Care Home: Sycamore House

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What the care home does well The home provides care and accommodation for people with enduring mental health problems and they are able to come and go freely from the home within any restrictions that may affect their safety. They are free to access all areas of the home where they are not at risk. There are no rules or regulations in the home that mean that people have to get up or go to bed at set times. The people living in the home are able to decide whether they sit in their bedrooms or in communal sitting areas. Friends and relatives are able to visit the home at all reasonable times. Food is provided that meets the needs of the people living in the home. What has improved since the last inspection? New care plans have been put in place which have the associated risks indentified in them. The quiet lounge is being used for socialising in and a pool table can be used in there by the people living in the home. More activities are available in the home meaning that there are more things for people living in the home to do. Some people are taken out to the local shops by staff working in the home. This enables them to be able to access local community facilities. What the care home could do better: Care plans could be more detailed and personalised to ensure that personalised care is being provided. Goals identified should be more measureable and achievable to enable people to remain involved in planning for their futures. Care plans should be written in language that is easy to understand for the staff and the people living in the home. House rules should be clearly defined in the service user guide and the contract of terms and conditions for living in the home so that people know what rules they are accepting when they come to the home. Issues raised by the people living in the home such as lost laundry, poor food quality or loss of money should be appropriately recorded and should show what actions have been taken to address the issues raised. The food provided in the home could be more varied and people could be made more aware of the choices available to them so that they can choose what they eat on a daily basis. They should be involved in developing menus. People living in the home could be more involved in the day to day running of the home to ensure that they develop and maintain their daily living skills. The staff group should be reflective in culture and language of the people living in the home. This will ensure that there is someone people can relate to. The decor of the home should reflect that people with diverse needs are welcomed in the home. This will ensure that people feel comfortable in the home. Some areas of the home eg garden and bathing facilities should be improved to provide a more comfortable environment. The acting manager should submit their application for registration to ensure that there is an accountable individual who is in charge of day to day control of the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Sycamore House 2a/2b Havelock Road Tyseley Birmingham West Midlands B11 3RG     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: Kulwant Ghuman     Date: 1 3 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 34 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 34 Information about the care home Name of care home: Address: Sycamore House 2a/2b Havelock Road Tyseley Birmingham West Midlands B11 3RG 01217074622 01217078172 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Marblefield Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 28 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: Mental Disorder, excluding learning disability or dementia, Code MD Date of last inspection Brief description of the care home Sycamore House offers residential care for up to 28 people who suffer with a mental health illness. It caters for a mixed client group, including service users over 65 years of age in need of care due to old age and mental health. The home is not registered to care for people with dementia. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 28 1 6 0 4 2 0 0 9 Brief description of the care home The home does not offer nursing care. The home is situated in a residential street, close to public transport links to the city centre. There are some small local shops within walking distance. The property is an extended and converted building that offers communal lounges and dining space on the ground floor and bedrooms spread over the ground and first floors. There are eleven bedrooms with en-suite shower facilities. The remaining rooms continue to have shared bathing and toilet facilities. The kitchen and laundry facilities are on the ground floor and are not generally accessed by the people living in the home. There is a shaft lift connecting ground and first floors on one side of the building only. There is a garden area to the side of the property and parking is on the street. There was no information about fees in the service user guide and individuals will need to ask the home for this information. Care Homes for Adults (18-65 years) Page 5 of 34 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: This inspection was carried out over one day by two inspectors. The home did not know we were going to visit that day. A lady called Terrie Riley also visited the home. She is known as an expert by experience. This means that she has used care services and she visited the home to provide an independent view on the home and the service it provides. During her visit she spoke to 3 people who were living in the home, one visitor and looked around the home and observed interactions. She wrote a report about her visit and her comments have been included within this report. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Care Homes for Adults (18-65 years) Page 6 of 34 Prior to this visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing the individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at to make sure that the people living and working in the home were safe. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent Have your Say surveys to 10 of the people who live in the home and 3 of these were completed and returned to us. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care plans could be more detailed and personalised to ensure that personalised care is being provided. Goals identified should be more measureable and achievable to enable people to remain involved in planning for their futures. Care plans should be written in language that is easy to understand for the staff and the people living in the home. House rules should be clearly defined in the service user guide and the contract of terms and conditions for living in the home so that people know what rules they are accepting when they come to the home. Issues raised by the people living in the home such as lost laundry, poor food quality or loss of money should be appropriately recorded and should show what actions have been taken to address the issues raised. The food provided in the home could be more varied and people could be made more aware of the choices available to them so that they can choose what they eat on a daily basis. They should be involved in developing menus. People living in the home could be more involved in the day to day running of the home to ensure that they develop and maintain their daily living skills. Care Homes for Adults (18-65 years) Page 8 of 34 The staff group should be reflective in culture and language of the people living in the home. This will ensure that there is someone people can relate to. The decor of the home should reflect that people with diverse needs are welcomed in the home. This will ensure that people feel comfortable in the home. Some areas of the home eg garden and bathing facilities should be improved to provide a more comfortable environment. The acting manager should submit their application for registration to ensure that there is an accountable individual who is in charge of day to day control of the home. 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can visit the home, get written information about the home and be assured that the assessment process ensures that their needs can be met by the home. Evidence: We looked at three peoples care records to see how they had been helped to decide if the home would be suitable for them to live in. The files showed the individuals had been visited by the acting manager or the owner of the home in the place that they were living. This enabled them to assess their needs. Information was also gathered from hospitals, social workers and relatives where possible to get a fuller picture of their needs. People thinking about whether they should move into the home were able to visit to see if they liked it. If they could not visit themselves their relatives or representatives could visit on their behalf. People moving into the home were provided with a brochure that gave them some Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: brief details about what was available in the home. They were also provided with a contract or terms and conditions of residence in the home so that they knew what services they would receive and what they would cost. There was a trial period after which the individuals and their representatives met to decide if the home was meeting their needs and if the individuals wanted to live there on a long term basis. We asked for the information given to people moving into the home and we were given a copy of the service user guide and a brochure for the home. The information included in these documents did not include all the information needed by people thinking of moving into the home. For example, there should be full information about the qualifications and experience of the registered provider, manager and staff, fees charged in the home and the views of the people living in the home about the home. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to receive care and risks are managed to keep people safe. People living in the home are not involved in running the home. This means that the home may not be run in the way that they would like. Some care plans lack clarity to ensure staff know how to care and support people. Evidence: We looked at the files of two of the people living in the home in depth and a third one briefly to see if the their needs were being met in a personalised way. We saw that the files were well organised and information was accessible. The care plans were structured so that there was a brief overview of the individual that told us about their likes and dislikes. Following the overview there were separate care plans covering areas such as dementia, mental health, mental capacity, emotional needs, abuse, overall health, Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: mobility, transfers, dressing, personal care, bathing, appetite, continence, night checks and communication. The care plans were split into sections covering the area of need, symptoms, emotional needs, risk, prevention, assistance required and objectives. The number of care plans could mean that staff would find them too time consuming to read and some of them were not applicable, for example, where individuals did not have any particular health problems there was no need to have a care plan listing the problems they did not have. Care plans should address only the areas where there was specified need. Some care plans were wrong and misleading, for example, one persons care plan said that the individual needed assistance with transfers however, the staff told us and it was observed that the individual was able to transfer and mobilise independently. Some of the language used in the care plans was difficult to understand for example, partial weight bearing equipment instead of walking stick. In another instance the care plans stated Xs overall level of perception via touch is moderate. This may affect many things like ability to pick up things. Carers may be required to assist him when relating to daily tasks that would require object interaction, it was difficult to know what object interaction meant. Writing care plans in this way could mean that staff and the people for whom the care plans have been written may not understand what they mean and people might receive assistance that is not how they want. Some care plans had good information about the individuals needs for example, for one person the detail regarding their mental health was very good but then details of how personal care was to be provided was very generic. The Care Programme Approach plan was not available on all the files we looked at so it was not possible to determine whether all the risks and relapse indicators identified on them had been transferred to the care plans ensuring that people were adequately safeguarded. There