Care Home: Roman Court (1)

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What the care home does well People have lived at the home for some time and have built up good relationships with members of staff. Each person has a care plan setting out most of their current care and support needs. Care plans are regularly reviewed. The daily reports are set out so that members of staff can record information that relates to people`s care plans. People are encouraged to be independent. People have good access to healthcare professionals. People`s medical needs are described in their health action plans. People have a form detailing their care and support needs to take with them if they need to go to hospital. Safe systems are in place for managing people`s medicines. Management monitors the arrangements for people to take medicine which is prescribed to be taken only when required. People decide whether they need this medicine. People are provided with a homely, clean and safe environment which is well maintained. People chose how they decorate and furnish their bedrooms. Members of staff have good access to training, both in house and external courses. What the care home could do better: People`s files should be rationalised so that only current information is available and duplication avoided. A medicine cabinet that meets the current storage regulations for controlled medicines should be installed. There must be information and guidance in people`s care records about whether two different medicines prescribed to be taken only when needed can be given at the same time. To reduce the risk of overdose. Handwritten entries in the medicine administration record should be witnessed, signed and dated. To ensure that prescribing instructions are correctly recorded. The manager should consult the supplying pharmacist about ways in which the labels can be attached to tubes of topical cream. This is so that the name of the person and prescribing instructions are still available if the box is discarded. People must have their own individual nail cutting facilities. This will reduce the risk of cross infection and provide a more personal service. Paperwork, including amendments, should be signed and dated. Consideration should be given to retain accident sheets for people who use the service in the log. This should aid review. The providers should consult their insurers to make sure that the arrangements for people to visit members of staff in their own homes are suitable. Records of transactions of people`s money held in the home must be made at the time. To ensure people`s money is safeguarded. Numbering of receipts for people`s purchases should show an audit trail of people`s expenses. Random inspection report Care homes for adults (18-65 years) Name: Address: Roman Court (1) 1 Roman Court Broadfields Pewsey Wiltshire SN9 5DS one star adequate service 18/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Walker Date: 1 0 0 6 2 0 1 0 Information about the care home Name of care home: Address: Roman Court (1) 1 Roman Court Broadfields Pewsey Wiltshire SN9 5DS 01672564412 Telephone number: Fax number: Email address: Provider web address: Steven@StevenAbbott.wanadoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Carol Bottoms Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Jane Abbott care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: Date of last inspection Brief description of the care home 3 1 8 0 8 2 0 0 9 1 Roman Court is one of five care homes for people with a learning disability run by Mrs Jane Abbott. All are small establishments, intended to offer a normal domestic lifestyle. She is supported by other senior colleagues, including family members. Pewsey offers a range of amenities. The market towns of Marlborough or Devizes are within 15 minutes drive. Slightly further afield, there are the larger centres of Salisbury and Swindon. The group of homes has a number of vehicles used to transport people, who contribute towards the costs from their Disability Living Allowance. Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home Most people have lived at the home for a number of years. Roman Court is on a housing estate in Pewsey. The home cares for up to three people. Each person has a single bedroom. There is an upstairs bathroom, and a separate toilet downstairs. There is also a living room, dining area and kitchen downstairs. There is an enclosed garden area at the back of the house. The current fees range from 636.00 to 745.00 pounds a week. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: This unannounced Random inspection took place on 10th June 2010 between 9.00am and 1.30pm. Mrs Abbott, registered provider, and Mrs Carol Bottoms, registered manager, were present during the inspection and received feedback. This is one of five care homes for younger people run by Mrs Abbott. We met with one person who used the service. We looked at their care plan, health action plan and medicines. Mrs Bottoms gave us a tour of the building. We looked at staff recruitment and training files. We looked at accident records. Before our inspection we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. The last Key inspection was on 18th August 2009. Following this inspection we asked the home to provide us with an improvement plan. This was received in November 2009 and set out what the home was doing to address the requirements we made. People had lived at the home for more than sixteen years. There was one vacant bedroom, currently being used by members of staff to sleep in. Mrs Abbott told us that she would take into consideration the needs of people currently using the service when offering another person the bedroom. The staff would then have to return to sleeping in the sitting room. One person told us they were getting ready to go to the