Care Home: Sydenham Terrace

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What the care home does well The management team are changing the culture of the home so that service users can have more control and more choice about their daily lives. So rather than staff simply following fixed routines and doing everything for service users, they are now supporting service users to develop the skills to do things for themselves. This is a very positive development. A member of staff who completed a survey made the following comment. "the home allows residents to run the home the way they want". Service users like living here. One said, "Staff are fantastic here. They understand you and look after you. We`re like one big happy family here". They enjoy the social activities provided. However, many of the social activities need to be pre-planned to ensure adequate staffing is available, which reduces spontaneity. People`s health is monitored and medical and other specialist expertise sought when necessary. Service users liked their bedrooms, which were homely and personalised according to their interests. The home was clean and nicely decorated and furnished. What has improved since the last inspection? Contracts have been put in place for existing service users which specify details of the service provided by the company running the home and the fees payable. Previously staff were not well enough informed about people`s individual needs and choices because care plans did not contain important information. This is now being addressed with detailed care plans being drawn up with service users. This helps the staff to support them in the ways they need and want. Shift patterns have been changed to help improve the quality of care. But the home still operates on minimal staffing levels as referred to below. Service users know that they can tell the staff about any concerns they have and they will sort it out. Parts of the home have been refurbished. Storage space is limited but staff try to ensure confidential information is stored appropriately. What the care home could do better: The manager and staff work hard to provide a caring and supportive home for service users, however they are being let down by the company running the home, which has taken insufficient action to ensure the home can provide high quality outcomes for people. Since the company took over the running of this home in 2008, two previous inspections have identified that minimal staffing as well as lack of training and procedural guidance for staff have had an impact on the quality of the service. Similar themes been identified at this inspection. The manager and a number of staff all feel that some service users need more assistance from staff with their personal care. Staff do not always have the time to provide this. So staffing levels need to be increased in the early morning and evenings so that service users who need more support and time can get this.If there were more staff on duty between 7.30 p.m. and 11.00 pm., service users would have more opportunities to enjoy spontaneous social activities in the community. Currently they all usually go their bedrooms by 8.30 p.m. One service user said they would "like to go to the pub more often" and another said they would "like more weekends out". The minimal staffing levels have been highlighted in the previous two inspections. Whilst people are not being harmed by this, their quality of life is not as high as it could be. A statutuory requirement was made at the last inspection for staff to receive up to date training about safeguarding service users from abuse. There was a lack of evidence available during this inspection to show that this requirement has been complied with. It is important that adequate evidence is provided to show that this has been done to prevent enforcement action being taken by the Commission. The manager was not fully confident about her role if a safeguarding concern was brought to her attention. It would be helpful to her to attend training specifically aimed at managers and other professionals about dealing with safeguarding alerts. This would help her understand her own role and that of other professionals. Staff are not following consistent practice when administering one person`s medication. The manager needs to ensure that the staff and records are clear about the correct time to give this medication. Some staff have not received accredited training about medication. This must be provided as it helps to reduce the potential for errors to be made. Some of the longer serving staff have had good training, but others have had very little. Where staff have not had relevant training this needs to be provided as follows:safe handling of medication; Mental Capacity Act and Deprivation of Liberty; understanding and dealing with challenging behaviour; restraint; safeguarding vulnerable adults; fire safety, first aid, control of infection and moving and handling skills. The procedures manual for staff continues to lack important guidance documents, as set out in Appendix 2 of the National Minimum Standards. Where sound policies are in place, the staff are much better informed about how they should go about their work in the best interests of service users. Vetting procedures for new staff are not robust enough which puts service users at risk if an unsuitable person is employed. The previous employment history of people being employed is still not adequately probed. This has been highlighted at previous inspections. Written references are not always being obtained. Staff records need to be better organised to make sure they contain the information required by the regulations. The staff and the manager still seem to lack job descriptions, which are an important way of ensuring people understand their responsibilities. This has also been referred to in previous inspections. The manager needs to record the outcome of induction training, so that it is clear whether the new employee has received and understood this and is judged competent to carry out their job. The home must implement a comprehensive quality assurance system. This helps them to find out if service