were risk assessments with the care plans and it was good that any associated risks were attached to the appropriate care plans. However, some of the risk assessments did not make sense. One of the care plans stated that the individual would be supported to take their medication by staff. The risk assessment put them at high risk. It was not clear if they were at risk of not taking the medication themselves Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: and therefore it had been determined that staff would adminster the medication or they were at risk when the staff gave them their medication. There was no rationale as to why assistance from two staff was needed for this and what the two staff had to do. Sometimes risk assessments were contradictory, for example, for one individual in one place it stated the individual could have one unit of alcohol and in another place it stated maximum 2. There was evidence of advocacy involvement with individuals and their capacity to make decisions was being assessed. One persons file stated that the individual was involved in a support group but the records did not document how support was obtained from this group. The care plans were signed by the people living in the home however, people told the expert by experience: He also has no idea what a care plan is and has never been asked about his care. and, He has never had his care plan explained to him as he didnt know what it was and has never been consulted on his care. A relative told her (they) had never had an input into the care plan and didnt know what a care plan was. Some of the people living in the home managed their own finances whilst others were supported by the local authority or their relatives. In these instances the registered person supported the individuals to have access to money. There were adequate records available for these monies with receipts for any expenditures made on their behalf. The records needed to make clear where money had been given to relatives what the purpose was and to obtain receipts where possible. Also where taxis were used the records needed to state what the taxis were used for. The people living in the home should be involved more in the running of the home by being able to be involved in menu planning, meal preparation, cleaning of their own rooms and undertaking some personal laundry. This would ensure that people do not lose, and continue to develop, daily living skills and have ongoing measureable goals in place. Records were kept in the office and they were not accessible to people who did not need to have access to them. This ensured their confidentiality. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not enable the staff to plan in an individualised way how people are to be supported to live meaningful lives. There are some social activities available in the home. Meals were repetitive and choices were not made explicit to the people living in the home. Evidence: Some people living in the home have activities that they take part in on a regular basis outside of the home. One individuals told us he is involved in the local church and helps on a daily basis. They also undertake errands for other people living in the home. Another person goes out on a regular basis and meets up with people they know in the community. Some people go out with staff to access local shops to buy items of shopping they want. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Since the last inspection it was pleasing to see that the level of activities in the home had increased. Records we saw showed that some people played on the pool table, the play station, baked some cakes, attended a coffee morning and exercise sessions in the home. Care plans did not clearly define how identified hobbies and interests would be encouraged and supported. The care plans indicated individuals daily routines so that staff could support them to live their lives as they wished within the home. People were provided with keys to their bedrooms if they wanted but keys to the front door were not available as there were some vulnerable adults who would be at risk if they went out unescorted. People could not go out of the home without staff unlocking the door for them. People living in the home told the expert by experience: it is very good here, the manager looks after the home, enjoys playing snooker and occupies himself most of the week by playing snooker with other residents although he would like to go out of the home more often as he would like to be able to put a bet on the horses occasionally. Another person said (they) also believe that they need more activities at the home. A relative said: that there should be more activities available and that the residents should have the opportunity to be taken out more. It was evident from records and observations that relatives and friends were enabled to visit in the home and people living in the home could go and stay with relatives if they wanted. House rules are discussed at meetings with the people living in the home so that they know what behaviour is acceptable in the home and what is not. The house rules on smoking and drinking should be clearly stated in the contract so that people know what could happen if they do not adhere to these rules and only accept a place at the home in the full knowledge of what the rules in the home are. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: The records of the meals served in the home showed that the meals were repetitive and the variety of food available was quite limited. No specific alternative meals were identified at meal times but we were told that sandwiches would be made available if people did not want to eat what had been prepared. People living in the home should be more involved in devising menus to ensure that the menus included meals that they liked. Nutritional needs were assessed and the staff were aware if anyone was on a special diet such as diabetes. People living in the home told the expert by experience: the food was alright and he has plenty of choice, and he is really disappointed with what is offered and he believes that the home uses cheap cuts of meat and the quality and quantity of food is not up to a standard he thinks should be available so he buys his own food in. He also informed me that some of the meals he has eaten have not been cooked properly. We looked at the food available in the store room and found the variety