day service run by the provider. They said they liked to cook, shop for ingredients, make their own drinks and do various cleaning jobs around the house. They told us they liked to relax watching DVDs and soaps or go to the pub. They said they were planning to watch the football World Cup on Saturday and have a Chinese takeaway. They showed us photographs of their recent holiday with family and told us they had a further holiday later in the year at the providers caravan. Peoples care plans generally set out their current care and support needs. One persons goal planning form in their person centred plan was not fully completed. Their communication passport was not completed. Some of the information was duplicated in different formats and some parts were not filled out in full. Some documents took the form of a tick list which gave little information of how needs were to be met. Some of the paperwork was not signed or dated. Mrs Abbott told us that some of the formats had just been introduced and members of staff were in the process of completing them. In her Improvement Plan Mrs Abbott told us that peoples behaviour management plans had been sent to the Community Team for People with Learning Disabilities for their approval. People had emotional behaviour support plans. The plans were reviewed in January 2010. There was good information about how people displayed behaviours. There was guidance to staff on how best to manage behaviours. Members of staff were required to sign up to the plans. Behaviours were recorded on incident forms and there had been no incidents for some time. There were three different documents on risk management Care Homes for Adults (18-65 years) Page 4 of 13 strategies. The daily reports were in a pre-printed format which identified areas of peoples care plan which needed to be reported upon each day. People attended GP and hospital appointments with staff or family support. The home had developed a form with brief details of an individuals needs, to take with them if they went to hospital. There was a separate form for recording the outcome of medical appointments. People had health action plans which set out their medical history and current healthcare needs. We were told that people were assessed as not able to manage their own medicines. Peoples medicines were stored in separate containers in a locked cupboard. Only members of staff who were trained in administering medicine could give people their medicines. There was guidance in peoples health action plans and in their care plans about when they should take medicines prescribed to be taken only when required. The information in the health action plan was not recorded in any detail. One person was prescribed two different medicines to be taken only when required. There was no information about whether the two medicines could be taken together. The home had a form for completion when this medicine was given. Members of staff were required to first seek confirmation from the provider or manager before this medicine was given. The records showed that people were asked if they needed this medicine. Handwritten entries in the medicine administration record were not always witnessed, signed and dated. The medicine administration record gave details of when medicines were stopped or changed. Some topical creams were not in their original boxes and did not have the pharmacy labels attached. There was a record of weekly checks of peoples medicines. At the last inspection we recommended that a suitable controlled medicine cabinet was installed. This was so that any controlled medicine could be safely stored. Mrs Abbott told us that no controlled medicines were currently prescribed. She went on to say that if controlled medicines were prescribed, she would ensure that a facility was immediately provided. There was a set of nail clippers and scissors which we were told were for communal use and would be disinfected after each use. Peoples bedrooms were individually decorated and furnished to reflect their personality. One of the windows in one of the bedrooms had condensation on the inside, indicating that the vacuum seal had degraded. Mrs Abbott confirmed that she would look to replacing the window unit. The staffing rota provided for one member of staff during the day and a member of staff sleeping on the premises at night. Mrs Abbott, Mrs Bottoms and senior staff provided an on call system for emergencies. Mrs Abbott sent us the homes policy for when people who use the service visit members of staffs own homes. There was no information about the insurance arrangements. One of the senior members of staff was responsible for inducting new staff and ensuring Care Homes for Adults (18-65 years) Page 5 of 13 that they completed training. Staff had recently trained in report writing, sexuality, Autism, moving and handling, care planning, bi polar disorder, first aid and medicines. Mrs Abbott showed us the supervision format which a senior member of staff was about to complete that morning. The sessions was about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding standards. Mrs Bottoms also attended the same training sessions as members of staff. In her Improvement Plan Mrs Abbott told us that she and Mrs Bottoms intended to complete the Leadership and Management Award by the end of February 2010. Mrs Abbott told us that they were both still undertaking the award due to pressures of running the home whilst undertaking the training. In her Improvement Plan Mrs Abbott told us that members of staff had been reminded to fill out the accident records which would be monitored at the providers monthly audit. Records of accidents to people who use the service had been removed from the accident book and attached to body maps in peoples files. In her Improvement Plan Mrs Abbott told us that members