users and other interested parties are satisfied with the quality of care and highlights what needs to be improved. The system used should include safety audits, for example, ensuring that safe hot water is provided, checking robust vetting procedures have been followed. The temperature of hot water supplied to baths was higher than advisable for safety. Appropriate thermostatic control valves must be in place and functioning correctly. Safety checks should be carried out. The organisation are not addressing such concerns quickly enough. Potentially hazardous substances should be stored more safely. A record needs to be kept of the food provided, so that it is can be seen that service users are offered a varied and nutritious diet. Key inspection report Care homes for adults (18-65 years) Name: Address: Sydenham Terrace 3 Sydenham Terrace South Shields Tyne And Wear NE33 2RY     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: Janine Smith     Date: 1 5 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Sydenham Terrace 3 Sydenham Terrace South Shields Tyne And Wear NE33 2RY 01914545383 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Potential Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 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: 6 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, maximum number of places 6 Date of last inspection Brief description of the care home Sydenham Terrace provides ordinary housing for six people who have a learning disability. The home is registered to provide personal care. Nursing care cannot be provided but district-nursing services can be used as required. The home is a large three storey terraced house and comprises six single rooms. There is a lounge and a spacious kitchen dining area. There are two bathrooms and two toilets and these are located on the first floor, close to bedrooms. As access to the first and second floor is via a flight of stairs the home would not be suitable for people who use a wheelchair. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 6 Brief description of the care home The home is situated within walking distance of the town centre of South Shields close to a number of local amenities such as shops, public houses, and places of worship, parks and the beach. There are bus stops nearby. Information about the fees payable was not available during this visit. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Before this visit we looked at information we have received since the last visit on 11th August 2009; how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run; the providers view of how well they care for people; the views of people who use the service and the staff. An unannounced visit was made on 13th April 2010. A further announced visit was made on 15th April 2010. During the visits we talked with people who use the service, staff and the manager. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept and checked that the staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We also checked what improvements had been made since the last visit. Care Homes for Adults (18-65 years) Page 6 of 37 Most of the issues identified during the inspection were discussed with the manager. We have reviewed our practice when making requirements, to improve national consistency. 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 signficant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The manager and staff work hard to provide a caring and supportive home for service users, however they are being let down by the company running the home, which has taken insufficient action to ensure the home can provide high quality outcomes for people. Since the company took over the running of this home in 2008, two previous inspections have identified that minimal staffing as well as lack of training and procedural guidance for staff have had an impact on the quality of the service. Similar themes been identified at this inspection. The manager and a number of staff all feel that some service users need more assistance from staff with their personal care. Staff do not always have the time to provide this. So staffing levels need to be increased in the early morning and evenings so that service users who need more support and time can get this. Care Homes for Adults (18-65 years) Page 8 of 37 If there were more staff on duty between 7.30 p.m. and 11.00 pm., service users would have more opportunities to enjoy spontaneous social activities in the community. Currently they all usually go their bedrooms by 8.30 p.m. One service user said they would like to go to the pub more often and another said they would like more weekends out. The minimal staffing levels have been highlighted in the previous two inspections. Whilst people are not being harmed by this, their quality of life is not as high as it could be. A statutuory requirement was made at the last inspection for staff to receive up to date training about safeguarding service users from abuse. There was a lack of evidence available during this inspection to show that this requirement has been complied with. It is important that adequate evidence is provided to show that this has been done to prevent enforcement action being taken by the Commission. The manager was not fully confident about her role if a safeguarding concern was brought to her attention. It would be helpful to her to attend training specifically aimed at managers and other professionals about dealing with safeguarding alerts. This would help her understand her own role and that of other professionals. Staff are not following consistent practice when administering one persons medication. The manager needs to ensure that the staff and records are clear about the correct time to give this medication. Some staff have not received accredited training about medication. This must be provided as it helps to reduce the potential for errors to be made. Some of the longer serving staff have had good training, but others have had very little. Where staff have not had relevant training this needs to be provided as follows:safe handling of medication; Mental Capacity Act and Deprivation of Liberty; understanding