limited with no snacks such as crisps available. The meats in the freezer reflected the limited variety on the menus. Care Homes for Adults (18-65 years) Page 18 of 34 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. People living in the home were receiving the appropriate support to ensure their personal and health care needs were met. Evidence: People were being supported with their personal care. Generally people living in the home looked well cared for. Care plans for personal care and bathing were generic and did not detail how individuals were to be supported to ensure personalised care was being provided. People were being supported with their healthcare needs. There was evidence to show that they were being referred to local facilities such as GP, district nurses, opticians, dentists and chiropodists. There was also liaison with local mental health teams and support groups such as those for people trying to stop smoking. Medication in the home was being managed through a monitored dosage system which provided medicines on a weekly basis. Medicines were given out only by staff who had been trained in the safe handling of medicines. Audits of the monitored dosage system showed that people were receiving medicines as they had been Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: prescribed. Audits of boxed medicines showed that there was only one minor error. This was good as it showed that people were receiving their medicines appropriately. The fridge used for storing medicines had a thermometer which showed that it was at the correct temperature on the day of the inspection however, daily maximum and minimum temperatures were not being recorded so that it could not be determined that the fridge temperatures were being maintained consistently. It was also noted that the acting manager was administering injections in the home. This was not appropriate as the home was not registered to provide nursing tasks and the home was not insured to provide these treatments. In addition, it could cause problems if the acting manager was not available in the home at the time the injections were needed. This was discussed with the proprietor who was to address the matter and who stated that the manager would no longer be administering the injections. Staff would continue to hand insulin pens to the people living in the home to administer themselves. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were informed about how to make complaints and they were safeguarded by the policies and practices in the home. Evidence: We had not received any complaints about the home since the last key inspection. One safeguarding alert had been raised but following investigation it was found that the concerns related to times when the individual went out unaccompanied as he was able to choose to do. We were told that people received a complaints procedure when they moved into the home. The complaints procedure had been discussed during a meeting with the people living in the home. This shows that the people living in the home were made aware of how to raise concerns within the home. However, the expert by experience spoke to some of the people living in the home and visitors to the home. She was told: X had never seen the complaints procedure and didnt know what an Advocate was but if he had a problem he would talk to the manager about it. X said that she had never been made aware of the complaints procedure and had never had an input into the care plan and didnt know what a care plan was, she also Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: did not know what an advocate was and had no idea of the rights her relative had. This would indicate that although some of the people living in the home did not know or understand the procedures they would be able to raise concerns they may have. The home should ensure that representatives of the people living in the home are also made aware of the complaints and safeguarding procedures and the availability of advocates so that they are enabled to raise any concerns they have on behalf of the people living in the home. During the inspection we were told that some issues regarding dissatisfaction with laundry, food and some money going missing had been raised with the home. These issues had not been recorded appropriately. It was advised that a grumbles book was set up where minor concerns could be recorded to show that people living in the home were being listened to. The expert by experience stated: I was also informed that money and clothes have gone missing on a number of occasions and that X does not feel safe in her room and she would like to have a key so as she could lock her room when she is not in there. Care Homes for Adults (18-65 years) Page 22 of 34 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. The home met the needs of the people living there. However, some areas and facilities need to be improved so that all areas of the home are of a good standard. Evidence: The expert by experience who visited the home said: My first opinion of the property was that it was clean and for the most part was free of odours although there was a slight smell of urine in the old part of the home. All the rooms I went into were tidy but there wasnt very much in the way of personalisation in any of them. This view generally reflected the views of the inspectors. One part of the building had had significant input into developing the environment so that people had pleasant en suite facilities consisting of wash hand basin, toilet and shower. The other part of the building had had some decoration and replacement of some furniture however, there was an odour on the top floor. Bedrooms did have flat screen televisions available and some were personalised whilst others were not. This could be the individuals choice or that they did not have personal belongings that they could personalise the rooms with. The key workers could assist people with making the bedrooms more homely if the individuals wanted this helping them to develop a pride in their environment. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: There were two communal sitting rooms and a smoking area. The large lounge was used for people to watch television in and although the chairs were located along the walls the room was quite comfortable and homely. The smaller lounge was used for games and people were seen to be playing pool. The smoking area is the conservatory that overlooked the garden. The garden could be developed to make it more interesting and pleasant for the people living in the home to look out on or sit in during the warmer weather. Some new pictures had been put up in the corridors, however, they did not reflect diversity in respect of religion, disability, race or sexual orientation. The communal bathing facilities in the home are basic providing facilities such as assisted bath and walk-in showers but they are not homely and issues such as the cleaning of bath chairs and bath seats need attention to ensure the minimising of spread of infections. As on previous occasions the floor tiling in the bathrooms was discussed as they looked dirty in places with ingrained dirt. We were told that the floors could not be cleaned any better due to the type of tiling. There were no curtains around showers and this could impact on the privacy and dignity of people in the home. Ramps into the home made it easy for people with reduced mobility to access the home. Other adaptations were in place such as rails in corridors, emergency call system and passenger lift. There is a laundry on the ground floor however, the size is not conducive to people being able to manage their own laundry. People are not generally allowed into the main kitchen for safety reasons but we were told that one individual had been provided with a kettle in their bedroom. The kitchen looked onto the dining room which was a pleasant area and we were told that some people living in the home had been able to do some baking. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff complement did not reflect the backgrounds of the people living in the home. Evidence: The staffing rotas showed us that in the mornings there are sometimes 3 care staff and sometimes 4 care staff on the early shift. There are 3 care staff during the late shift and two care staff during the night. There is a cook and domestic on duty 5 days a week and at weekends there is a fourth carer on duty during the early shift who would undertake catering and domestic duties. The managers hours were in addition to the carers hours ensuring she had dedicated management time. We looked at the files of three staff to ensure that the recruitment process was robust. We do this to ensure that all the appropriate employment checks were in place before people started working in the home ensuring the safety of the people living there. We found that one individual had been given notice to terminate their post due to not complying with study arrangements, the individual found another placement but then returned to work in Sycamore House. The documentation in respect of police checks and references related to the individuals initial employment at the home. The second file showed that the individual had had references and CRB checks Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: undertaken. Two references were in place but neither of them were from the last place of employment. The third file showed that there was no application form in place, no references had been sought for the individual and their contract of employment showed they had started employment before the pova first check had been received by the home. This indicated that the recruitment process needed to be improved to ensure that the people living in the home were fully safeguarded. None of the files showed that there had been any induction training in the home although one person we spoke with stated that they had received induction training and the training matrix indicated that this had taken place. The files we looked at showed that people were receiving some training however the registered person needed to ensure that people were given sufficient time to absorb the information given. The certifcates showed that on one day mental capacity act, infection control and coping with aggression in the work place were all undertaken on the same day. The training matrix showed us that staff had undertaken safeguarding adults, coping with aggression, medication and infection control training. The training matrix did not evidence that first aid or fire awareness training had been undetaken within the past 12 months. Diet and nutrition training had been undertaken by one staff member but not by the cook. It is advisable that the cook undertakes this training to ensure that he is aware of recent developments in diet and nutritional planning. The training matrix also showed that all the staff had either completed training to a minimum standard of NVQ level 2 or were undertaking it. We discussed with the registered person the need for there to be a balance in the staff group regarding student and experienced staff to ensure guidance, support and a sharing of experiences is in place. We also discussed the importance of having a diverse staff group that reflected the racial, gender and linguistic needs of the people living in the home. One of the people living in the home told the expert by experience He didnt think that the staff have enough training and would benefit from more especially some English as a lot of the staff who work at the home are non English and some of the residents struggle to understand them. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Staff generally receive one appraisal every six months. This does not ensure that people are kept up to date with current good practices. As the majority of staff are students studying some have assessors who come into the home to assess their skills and others attend college. Care Homes for Adults (18-65 years) Page 27 of 34 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. Overall the home keeps people living there safe. There are a number of improvements in progress to ensure that people are given the appropriate level of care however there is a need for developing independence and daily living skills. Evidence: The registered manager had left the home since the last key inspection. An acting manager was in place and an application for registration was to be forwarded to the commission in the near future. The acting manager is a registered nurse and is undertaking a Leadership Management Award. It was observed that the home felt comfortable and she appeared to have a good rapport with the people living in the home. Files were being organised but further improvements were needed in care planning and the management of risks. The acting manager needed to ensure that she was aware of her