Care Home: Shaftsbury House Care Home

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What the care home does well The service had a manager that was registered with the CQC, which meant he had the relevant qualifications and experience for the role. People only moved into the home after their needs and aspirations were assessed to ensure that the home could meet their needs. From the assessment, an individual plan was developed to reflect assessed and changing needs and personal goals. People were satisfied with their personal support. In the main, people made decisions about their lives and had good support to take risks that enabled them to be independent. Generally, peoples` rights were respected and responsibilities recognised in their daily lives. In the main, people felt their views were listened to and acted on. People were able to take part in valued and fulfilling leisure activities in the community such as visiting local parks, attending weight watchers, a dance/drama class, day centres and going on holiday. They were supported to maintain relationships with their family and friends. People had meals they enjoyed. Systems were in place to protect them from abuse, neglect and self-harm. Generally, people had good support from an effective staff team and people were satisfied with the care they received. Staff said they received training and the home followed recruitment procedures. In the main, there was effective quality assurance systems. What has improved since the last inspection? There were no previous requirements for the service, but the service in the AQAA told us they had changed their transport to allow better access for people who use wheelchairs. With reference to the environment they stated they had upgraded the laundry, replaced lounge furniture, continued to model the garden and re carpeted the home. The AQAA stated the manager had obtained the Registered Managers Award, a recommended qualification in the National Minimum Standards. What the care home could do better: Staff must make sure they always act on information in the individual plan of care to make sure people`s personal and healthcare is maintained as identified, for example, taking their weight and managing people`s behaviour. Support people more safely with their medication, such as discarding medication as identified and recording this and making sure people take their medication as prescribed and check this out when there are any discrepancies. Also, keep better records of medication, for example, the amount of medication they receive into the home and when any of this medication has been discarded. An immediate requirement was issued to the provider about these concerns on the day of the inspection. They responded, identifying how these had been addressed. So that as far as possible, the health, safety and welfare of people and staff are promoted and protected training should be arranged for staff in how to move people safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Shaftsbury House Care Home 53 Mount Vernon Road Barnsley S70 4DJ     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: Jayne White     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Shaftsbury House Care Home 53 Mount Vernon Road Barnsley S70 4DJ 01226786611 01226786622 lee.watson@sunhealthcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sun Healthcare Limited care home 10 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: 10 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 category: Learning disability Code LD Date of last inspection Brief description of the care home Shaftsbury House is a care home for younger adults with learning disabilities, providing personal care and accommodation for up to 10 people. Two of its beds are used for respite care. Sunhealth Care Limited provides the care and accommodation. Shaftsbury House is within easy reach of Barnsley town centre. The home is close to a bus route and has its own transport. The home is set in its own grounds with gardens and parking space. There is ground and first floor accommodation and a passenger lift gives access to both floors. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 10 Brief description of the care home The owner provided the information about the homes fees and charges on 14 August 2009. The fees ranged from £900 - £2000 per week. The fees are based on individual needs and assessments. If there are any additional charges these are agreed in the contract of care. Enquiries about the homes fees can be discussed with the manager. Prospective residents and their families can get information about Shaftsbury House by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. Care Homes for Adults (18-65 years) Page 5 of 32 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: To improve national consistency, we have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was a key inspection and comprised information already received from or about the home and a site visit. The site visit was carried out without giving the service any notice on 10 August 2009 between 9:15 am and 3.15 pm. The manager of the home completed an Annual Quality Assurance Assessment (AQAA) before the site visit. This document gave him the opportunity to tell us what the home did well, what had improved and what they were working on to improve since the last inspection on 24 July 2007. Various aspects of the service were then checked during the site visit. Care practices were observed, a sample of records was examined, a partial inspection of the Care Homes for Adults (18-65 years) Page 6 of 32 building was carried out, records relating to the running of the home were checked and a sample of policies and procedures. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received. We also spoke with staff about their knowledge, skills and experiences of working at the home. Questionnaires were sent to people living and working in the home, their representatives and health care professionals. We received three health professional surveys, two staff surveys, one representatives survey and two surveys from people who lived there. All information, opinions and comments were considered for inclusion in this report. We checked all the key standards and previous requirements. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Staff must make sure they always act on information in the individual plan of care to make sure peoples personal and healthcare is maintained as identified, for example, taking their weight and managing peoples behaviour. Support people more safely with their medication, such as discarding medication as identified and recording this and making sure people take their medication as prescribed and check this out when there are any discrepancies. Also, keep better records of medication, for example, the amount of medication they receive into the home and when any of this medication has been discarded. An immediate requirement Care Homes for Adults (18-65 years) Page 8 of 32 was issued to the provider about these concerns on the day of the inspection. They responded, identifying how these had been addressed. So that as far as possible, the health, safety and welfare of people and staff are promoted and protected training should be arranged for staff in how to move people safely. 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 32 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 32 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. Generally, people could be confident the home could support them, because an assessment of their needs and aspirations was carried out before they moved into the home. Evidence: There was a mixed response from people about whether they had been asked if they wanted to move into the home and received enough information before they moved in, so that they could decide if it was the right place for them. The manager in the AQAA told us all people were assessed prior to admission and that this involved the person, their family and carers and other professionals. He stated the assessments were carried out by a registered nurse. He told us people were invited to look round the home and encouraged to have regular visits. We looked at the files for two people living in the home, one who lived there permanently and one who used the respite service. Both contained the homes own assessment to verify that the home could meet each persons individual needs. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: However, the assessment needed to be signed and dated, so that everyone knows when the assessment took place and how current it is in identifying peoples needs. The assessments covered aspects of physical, health, emotional and social needs, including, leisure and work. Also included were peoples choices, preferences, likes and dislikes. The assessment also included assessing restrictions on peoples freedom and choice, for example, how peoples behaviour was managed and access to the local community. For people who used the homes respite service, there had not been a re-assessment of the persons needs at the time of each of their admissions to make sure their individual needs had not changed. A discussion with the manager told us this did take place, but it needed to be demonstrated. In addition, the service needed to make sure they obtained in all instances a summary of the local authority assessment. Peoples assessments formed the basis of their care plan, with any potential restrictions on choice, freedom, services or facilities part of that plan. Care Homes for Adults (18-65 years) Page 12 of 32 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. People had an individual plan that identified how their needs were to be met. This meant, in the main, they were supported by staff to make decisions and choices in their lives. Evidence: The manager in the AQAA told us people chose their key workers and each person had an individual support plan, that people were involved in the development of. He stated the plans were reviewed monthly and changes made to meet the changing needs of the person. The manager also stated risk assessments were conducted and support was given to help people manage any risks identified. The inspector looked at three support plans to check this information. The plans did contain information about how to support people, although these could be more person centred and be in a better format for people to understand. They contained some information about what people could do for themselves and what help they required. This helped to promote their independence. The plans had guidance for staff Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: about how to support peoples health and personal care and behavioural needs. There had been some attempt to include the persons preference in each of the support plans and what they liked and disliked, which demonstrated how they were encouraged to voice their opinion about how they wished to lead their lives. The plans included some risk assessments that identified events in peoples lives that may present risks to them, for example, their behaviour and looking after their own medication. However, staff need to describe when making records about peoples behaviour, what this was and when, so the action taken reflects the action to be taken in the care plan, so that a consistent approach is taken by staff. When we spoke to people it told us that in the main staff respected peoples rights to make decisions. However, one person said, I sometimes dont like living here, because they make me go out on trips. A staff survey that was returned commented in what they thought the service did well, I feel the home does very well at promoting independent living within each individuals capabilities. All service users are treated as individuals. When we spoke to staff they could describe how people made decisions about their life and when limitations of choice might be imposed to prevent self harm or neglect in peoples best interests. Care Homes for Adults (18-65 years) Page 14 of 32 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 were able to take part in valued and fulfilling leisure activities in the community. They were supported to maintain relationships with their family and friends. Generally, peoples rights were respected and responsibilities recognised in their daily lives. People had meals they enjoyed. Evidence: The two surveys returned by people living at the home told us they always made decisions about what to do each day. When we spoke to people they described the activities they took part in and they were generally happy with their daily routines. They included, visiting a local park, attending weight watchers, a dance/drama class and where they had been on their holidays. On the day of the site visit two people were leaving to go to the day centre they attended. For the people left at home, they sat watching the TV. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The representative survey that was returned told us the care service always helped the person they represented to keep in touch with them and always supported people to live the life they choose. Three health care professional surveys that were returned told us the care service usually supported people to live the life they choose wherever possible. A staff survey that was returned commented, I find there is a lot of variety in every day activities for service users so that they can live a full and active life. When we spoke to staff they described how people could follow their preferred routines, for example, getting up and going to bed when they choose. This encouraged people to have independent lifestyles and encouraged people to make choices. The manager in the AQAA told us holiday destinations were chosen by the people themselves and they continued to choose and plan activities. He stated support was given to enable people to access activities they wanted and supported to choose what they would like to do. The manager stated activities were planned on a daily basis and people could change their minds and staff supported the changing activity required. He stated all services and activities were accessed in the local community and transport had been changed to allow better access for people who use wheelchairs. He also stated people were supported to call, visit and maintain relationships with their family and friends. The manager in the AQAA told us people helped plan the menus. The main meal of the day was usually in the evening. When we spoke to people they said they were satisfied with their meals. One person, described how they helped with shopping. We saw some people going and making their own drinks or snacks when they wanted to and staff supporting people with this if they were not able to do so. We saw the breakfast and lunchtime routine for some people. It was relaxed and people could choose when they wanted to eat their meals. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were satisfied with their personal support. Staff did not always act on information in the individual plan of care to make sure peoples healthcare was maintained or support people safely to help them with their medication. Evidence: When we spoke to people, generally they told the inspector they were happy with the way staff supported them. They knew who their keyworker was and said that they got on with them well. In one of the surveys there was a comment, I get better care here than other places. We observed staff working. They were helpful, supportive and encouraged people to be independent. Three health care professional surveys were returned. One stated the service always monitored, reviewed and met peoples health and social care needs properly and always sought advice and acted on it to meet those needs to improve peoples wellbeing. The other two stated the service usually did. Comments about what they did well included, communicate with service users, adapted to needs of individual client Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: with dementia, follow up of all health needs, individualised care planning for disturbed patients and for what they could do better, listen and act appropriately on advice given by therapists and individual/person centred planning. Both surveys returned by staff stated they were always given up to date information about the needs of people they supported or cared for. A representative survey that was returned felt the service always met the needs of the person they represented, the service always gave the support or care they expected and always responded to the different needs of people. They also stated they were always kept up to date with important issues affecting the person. The manager in the AQAA told us care plans were evaluated monthly and developed with the aid of the care team and the person and care was provided to meet the individuals needs and preferences and support was given to people to do this. It stated people see their GP regularly and support was given for people to access specialist health care professionals as needed. It also stated support was planned proactively to support people when attending appointments or undergoing treatment and that people were encouraged to be involved in their care, including medication. We looked at peoples plans of care to check their personal and health care was being met as identified in the plan. For one person they had lost weight over a 4 month period, but had only been weighed at the beginning and end of that period, despite the assessment identifying their weight needed monitoring and identifying a poor appetite and that they would readily miss meals. In addition, the care plan stated weigh monthly. A discussion with a member of staff highlighted this had now been acted on. It was recorded in their file, although it was not immediately apparent, without an explanation from the staff member and no concerns were raised by the health professionals. The member of staff stated the person couldnt be weighed at the service, because appropriate weighing equipment was not available. This meant some people could not have their weights monitored in their home environment and any potential problems identified and dealt with at an early stage, including prompt referral to appropriate health professionals. The home had good procedures in place to support people who had disruptive behaviours, focusing on calming down situations before they became a crisis. However, when we looked at daily evaluations, staff had not described they had followed this plan, before the last resort of giving people their medication. Medication was stored safely and when the inspector spoke with staff, they said they Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: had undertaken medication training. They could not say whether an assessment of their competency took place, to confirm they were competent to deal with medication safely. However, when we looked at medication systems it told us that staff were not putting this into practice to make sure all people received their medication safely. People were receiving medication that was past the discard by date. In one instance, there was no record of medication that was being disposed of. It was difficult to confirm that people who looked after their own medication was taking this as prescribed. This was because the medication administration record did not identify the medication given to the person to take or the amount of medication received by the home and given to the person. There was medication identified on the medication administration record that was not being administered as the prescription. This could affect peoples health. There was a prescribed cream that had been identified to be applied daily in the plan of care, that wasnt identified on the medication administration record. A carer said it wasnt applied on a daily basis. There were gaps in the quantities of medication