and dealing with challenging behaviour; restraint; safeguarding vulnerable adults; fire safety, first aid, control of infection and moving and handling skills. The procedures manual for staff continues to lack important guidance documents, as set out in Appendix 2 of the National Minimum Standards. Where sound policies are in place, the staff are much better informed about how they should go about their work in the best interests of service users. Vetting procedures for new staff are not robust enough which puts service users at risk if an unsuitable person is employed. The previous employment history of people being employed is still not adequately probed. This has been highlighted at previous inspections. Written references are not always being obtained. Staff records need to be better organised to make sure they contain the information required by the regulations. The staff and the manager still seem to lack job descriptions, which are an important way of ensuring people understand their responsibilities. This has also been referred to in previous inspections. The manager needs to record the outcome of induction training, so that it is clear whether the new employee has received and understood this and is judged competent Care Homes for Adults (18-65 years) Page 9 of 37 to carry out their job. The home must implement a comprehensive quality assurance system. This helps them to find out if service users and other interested parties are satisfied with the quality of care and highlights what needs to be improved. The system used should include safety audits, for example, ensuring that safe hot water is provided, checking robust vetting procedures have been followed. The temperature of hot water supplied to baths was higher than advisable for safety. Appropriate thermostatic control valves must be in place and functioning correctly. Safety checks should be carried out. The organisation are not addressing such concerns quickly enough. Potentially hazardous substances should be stored more safely. A record needs to be kept of the food provided, so that it is can be seen that service users are offered a varied and nutritious diet. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the information they need about the service, but this may not always be in a format which helps them understand it. Evidence: There have been no new admissions since the last key inspection. The manager described the process that would be followed if there was a vacancy in the home. This process would ensure that any potential service users were given plenty of information about the home and what they could expect. The manager would also gather information about their needs and wishes to ensure that they could offer the care and support needed. Paper copies of the companys Statement of Purpose and guide for Service Users were included in each of the current residents records. The guide used pictures to help explain what it was about. Each person also had a contract in their records which detailed information such as the bedrooms they occupied and the fees charged. Service users had signed these. The new manager did not know how the contracts were explained to service users, as many could not understand the written format, Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: due to their disabilities, for instance visual impairment. Care Homes for Adults (18-65 years) Page 13 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home are given the support they need to help them make decisions about their day to day life in the home and improve their life skills. Evidence: Since the last inspection more advice and support has been provided to care staff to help them understand and participate in drawing up care plans with service users. The new management team had encountered problems with the previous care plan structure as important information about individual service users had not been clearly shown in care plans, which meant they had not been as informed as they needed to be. The manager has now implemented a new care plan structure and is working with the staff to ensure up to date care plans are in place. Good progress was being made with this. The care plans seen were detailed and described each persons individual needs, choices and wishes, such as personal and health care needs, personal life choices and any equality and diversity needs. Service users had signed their care plans. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Risk assessments were being put in place and there was guidance to staff about responding to unwanted behaviours. A member of staff was aware of the guidance and understood that behaviours could occur if service users became stressed or worried and that staff were there to help support them to feel safe. Surveys were received from five staff who all state the methods used to pass information on between staff always or usually work well and they always have up to date information about the people they care for. One stated the home promotes independence and choice. Has care plans, risk assessments and support plans in place to allow staff to fully understand the residents. The new management team had been concerned that some institutionalised practices had developed over the years. which had led to staff following fixed routines which mainly involved them doing things for service users, instead of service users developing the skills needed to do things for themselves. They are making good progress with changing this. Examples of this could be seen, with service users coming down to breakfast when they wanted to and being given choices about what they would like to eat. They were also offered support to help do some tasks themselves, like making drinks. A member of staff who completed a survey said, the home does well with supporting adults with learning disabilities with daily living tasks. It has a high level or morale and gives the service users a chance to do what they want. Another said, the home allows residents to run the home the way they want.... Care Homes for Adults (18-65 years) Page 15 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home tries to be flexible and attempts to provide a service that is as individualised as possible, within the staffing constraints. Evidence: Most of the service users attend work or day centres during weekdays. At the last two inspections, there were some restrictions on the extent to which service users could go to outside social activities because of the way the home was staffed. The manager has made changes to the rota so that there are more staff available when service users are at home from their work or day centres but there is often still only one member of staff after 7.30 p.m. The manager and a member of staff confirmed that staffing is increased at night times and weekends for pre-planned activities. For instance, service users had gone to the theatre in the evening. But on most days, service users have gone to their own bedrooms by 8.30 p.m. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: Two service users chatted about the things they enjoyed doing, like going out for meals in pubs or cafes, watching football in the pub, going shopping, seeing their relatives. They had both enjoyed holidays with the staff and one described their trip to Blackpool. They also enjoyed doing things at home, like watching television, listening to CDs and playing bingo for prizes. One was excited about planned trips to a farm, the theatre and a fishing trip. Surveys were also received from service users before the inspection and several commented about enjoying social activities. One said they would like to go to the pub more often and another said they would like more weekends out. Service users spent time in the home where they wished and got up when they wished. One liked to lock his bedroom door with a key. One said they helped out with dusting. Staff were observed giving people choices and offering them support to do things like making their breakfast. Information provided before the inspection said that pictorial menus were in place to help service users decide what they would like to eat. However, there was no menu plan or records of food provided when this inspection was carried out. The manager and staff said that people were given choices about what they had to eat, which was confirmed by service users spoken to. One said he loved the food. Another said they enjoyed having a takeaway meal. Entries in some of the records also showed that people decided what they wanted to eat. Service users were seen to choose what they wanted for breakfast. The manager said that whilst there was no menu plan in place, they encouraged people to have healthy options, such as fresh fruit, brown bread. There was two bowls of fresh fruit in the lounge and fresh fruit in the fridge. Service users are weighed regularly and a record kept for monitoring purposes. Care Homes for Adults (18-65 years) Page 17 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst service users receive reasonably good care, staffing levels need to be increased to ensure that the health and personal care that people need is sufficient to meet their individual needs. Evidence: Surveys were received from five staff who all stated they feel they have the right support, experience and knowledge to meet the different needs of people living here but four of them commented that more one to one time is needed with individual service users. During the inspection, the manager stated that one service user receives additional funding from the local authority to help fund more staff time to assist with his personal care. The manager and another member of staff both felt that two other service users would also benefit from more time being spent with them to support them with their personal care but the staffing resources available do not enable this support to be provided. There are currently one or two staff on duty in the early mornings between 7.30 am to 10 am and only one member of staff after 7.30 p.m. unless more staff have been brought in to accompany service users on a pre-planned social activity. Some personal Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: care might also be carried out in the evening, such as shaves. The manager has discussed this issue with care managers but nothing has been resolved as yet. Where staff have had more time, they have been able to provide more support. For instance, they have supported a service user to become more continent, which is commendable. Six surveys were received from service users, who were assisted by staff to complete them. All six said they are always treated well by staff, who always listen to what they say. Care records and discussion with service users showed that GPs are contacted if service users were unwell and they saw consultants and other specialists when necessary. Advice was sought from occupational therapists if any specialist equipment, such as a special bed, was needed. Records showed routine check ups by opticians, dentists and chiropodists. Peoples weight was monitored regularly. The system for ordering, storing and administering medication was looked at and discussed with the manager. Photographs of service users are kept within their medication records. Appropriate systems for ordering, administration and disposal of medication were described. A sample of the medication administration records were looked at which indicated these were being kept properly. A member of staff had documented a concern on the 9th April about staff not being consistent with the time a particular medication was administered to one service user. The packaging from the pharmacist indicated it should be given at night but it was sometimes being given at tea-time. The manager said she was going to contact the service users general practitioner to find out when this medication should best be given and ensure that staff followed a consistent pattern. The manager said that the bank staff and one other member of the staff have not yet completed their accredited training in safe handling of medication. A planned course had been cancelled and was not yet re-arranged. Three staff records were looked at but evidence of medication training was only available on one of them. Another member of staff confirmed they had received training about