of the houses and bungalows. Surveys from people told us that they always(6), usually (3) or sometimes (3) can Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: make decisions about what they do each day. Since the last key inspection three people have started to go to a local bible class. One person told us that they were very pleased with the new classes, they had also written to the general manager to thank him for organising this. There are house meetings taking place so some people have an opportunity to make their views known. There has been a dishwasher, washing machine and tumble dryer installed in Harmony House. There are plans to fit a kitchenette so people can cook their own meals. One person told us that they were looking forward to the new kitchenette. The house manager and people told us that they plan to cook their own meals in the training kitchen rather than have them from the main kitchen whilst they wait for the kitchen to be fitted. People who live in Garden Cottage have their own budget and have planned their own menu. One person has joined weight watchers and is planning and shopping for their own meals. People who live in East Stoke House will continue to have their meals from the main kitchen. From house meetings we can see that people are now considering how they can plan healthy options of their meals and plan to grow their own vegetable in the garden. Since the key inspection new crockery and cutlery has been purchased for Harmony House and some of the plastic crockery has been replaced in Stable cottage. Care Homes for Adults (18-65 years) Page 18 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people in this home receive is based on their individual needs. Medication systems in place are largely safe. Evidence: There were positive relationships and interactions observed between staff and the people who live at the home. Surveys from people told us that staff always(8), usually (2) or sometimes (2) treat them well. We did not observe or find any records that raised concerns about how peoples privacy and dignity is being maintained. This is an improvement from the key inspection. Staff are being provided with training on how to safely support and guide people with personal and intimate relationships and expressing their sexuality. Peoples preference of gender of staff is now sought and recorded in peoples assessments or plans. Gender of staff is also specified is specific risk assessed circumstances. There is now a Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: gender mix of staff on duty in each house so that people can be supported by their preferred gender. Peoples health records and care plans showed that their right to good-quality health care is now being promoted. We saw evidence of people with diabetes now following healthy eating plans. One person is awaiting a domiciliary visit from a dermatologist as they are unwilling to visit a hospital. There were fluid charts in place for two older people who live in East Stoke House. One person will be returning to the home from hospital with a PEG feed. Staff were being trained during the inspection and support form the district nurses and other health professionals had been agreed. We looked at the incident records for the people that were were case tracking. There was a record of an incident made by an agency member of staff that was not dated. There are plans to further analyse the incident and accidents reports by each house manager. This should be followed up so that any errors or shortfalls can be identified and any trends or reductions in behaviours can also be identified. We looked at the epilepsy plans for three people. They had all been updated since the key inspection and staff are now trained in the administration of epilepsy medication. All staff now carry a key fob with pictures on so that people can point to a picture if they are not able to express themselves. This is good practice. We looked at the medication administration and systems in place in each of the houses. We did not look at medication administration in the bungalows. Overall the systems have improved and the medication for Garden Cottage is now stored in peoples bedrooms and administered by the staff on duty. We found the following shortfalls; PRN as needed plans were not completed for an inhaler and a cream was not dated when it was opened. In Stable Cottage there were PRN as needed plans in place for medication that was no longer prescribed and handwritten entries were not signed by two members of staff. The General manager took immediate action following the inspection to update the PRN plans and to ensure that the medication shortfalls were rectified. We saw medication monthly audits completed for all of the houses/bungalows except for East Stoke House. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: Staff have now been trained in the administration of medication. Care Homes for Adults (18-65 years) Page 21 of 37 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. Some people who live in this home are able to express their concerns and know whom to speak to if they are unhappy or feel unsafe. They are now supported by a staff team who have a good knowledge of how to respond to any suspicion of abuse. Evidence: The complaint procedure is included in the service users guide. The guide is supported by pictures and photographs. There is not a separate easy read version of the complaints procedure that is supported by pictures and photographs. As some people who live at the home communicate in complex ways written and or pictorial information is not necessarily accessible to them. There should be descriptions in peoples plans as to how they let people know when they are unhappy and unsettled. Further consideration should be given to