limitations as a qualified nurse in a non nursing environment. The quality assurance system needed to be developed to show that audits were being Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: undertaken and that the results of these audits were initiating improvements in the home. The expert by experiences overall view of the home was: Overall I feel that the new manager is trying to make a difference but she has a long way to go as in my opinion the care the residents receive is not personalised enough and I think the residents need more control over their care. I believe from feedback from residents that staff training needs to be looked at as that will enable residents to feel safer. Residents need more encouragement to help around the home more thus making them more independent. While speaking to residents none mentioned about any meetings these are important as it give the residents the opportunity to give ideas on activities and menus. The AQAA told us that the equipment in the home was regularly maintained ensuring it was safe for use. It was observed during the day that staff had to return to the office to get the key to open the front door and this would be the case if theree was a fire in the home. The registered person should ensure that the door can be opened easily in the event of a fire. Care Homes for Adults (18-65 years) Page 29 of 34 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 30 of 34 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 37 8 There must be a registered manager in place. This will ensure that the person in charge on a day to day basis is competent and experienced. 30/06/2010 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 1 The service users guide should include all the information required by people thinking about moving into the home. This will ensure that people can make an informed decision about whether the home is suitable for them. All sources of information about needs should be available on the care files so that people can determine where the information has been obtained. This will ensure that all available information is used to formulate care plans and risk assessments. People living in the home and their representatives, where appropriate, should be involved in drawing up their care plans and risk assessments. This will ensure that people agree with the care they receive and the way they are assisted. Page 31 of 34 2 6 3 6 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 4 6 The care plans should be in a format that is easy for the care staff to read and understand so that they can provide care in a personalised way. There should be receipts to account for all monies that the home is helping people to manage. This will ensure that people are safeguarded. People should be offered opportunities to participate in the day to day running of the home. This will ensure that people are involved in making day to day decisions. Risk assessments should be clear and accurate. This will ensure that the people living in the home are safe and risks are adequately managed. People should be provided with opportunities to develop independent living skills where appropriate. This will ensure that people are able to remain as independent as possible. People should have individual care plans showing how their leisure activities would be facilitated. This will ensure that people live lives that are relevant to their wishes. House rules should be clearly stated in the contract and service user guide. This will ensure that people know if the home is suitable for them when they decide to move into the home. People living in the home should be involved in developing menus and meaningful choices must be available. This will ensure that people receive the food they want. Care plans should be detailed about how personal care is to be provided. This will ensure that they receive personalised care in a way that does not limit their independence. All expressions of dissatisfaction and the actions taken should be recorded in a way that enables the registered person to monitor for any patterns and to be able to address the issues. Representatives of the people living in the home should be made aware of the complaints procedure and how to access advocacy services. This will enable them to raise any issues on behalf of the people living in the home. The homes decor and facilities should reflect that it promotes diversity and equality. This will make people with 5 7 6 8 7 9 8 11 9 14 10 16 11 17 12 18 13 22 14 22 15 24 Care Homes for Adults (18-65 years) Page 32 of 34 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 diverse needs feel more accepted. 16 28 The garden should be developed to make it more interesting and pleasant place for people to sit in the warm weather. All areas of the home should be clean and free of odours. This will ensure that there is a pleasant environment for people to live in. The staff team should reflect the cultural and gender composition of the people living in the home. This will ensure that there are staff available with whom the people living in the home can relate. Trainees should not make up the majority of staff on any shift. This means that there are not sufficient people on duty with the appropriate knowledge and experience of providing good care and to provide support to trainees. The recruitment process should ensure that all checks are appropriate and in place before people start work. All staff should undertake training suited to the role they undertake. This will ensure that all staff are equiped to undertake their roles in a knowledgeable and safe way. Training should be provided in manageable chunks. This will ensure that people are able to assimilate the information being provided. Staff should have regular, recorded supervision meetings at least six times a year to ensure that they are working as required by the home and so that they can raise issues of development if needed. The quality assurance system must ensure that the service is developed in lines with the views of the people living in the home. The registered person should ensure that the front door can be opened quickly in the event of a fire. This will ensure that the people living in the home are safeguarded. 17 30 18 33 19 33 20 21 34 35 22 35 23 36 24 39 25 42 Care Homes for Adults (18-65 years) Page 33 of 34 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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