the medication system. Care Homes for Adults (18-65 years) Page 19 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here feel comfortable about talking to staff about any concerns they may have, but insufficient action has been taken to ensure that the manager and staff team have had sound training about safeguarding people from abuse and the action they need to take if concerns come to light. Evidence: Requirements have been made at previous inspections concerning the need for the company running this home to provide copies of the companys complaints procedure to each service user. The companys complaints procedure is now in place and pictorial versions were in each of the service users records viewed. A member of staff confirmed he was aware of the complaints procedure and that any complaints would be followed up. Five staff who completed surveys stated they know what to do if anyone has a concern about the home and all stated they meet with the manager regularly or often to discuss their work. A service user was asked what he would do if he wasnt happy about anything. He said, dont bottle things up. Tell the staff. They sort it out. A statutory requirement was made at the last inspection that staff must receive up to date training about safeguarding service users from abuse and handling safeguarding referrals. The new manager was not totally clear about her role and the need for collaboration with health, social services and police, if a safeguarding alert was made. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: The policy and procedures manual within the home is not complete. The manager had only recently managed to obtain the companys whistle blowing procedure and so not all staff have yet signed to say they have read and understood it. One member of staff was aware of the procedure to follow and had had training about safeguarding vulnerable adults. Information provided by the company before the inspection indicated that staff had been trained in safeguarding but there was no certificates on three of the staff records looked at to show that they had been trained. A member of staff could clearly demonstrate that he understood that physical and verbal aggression from service users could be caused by underlying factors which needed to be understood and resolved. He confirmed he had received training about understanding challenging behaviour, dealing with violence and using breakaway techniques. However, there was no evidence of such training being provided to three other members of staff whose staff records were looked at. In addition, information provided by the home before the inspection, showed that the staff lack access to important policies and procedures that should be in place. These include Aggression toward staff; Dealing with violence and aggression, Emergencies and Crises, Physical intervention and restraint. It is vital that these documents are put in place and staff know about them, particularly as the home has experienced incidents in the recent past. The manager said that all service users benefits and fee payment is handled by their company office. There is an issue currently because a member of staff who was a signatory on service users bank accounts has left, which means neither the service users nor anyone else can access their money. They are trying to sort this out and in the meantime the company is funding service users. Records were kept of the monies handled on behalf of service users. The records were individualised and showed amounts held, what money had been spent on cross-referenced with receipts. Service users also signed where they were able. A sample check on two balances was correct. The manager said that the companys area manager caries out checks on this system during unannounced visits to the home. Care Homes for Adults (18-65 years) Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is homely and comfortable and meets the needs of service users at the current time. Evidence: Information provided by the manager before the inspection indicated that communal areas and bathrooms had been repainted and the dining room flooring replaced. Storage space in the home is limited but they were trying to ensure that confidential records and information was stored safely which was a recommendation at the last inspection. They are hoping that service users will be more involved in reporting problems with the building and aim to provide them with training in basic health and safety. The building was toured. A service user enjoyed showing the inspector her bedroom and said she liked it very much. All the service users have their own bedroom. Bedrooms were comfortable, clean and reflected the interests of the occupants. One had a slight odour of urine and the manager said they were going to replace the carpet in this bedroom. Negotiations are currently taking place with all interested parties so that two service users can swop bedrooms if all are agreeable. This is so that one person is nearer to Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: the bathing facilities on the first floor. There are two separate toilets and two separate bathrooms. One of the baths is equipped with a bath lift which is used by one service user with some mobility difficulties. The manager said she also intends to change the uplighters to downlighters, which will be better for a service user with visual impairment. Radiators are fitted with covers to safeguard service users from burns. The manager said all upper windows were fitted with restrictor opening devices, two of which were seen. The laundry area is located out in the yard. Surveys were received from six service users survey. All said the home is kept clean although one additionally commented general cleaning could be done better. One says, nice bed. Nice bedroom. Gloves and protective clothing was readily available throughout the home. One member of staff said that they had had training about infection control and evidence of this was seen on another persons record. There were no certificates to show that two newer members of staff had yet had this training. Care Homes for Adults (18-65 years) Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Weaknesses