developing ways of each individual having accessible information about how they can complain or let staff know they are unhappy. This good practice recommendation is carried forward from the last inspection. Surveys from people told us that they know who they can talk to if they are unhappy and know how to complain. We looked at the complaints records. There have been two complaints made to the general manager since the last key inspection. These have both been investigated and Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: an outcome given to the complainant. The complaint responses and investigations have also been reviewed by the Responsible Individual. All staff have now been trained in adult protection and safeguarding. Each member of staff has been issued with a small card to remind them how to report any allegations of abuse. The general and house managers have reported any adult protection incidents to both us and the local authority as needed. The general manager has taken appropriate action when there have been allegations against members of staff. The general manager and organisation has co-operated fully with any investigations completed by the local authority and taken action where necessary. Safeguarding information should be made available to the people who live at the home in a format that is accessible to each individual. This is so that they know who they can communicate with if they dont feel safe or they are worried about abuse. We looked at the financial records for the people we case tracked. The monies and records balanced. Care Homes for Adults (18-65 years) Page 23 of 37 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. Not all of the houses are well maintained and furnished so that all of the people live in a clean, comfortable and homely environment. Evidence: Since the last inspection the new bungalows have been completed. These have been finished to a high standard. One person showed us their bungalow they had personalised it and it reflected their personality. They had their hamster and chickens in the garden. They told us that they like new house. The people who live in two of the houses have chosen new less institutional names. West Wing is now called East Stoke House and East Wing is now called Harmony House. The two people who live in the bungalows have chosen their own names for their home. Overall the standards of cleanliness at the houses has improved and there are systems in place to monitor the daily cleaning of each house. Each house has a planned programme of refurbishment and since the last key Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: inspection work has started to refurbish each house. During the inspection the new kitchen and dining room was being fitted in Stable Cottage. People told us that they have been involved in choosing the decor, furniture and fittings. We acknowledge that lots of works have been undertaken to make safe and good the environmental shortfalls that we identified at the last inspection. The requirements we made about the environment at the last inspection have been met. However, we identified a number of different concerns about the environment particularly in East Stoke House. There was an unpleasant smell in the downstairs bathroom and the bath aid with needs replacing or deep cleaning. The upstairs bathroom has rotten skirting and cracked tiles, The cistern in the upstairs toilet was taped on with duck tape. There were some areas where wall paper was hanging off. One persons bedroom door (fire door) had a hole that had been filled with kitchen paper. The general manager took immediate action following the inspection to remove this and arranged for a plate to placed over the hole the following day. We strongly recommend that each manager complete a full audit of every part of each home and produce a detailed refurbishment and redecoration programme. This is to ensure that people live in a comfortable and safe environment. The doors in Stable Cottage are still locked due to the behaviour of one person which means that people cannot independently access their bedrooms. However, the bedrooms are not unlocked when the individual is not in . This practice needs to be kept under review and ways of bedrooms being unlocked explored. The doors in East Stoke House are also locked and it was not clear what the rationale for this is. Again this practice should be reviewed. All of the people in Harmony House now have a bedroom key and are encouraged by staff to keep it with them so they can independently access their bedrooms. Care Homes for Adults (18-65 years) Page 25 of 37 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 people living in this home are protected by safe recruitment practices and staff who are being trained to meet their needs. Evidence: Since the key inspection the overall staffing levels at the home have increased. A manager has been appointed for Harmony House, East Stoke House, The Bungalows and one manager for Garden and Stable Cottages. The week of the inspection was the first week of a new three week rolling rota. The rota has been planned to ensure consistency for each house and to ensure that the maximum number of staff are available at all times. Most staff we spoke with felt that they had been consulted over the changes but there were some who did not feel completely informed that they would need to make up some hours over the three week period. Staff we spoke with were very positive about the changes being made in the management of each house and the investment in their training and development by the organisation. They told us that they now receive regular supervision and feel well supported. Staff we spoke with were enthusiastic about the changes for the people that they support. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: We were not able to discuss the induction with new staff as they were attending training during the inspection. The induction in place meets the skills for care standards and the general manager is confident that staff are well prepared before working with people. He is planning to consult with new staff as to whether they felt that they received enough information before they start working on the rota. We looked at the staff files for the last five recruited members of staff. They all included two references and ISA first checks. One person had previously worked at the service but had also worked at two other care homes since. One of the references provided was written by one of the managers at Purbeck Care. We would recommend that references be sought from more recent care sector references where they are available. Four staff files included their CRB check. One staff was still awaiting their CRB check to come through. At the last inspection we identified that new staff must be supervised whilst waiting for their CRB checks to be returned. From looking at the rotas and current systems in place we were not able to identify an actual rota of who worked, where they worked (night staff) and who was supervising them if they were waiting for CRB clearance. The general manager and a one of the house managers acknowledged that they were not able to demonstrate an actual rota. They quickly identified a way of recording an actual rota. People who live at Garden cottage were involved in the recent interviews for the new manager. House managers told us that they also plan to involve people in the recruitment of their staff. Since the key inspection a comprehensive staff training programme has been implemented. Staff spoke positively of the training and support they had been provided with so far. The training programme includes; safeguarding adults, medication, epilepsy, mental health, record keeping, equality and diversity, fire safety, moving and handling, autism, care of older people, managing risks, first aid and the Mental Capacity Act and Deprivation of Liberties. Now that staff have received mandatory and some specialist training there should be a training plan developed for each of the houses and bungalows. This is because the people who live each house and bungalow have very differing and sometimes complex needs that staff will need specialist training for. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: Care Homes for Adults (18-65 years) Page 28 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in an improving home. Some people and others are able to express their views and these are listened to and acted upon. Evidence: Since the key inspection the registered provider has met with us and provided us with progress updates of the action they have taken following the inspection. The new general manager has also provided us with an improvement plan. The general manager is planning to be registered with commission. During the visit staff appeared confident in their roles, the houses and bungalows were relaxed and people appeared at ease and comfortable. The general manager told us that there is now a three year development plan for the home. This acknowledges that there is a commitment to continue to improve the services provided by Purbeck Care and also to develop the current and further specialist houses/homes. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: There has been action, dialogue and cooperation between the managers, directors and us to improve the quality of service, care and environment provided to people who live at the home. There has been very good progress made in meeting the many requirements identified at the last inspection in a short space of time. The organisation and managers have identified and focused on the areas of highest risk. We have carried forward a number of requirements and recommendations as the organisation, managers and staff have not yet had time to complete all of the actions required. The responsible individual, general manager and managers told us that they are committed to continue to improve the standards of care, support and environment for the people who live there. People who were able to told us that they are much more involved in all aspects of managing each house and that they are asked about things that are important to them. There is now a newsletter that people and staff have contributed to. The general manager has kept us informed and made regulation 37 notifications as required. The responsible individual told us that they are now visiting the home more frequently to monitor standards. This is in addition to regulation 26 visits and care plan audits undertaken by other staff in the organisation. We looked at these and they identified clear areas for improvement and monitored any action required. The managers at the home have undertaken random unannounced visits at night and during the evenings to monitor the working practices of staff. Each house manager has recently started an audit file that includes all of the monthly monitoring. Some systems are more developed that others. The auditing and monitoring systems at the home are improving and should be able to identify any shortfalls. There are now systems in place to manage the health and safety at each house. People who live at the home are involved in health and safety meeting where they choose to be. All of the requirements and recommendations form the Environmental Health and Fire Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: service have been met. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 People must only be 01/01/2010 admitted to the home following an accurate full assessment that demonstrates that staff have the skills and knowledge to meet their needs. This is to make sure that people are placed at the right home, and that their needs can be met. 2 2 14 People must be consulted and be involved in their own assessments and any decisions as to where and with whom they live. This is to make sure that people are involved about where and who lives with them. 01/01/2010 3 6 12 People must be provided with 05/02/2010 suitable communication support to make their views and wishes known in their care plans. This is so people can contribute to their plans and their views are recorded. 4 6 15 Peoples care plans must be reviewed, kept up to date, and include all the individuals needs identified 01/01/2010 Care Homes for Adults (18-65 years) Page 32 of 37 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 in their assessments and their wishes and aspirations. This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. 5 17 12 People must be given a choice of food that is in an accessible format. This is so people can choose their food each day. 6 34 19 Staff waiting for CRB clearance must be supervised by a named member of staff. Any declarations of convictions must be risk assessed. This is to make sure that whilst the suitability of staff is verified they do not work unsupervised. 16/11/2009 01/01/2010 Care Homes for Adults (18-65 years) Page 33 of 37 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 9 13 Risk assessments and management plans must be reviewed and kept up to date. This is so that staff are given the up to date information so they can manage risks. 01/07/2010 2 24 16 The downstairs bathroom in East Stoke House must be deep cleaned and or the equipment be replaced. This is ensure that any unpleasant odours are eliminated and that the bath seat is clean. 02/08/2010 3 33 17 An accurate staffing rota must be kept that shows in what house or bungalow they worked in. This is to show where and in what capacity staff have worked. 01/07/2010 Care Homes for Adults (18-65 years) Page 34 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Assessments should include and explore peoples cultural and faith, preference of gender of staff, sexuality and important personal relationships, their finances and their communication needs. This is to make sure that that the home can meet all of peoples needs. People who are already living at the home should be consulted about any new people who may wish to move in. Goals or actions should be identified in peoples care plans to show how their wishes and aspirations are to be achieved. Individual ways of including people in their reviews and their care plans should be developed. This should include investigating different recording mediums such as photographs, communication in print, DVDs, audio and the computer. This is so people are involved with the records kept about them and have this information in a format or medium that is accessible to them. It is recommended that the monthly reviews collate all of the information recorded about individuals. This is so there is a clear monthly summary that gives a picture of how people have been and how they have spent their time. Life history works should also be developed that include details and photographs of their history such as family, friends, where they have lived, pets, work etc where appropriate. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. Staff should make sure that when they review peoples plans they should change any references to the previous house names. Further work is still required to ensure that in care plans and risk assessments there are full descriptions of how people present and how and when staff need to intervene with them. Further action must be taken to ensure that there is not any personal information recorded about individuals in any staff communication books in any of the houses or bungalows. Page 35 of 37 2 3 4 6 4 6 5 6 6 6 7 6 8 6 9 10 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 10 20 The managers should ensure that the medication practices are safe. There should be PRN as needed plans in place and creams should be dated when opened. Hand written entires should be checked and signed by two members of staff. There should be a separate easy read complaints procedure for people. For those people who this information is not accessible there should be descriptions in peoples plans as to how they let people know when they are unhappy and unsettled. Safeguarding information should be made available to the people who live at the home in a format that is accessible to each individual. This is so that they know who they can communicate with if they dont feel safe or they are worried about abuse. We strongly recommend that each manager complete a full audit of every part of each home and produce a detailed refurbishment and redecoration programme. This is to ensure that people live in a comfortable and safe environment. Unless there is an assessed need for an individual the hospital type floor covering or floor tiles, these should be replaced with less institutional floor coverings. People should have free access to their bedrooms. Ways of reducing the impact that other peoples behaviours have on individuals free movement in their own home should be investigated rather than locking doors. Ways of reducing the noise of slamming doors in stable cottage should be investigated. References should be sought from the most recent care sector employers. There should be a training plan developed for each of the houses and bungalows. This is because the people who live each house and bungalow have very differing and sometimes complex needs that staff will need specialist training for. 11 22 12 23 13 24 14 24 15 24 16 17 18 24 34 35 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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