received into the home and of medication carried forward from one month to another. This again made it very difficult to check whether medication was being given as prescribed, to maintain peoples health. An immediate requirement was issued for the service to address concerns of using discarded medication and to look at the medication being taken by one person, to make sure it was being taken as prescribed. This was given to the carers in charge of the shift. One of them, who was responsible for medication, said they would deal with it and the deputy would respond in writing to confirm what had been done. For people who lived at the home on a temporary basis, the medication to be administered had not been verified with the GP and there was a discrepancy between the prescription label and what the persons representative had stated. Care Homes for Adults (18-65 years) Page 19 of 32 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. If people had concerns with their care, they or people close to them knew how to complain and in the main, their complaints were looked into and action taken to put things right. Systems were in place to safeguard people from abuse, neglect and selfharm. Evidence: When we spoke to people, most people said that they were happy living in the home and there was a good rapport between them and the staff. One of the questions in the questionnaires asked if they knew how to complain. All had responded that they did. The representative survey that was returned stated they knew how to complain and that the service always responded appropriately if they or the person using the service had raised any concerns. Surveys returned by health care professionals stated the care service usually responded appropriately if they, a person using the service or another person had raised any concerns. Both staff in their surveys stated they knew what to do if someone had concerns about the home. The manager in the AQAA told us the complaints procedure was displayed on the Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: entrance wall. We saw this, but it needed updating to make it more user friendly and to tell people the timescale by which they would receive a response if they made a complaint. He also told us no complaints had been received and there had been no adult safeguarding investigations. We looked at the complaints record to check this. There were no recent complaints. When we spoke to staff they told us they had undertaken adult safeguarding training with the local authority safeguarding team. This corresponded to information the manager gave us in the AQAA. Although the inspector was unable verify this because there was no-one that could access staff training files, the quality audit for training on 17.03.09 told us 54 of staff had received adult safeguarding training. Notices in the office told us further training was planned. The manager in the AQAA told us all finances were audited weekly. The inspector checked one of these. It was clear and easy to follow. The records contained signatures and receipts to support peoples withdrawals. Care Homes for Adults (18-65 years) Page 21 of 32 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. The home was clean and hygienic and the environment was comfortable and safe. Evidence: When we spoke to people they were satisfied with the homes environment, including their own room. The surveys they returned told us one always thought the home was fresh and clean, one usually. One person described to us how they helped in the garden and tended to flowers and the lawns with support from staff. When we looked round the home it was clean and bright and domestic in character. Furnishings, furniture and decor were all in good condition. Bedrooms were clean and had been personalised by their occupants. People living in the home had keys to their bedroom doors and lockable facilities. The home employed a cleaner, which in addition to the cleaning that took place by people and other support staff meant the home was cleaned to a good standard. The home also had a maintenance person. The manager in the AQAA told us people had their own rooms with en-suite facilities, which they could decorate to their taste. He stated they were encouraged and supported to help maintain, decorate and design the home. It stated they had Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: improved the home by upgrading the laundry, replacing lounge furniture, continuing to model the garden and recarpet home. The next plan was to replace dining room furniture. Care Homes for Adults (18-65 years) Page 23 of 32 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. In the main, people had good support from an effective staff team. Staff said they received training and the home followed recruitment procedures. Evidence: We looked at the quality audit for training on 17.03.09. It told us 61 of staff had a National Vocational Qualification in Care to at least Level 2 and 46 had a Learning Disability Qualification. This met national minimum standards, the outcome being that staff having National Vocational Qualification can demonstrate knowledge and skills in caring and supporting people. When we spoke to people they said that they liked most of the staff. When we looked at their surveys it told us that one of them thought that staff always treated them well, one usually, but they both felt the carers always listened and acted on what they said. A representative survey told us care workers always had the right skills and experience to look after people properly. The health care professional surveys that were returned told us the services managers and staff usually had the right skills and experience to support peoples social and health care needs. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The manager in the AQAA told us all staff had an enhanced Criminal Record Bureau check (police check) before starting work and that their employment was subject to this and satisfactory references. He stated they must complete an induction process. He also stated all staff have access to the manager or senior staff to give guidance and training. The AQAA said there was sufficient staff to provide appropriate levels of care and to cover holidays and nominal sickness. There was a recognised staffing structure with a desginated senior care in charge of each shift. The staff surveys supported information the manager had told us in the AQAA. Both stated their employer carried out checks such as a CRB and references before they started work, both stated their induction covered everything they needed to know to do the job when they started very well, both stated they were given training relevant to their role, helped them understand and meet the individual needs of people, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. Both stated the way information about people they support or cared for was shared with other carers and the home manager always worked well. One felt they always had enough support, experience and knowledge to meet the different needs of people who lived at the home, one usually. One stated there was always enough staff to meet the individual needs of all people who used the service, one usually. Their comments included, there are always more than enough staff to care for the service users, there is good communication between support staff, service users and their families, I am happy to come and work in such a warm, friendly environment. The care home is like home from home for the service users and the management is very supportive and gives all staff supervisions regularly. This was reflected when we spoke to staff. They were also positive about their work at the home. They said, brilliant, its a good staff team and fantastic. Care Homes for Adults (18-65 years) Page 25 of 32 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 had confidence in the home, because in the main their opinions were central to the homes development. Systems were in place to identify how they got this right, but these hadnt always been effective. Generally, people and staff were safeguarded by the health and safety practices that were in place. Evidence: The manager was registered with the CQC and in the AQAA he told us he was a registered learning disability nurse and had completed the Registered Managers Award. This meant he had the relevant qualifications and experience for the role. The home had a quality assurance system. The manager told us in the AQAA regular service user meetings were held and questionnaires were given to people, their families and other professionals through anonymous questionnaires. It also told us several areas of the home were audited regularly including medication, the environment, care planning, finances and health and safety audits. However, all the audits had not been effective, for example, the medication audit carried out on 16.07.09, no action had been identified to be taken with the medication systems. It Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: was discussed with the manager that this could be because the person that conducted the audit was the person responsible for medication. The responsible individual also visited the home. Subsequent to the inspection the manager wrote and stated the latest report from these visits was available when I visited and took place on 12.07.09. Subsequent to the inspection the provider stated training records held in the office identified 93 were trained in infection control, 64 in dealing with aggression, 38 in first aid and 79 in fire safety. In addition, it stated all senior staff have received first aid training to ensure that there is always an individual with training on each shift. In respect of fire safety, all staff have received education on fire safety and the procedure to be followed during induction. The manager stated all the necessary future training is booked. There was no evidence staff had received moving and handling training. This was supported a comment made by a health care professional about what the service could do better. They commented, manual handling training and regular updates to protect staff and service users. The manager told us in the AQAA maintenance and servicing was in place for premises electrical circuits, lift, fire detection and alarm, fire fighting equipment and emergency lighting. The portable appliance testing (of electrical equipment), heating and gas servicing was out of date. It stated they didnt have hoists, emergency call equipment and soiled waste disposal. Subsequent to the inspection the manager wrote to us and said records were available in the correct file. The records show PAT records are next due for renewal July 2010, records for gas and heating show they were last undertaken on 6 June 2009. Care Homes for Adults (18-65 years) Page 27 of 32 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 28 of 32 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 1 20 13 Discard all medication that 17/08/2009 has been labelled as to discard by, ensuring replacement medication is in place. So that people receive medication that is not out of date. 2 20 13 Audit medication for the person identified. So that they receive safely their prescribed medication. 17/08/2009 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 19 12 People must be weighed as identified in their plan of care. So that any potential problems are identified and dealt with at an early stage, including prompt referral to appropriate health care professionals. 17/10/2009 2 20 13 There must be a record of all 17/09/2009 medication discarded by the home. Care Homes for Adults (18-65 years) Page 29 of 32 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 So that people are protected by the homes policies and procedures for dealing with medication. 3 20 13 There must be a record of all 17/09/2009 medication received by the home. So that people are protected by the homes policies and procedures for dealing with medication. 4 20 13 People must receive their 17/09/2009 medication as it is prescribed, unless there is a documented reason why and by whom this has been changed. So that people receive their prescribed medication to maintain their healthcare needs. 5 41 17 Recruitment and training records for staff must be available for inspection. So that information about recruitment and training can be verified and that they meet the required regulations. 26/10/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 19 The daily evaluation should describe the action staff have taken to deal with peoples behaviours, so that it can be verified they have followed the plan of care to do this and medication has only been given as a last resort. Appropriate weighing scales should be provided, so that people can be weighed in their home environment, at the intervals described in their plan of care. So that people receive the medication they are prescribed, staff should verify peoples medication prescriptions with their GP, if there is a discrepancy. To ensure the health, safety and welfare of people and staff are promoted and protected, training should be arranged for staff in how to move people safely. 2 19 3 20 4 42 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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