in the recruitment and training systems, as well as reliance on minimal levels of staff, place service users at risk. Evidence: There have been some staff changes since the last inspection. The previous deputy manager had left and a temporary member of staff from another service has now been promoted to deputy manager. The manager said the home was currently fully staffed. The staff carry out all domestic, kitchen and administrative duties. The manager has a forty hour working week, but only eight of these hours are spent on managerial duties. She had made some changes to the shift pattern in the home to prevent staff from having to work too many long shifts as she felt this was detrimental to service users. This means there is a varied shift pattern each day and it has also helped provide more staff when service users are at home from work or day centres. However, the overall numbers of staff available remains similar to previous inspections. There is generally only one member of staff on duty after 7.30 pm in the evening unless some social activities have been pre-arranged. As stated earlier, the staff do not always have the time they need to help service users who would benefit from more support with their personal care. This will tend to lead to staff doing things for service users Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: instead of being able to give them the time to learn things for themselves. The manager had identified this as an issue. Four staff commented in surveys as follows about what could be improved in the home, Offer 1-1 hours for residents whose needs are changing (discussed at reviews), I feel the home could be given 1-1 additional hours to certain individual service users to allow them to reach their full potential, More staffing hours for 1-1 individual needs, Extra hours are needed desperately for more staff to ensure current staff are not working excessive hours and the residents get the support they need. Comments were received in surveys from service users. All said they are treated well and listened to by staff. Some additionally comment, Everyone is kind here. I am very happy here. One said the home could be improved if there were more staff. A support worker sleeps over on the premises each night. The manager and deputy manager work an on-call rota between them, which means staff have access to advice and support should they need it. The manager said she had done a little bit of training on the Mental Capacity Act but has not completed this yet. This legislation became law in 2005 to help protect service users. But evidence of this training was not seen on the staff records of three other members of staff although a training matrix drawn up in 2009 indicated that three people had had some training. One member of staff said they had completed a sixteen week course about the Mental Capacity Act and understood the concepts involved. He also confirmed he had had training in other relevant areas such as safeguarding vulnerable adults, diversity, dealing with violence, breakaway techniques and challenging behaviour and person centred planning. He had also completed National Vocational Qualifictions at Levels 2, 3 and 4. The staff record for another experienced member of staff showed that they had completed an NVQ at Level 2 and 3 and had had training around health and safety issues, but lacked evidence to show that they had had training in safeguarding, understanding challenging behaviour and other relevant training. Information provided by the manager before the inspection indicated that six of the seven staff had obtained an NVQ but this could not be confirmed at the inspection. Some training was taking place when the inspection commenced. The records of two staff employed earlier this year were looked at. Both applicants had made signed declarations about any offences within their job applications. One staff record was missing basic information like her job title, hours worked and date Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: started. Her job history on her application form showed gaps between jobs. She had also given another care home as a reference but did not declare this employment on the job history. There was no documentary evidence to show that these gaps had been employed at interview. This was also an issue at the last inspection. No written references could be found in this persons record although the manager said she was sure they had been posted and she had signed a checklist to say they were in place. The manager said she had known the applicant for many years. A memo from the companys office indicated that a satisfactory disclosure from the Criminal Records Bureau (CRB) had been received. There was no job description on file and no copy of her contract of employment. The carer had signed her induction record but the manager had not signed it to show that their induction had been completed satisfactorily. Similar findings were made at an inspection carried out in September 2008. There was no certification to show that she had completed any mandatory or other important training such as safeguarding vulnerable adults. The other record of one person employed earlier this year showed that two written references were available on her record, along with confirmation from the companys office that a satisfactory CRB disclosure certificate had been obtained. There was evidence the person had completed an induction training programme and received training about food hygiene but lacked evidence of any further important training such as safeguarding vulnerable adults. There was no copy of a job description on their file although there was an indication they had been given a code of good practice. Five surveys were received from staff who all stated that vetting checks were carried out before they were employed. Four said their induction covered everything they needed to know mostly or very well; one said it did not at all. All said they are given relevant training and kept up to date and the manager meets with them often to discuss their work. Care Homes for Adults (18-65 years) Page 26 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff work hard to ensure that the home provides a safe place for people to live, but the company who run the home are failing to provide the guidance and support they need to ensure that the quality of the service is assured as far as possible. Evidence: Since the last key inspection the registered manager has left and a new manager been recruited who has not yet applied for registration with the Commission. The manager said she worked forty hours a week with a varied working pattern, including sleep in but only eight of these hours are spent on managerial duties. The rest is spent on direct support of service users. She said she had not got a job description but she was aware that the company is updating these. The lack of job descriptions for the manager and staff were highlighted in an inspection in 2008. She has previous experience working with people with learning disabilities and also as an NVQ assessor. She said she had completed the Registered Managers Award (RMA) and NVQ 4. She said she did not have a specific training plan for herself from the Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: organisation but she would be updating her mandatory training and was doing distance learning in LDQ, life coaching skills, nutrition and health, health and safety and equality and diversity. She said she had arranged LDQ training for all the staff. The manager said she received good support from her manager and also peer support. The manager provided detailed documentation to the Commission before this inspection which is a regulatory requirement. Good relationships were observed between the manager, staff and service users. The following comments were received in surveys from members of staff. I feel my home provides service users with excellent care and feel their needs are now being met to a high standard, Staff team settled, now that there is a full time manager in situ, I feel Sydenham has vastly improved since new management has come in. The home is now running better than ever, The home is now under new management and runs much better than previously. The manager said she was receiving good support from her area manager, who also visits the home each month to comply with regulations. Comprehensive written reports of these visits were seen. Minutes of staff meetings were detailed and showed good discussion. Pictorial minutes were kept of meetings with householders. Weekly checks are carried out on fire systems and fridge temperatures. The manager said that the company did not have a quality assurance system in place as they were reviewing the system. She has to complete a three monthly report to her manager covering any untoward events, complaints, compliments, staffing levels, supervision, appraisal and health and safety. The policies required for this type of home are set out in the National Minimum Standards. Information provided by the manager before the inspection showed that the home lacked a number of these policies, such as Accidents to service users, Aggression toward staff, Dealing with violence and aggression, emergencies and crisis amonst others. The staff have had to deal with such situations, so it is vital that the company provides the guidance they need. Some time was spent looking through the procedures manual as this has been an issue on previous inspections. It was confirmed that a number of policies were not in place. Of those available, generally about four staff had signed to say they had read the individual policies, but mostly only two of those signatures were current staff. The manager said she had indexed the policy file the previous day. She had not been able to find some and has had to request copies, for example, whistleblowing. She said she believed the company had employed someone to review the policies. Staff were being given 10 of the policies at a time to read through. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: The lack of a comprehensive policy manual was identified at an inspection in September 2008, following the companys takeover of this home. Following the last inspection the company had told us that staff would be given a half days training on the homes policies and procedures but it was not clear if this had happened. There was no policy on moving and handling and no staff had received moving and handling training, apart from the manager who completed this training in previous employment. There were plans to arrange this but nothing has happened yet. One person living in the home has mobility difficulties and needs to use a bath lift. The checklist for recording tests on bath water temperatures on a bathroom wall had not been completed since January 2010. Some service users use the bath independently. The manager said she believed the baths had thermostatic devices fitted but the sinks have not and they are waiting for this to be done. Warning notices were posted about the hot water temperatures at the wash handbasins. A thermometre was available for testing the bath temperatures. One was tested and found to be 48o centigrade which is above the recommended maximum for safety. The manager immediately reported this for repair and was to ensure that all staff be made aware of the risk and that they should test temperatures before service users have a bath. A similar checklist for testing water temperatures in the other bathroom had not been completed. The temperature of hot water supplied to this bath was also above the recommended maximum for safety. The risks from the hot water supply to bathrooms had been a recurrent item in the reports of the Area Manager over several months. Two days later no further action had been taken to remedy this safety concern, so a notice was issued that immediate action was required. In the laundry area, the door of which was open, there were large containers of bacterial soap and washing up liquid. One container had been labelled conditioner but did not have a proper ingredient label attached. The manager said that there was no risk assessment in place for the control of substances which may be hazardous. A sample check of maintenance records was made. The manager said that the bath seat