of staff had been reminded to record and keep receipts of transactions of money that was kept on peoples behalf. Mrs Abbott told us that this would be monitored at the providers monthly audits. We looked at the arrangements for one persons money. The amount of money was more than was recorded in the balance. Mrs Abbot told us this was because peoples personal allowances were recorded on a different day to when the allowance actually went into the account. There were receipts for purchases attached to the sheets. What the care home does well: People have lived at the home for some time and have built up good relationships with members of staff. Each person has a care plan setting out most of their current care and support needs. Care plans are regularly reviewed. The daily reports are set out so that members of staff can record information that relates to peoples care plans. People are encouraged to be independent. People have good access to healthcare professionals. Peoples medical needs are described in their health action plans. People have a form detailing their care and support needs to take with them if they need to go to hospital. Safe systems are in place for managing peoples medicines. Management monitors the arrangements for people to take medicine which is prescribed to be taken only when required. People decide whether they need this medicine. People are provided with a homely, clean and safe environment which is well maintained. People chose how they decorate and furnish their bedrooms. Members of staff have good access to training, both in house and external courses. Care Homes for Adults (18-65 years) Page 6 of 13 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 13 You must ensure that any accidents/incidents are fully detailed and recorded. This will provide a clear audit trail. 09/11/2009 2 9 13 You must ensure that a risk assessment is completed in relation to visitors/new staff coming into the home and service users visiting staff in their own homes. To ensure that people are protected. 09/11/2009 3 9 13 You must ensure that where 09/11/2009 physical intervention may be uses, a risk assessment is completed and kept under review. To ensure that people are protected. 4 22 22 You must have a log to record any complaints/concerns received. This log must be kept within the home. To monitor for patterns or trends. 09/10/2009 5 23 13 Strategies for management of behavioural needs must 09/12/2009 Care Homes for Adults (18-65 years) Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them, and be kept under regular review. To ensure they are appropriate to the needs of the person. 6 23 17 You must ensure that all 09/11/2009 financial transactions of money held by the home, on behalf of the person using the service, are recorded straight away and receipts are kept. To safeguard peoples finances. 7 37 9 The registered manager 09/12/2009 must complete management training required for her role. To ensure that the home is run in the best interests of the people who live there. 8 39 24 The registered person must continue to implement an effective cycle of quality assurance and ensure that the views of all stakeholders are represented. Some progress has been made in relation to this requirement. 9 39 26 The registered provider must 09/10/2009 complete monthly quality audits of the service and Page 9 of 13 09/12/2009 Care Homes for Adults (18-65 years) 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action keep records for inspection. To comply with Regulation 26 of the Care Homes Regulations. 10 39 24 The registered person must 09/12/2009 supply to the Commission a copy of the report about quality assurance survey and make a copy of the report available to service users. The timescales previously set have not been met. Some progress has been made in relation to this requirement. Care Homes for Adults (18-65 years) Page 10 of 13 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, 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 20 13 There must be information 30/06/2010 and guidance in peoples care records about whether two different medicines prescribed to be taken only when required can be given at the same time. To reduce the risk of overdose. 2 23 17 Records of transactions of peoples money held in the home must be made at the time that it is received. To ensure peoples money is safeguarded. 30/06/2010 3 30 13 People must have their own individual nail cutting facilities. To reduce the risk of cross infection and provide a more personal service. 30/06/2010 Care Homes for Adults (18-65 years) Page 11 of 13 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 20 The manager should consult the supplying pharmacist about ways in which the labels can be attached to tubes of topical cream. This is so that the name of the person and prescribing instructions are still available if the box is discarded. Handwritten entries in the medicine administration record should be witnessed, signed and dated. To ensure that prescribing instructions are correctly recorded. A medicine cabinet that meets the current storage regulations for controlled medicines should be installed. Numbering of receipts for peoples purchases should show an audit trail of peoples expenses. Consideration should be given to retain accident sheets for people who use the service in the accident log. This should aid review. Paperwork, including amendments, should be signed and dated. Peoples files should be rationalised so that only current information is available and duplication avoided. The providers should consult their insurers to make sure that the arrangements for people to visit members of staff in their own homes are suitable. 2 20 3 4 5 20 41 41 6 7 8 41 41 43 Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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