hoist had been serviced but no documentation had been left and there was no labelling on the hoist itself to indicate this had been done. The gas system had been checked within the last twelve months. There was a lack of evidence in the files of two staff recruited earlier this year to show Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: that they had received any essential health and safety training, such as first aid, fire safety, control of infection, safe handling of medication. One had had training in food hygiene but the other had not. The record of a member of staff who had been employed for over three years showed that they had had training in first aid, fire safety, control of infection and had completed an NVQ2 in safe handling of medication but lack training in other essential health and safety areas. Care Homes for Adults (18-65 years) Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13(6) The registered provider must 30/11/2009 ensure staff receives up to date training to do with safeguarding service users from abuse and handling safeguarding referrals. 2 34 7, 9 & 19 and When recruiting staff a full Schedule 2. employment history of the applicant must be obtained as part of the recruitment process. 11/08/2009 Care Homes for Adults (18-65 years) Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 42 13 The baths must be fitted with 17/04/2010 suitable functioning thermostatic control valves which ensure that the temperature of hot water is not above 43 degrees centigrade. A system must be in place so staff check that the hot water is safe for bathing where service users are not able to do this for themselves. This ensures that service users are not scalded. 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 17 17 Records must be kept of the food provided to service users. This helps to ensure that service users are provided with a varied and nutritious diet. 31/05/2010 2 20 13 All staff who assist service users with their medication must be given accredited training. The manager must ensure that staff are clear about the 31/07/2010 Care Homes for Adults (18-65 years) Page 32 of 37 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 correct time to administer medication and the medication administration record shows this clearly. This helps to ensure that mistakes are not made. 3 31 18 All staff, who have not yet received relevant training, must be given this. This would include training about the Mental Capacity Act and Deprivation of Liberty, dealing with challenging behaviour, safeguarding vulnerable adults from abuse. This training ensures that staff have a good understanding of their role and helps protect service users from abuse. 4 34 19 Two satisfactory written 31/05/2010 references must be obtained by the company before employing someone to work in the home and kept within their staff record. Their staff record must also contain details of their job and the dates their employment started and finished. Their induction training record must show whether this was completed satisfactorily. 31/10/2010 Care Homes for Adults (18-65 years) Page 33 of 37 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 This helps to ensure that employees have the right skills, aptitudes and qualities to work in the home. 5 35 19 The manager must record the outcome of the staff induction process for each new member of staff. This helps ensure that the new employee and manager are aware of any further training needs required. 6 39 24 A quality assurance system 31/07/2010 must be in place so that the quality of care provided can be measured. This must include a system for seeking the views of service users and their representatives as well as other stakeholders, such as care managers, doctors, community nurses. This helps the company to know whether the home is meeting the needs of people living here or where improvements need to be made. 7 42 13 Staff must be given training about how safe moving and handling techniques. 31/07/2010 31/07/2010 Care Homes for Adults (18-65 years) Page 34 of 37 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 This helps to reduce the potential for accidents and injuries to service users and staff. 8 42 18 All staff must be given essential training in fire safety, first aid, control of infection and safe handling of medication and given regular updates of training when required. This helps to ensure that service users and staff are kept safe. 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 31/07/2010 1 13 If there were more than one member of staff on duty between 7.30 p.m. and 11 p.m. service users would have more opportunities to enjoy planned and unplanned social activities in the community. The staffing levels in the early mornings and evenings should be increased so that people who need more help with their personal care can be provided with this assistance at a pace and time that suits them. If staff have to record details of a prescribed medication on the medication administration record, they should sign and date the entry they have made to show they have done this. The manager should put systems in place so that staff practice with medication is checked at regular intervals to ensure that they handle medication safely. The temperature of the medication storage area should be 2 18 3 20 Care Homes for Adults (18-65 years) Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations monitored daily to ensure that the correct temperature is maintained. This helps ensure that the quality of the medications does not deteriorate by being stored at the wrong temperature. 4 23 It would be helpful to the manager to attend multidisciplinary training organised by the local authority specifically for managers of care homes, as well as other professionals. Such training will help the manager understand her own role and that of other professionals when dealing with safeguarding vulnerable adults when concerns have been raised. The home should have more staff on duty in the early morning and in the evenings to enable more person centred care and to enable more spontaneous outings to take place. A copy of employees contract of employment should be kept on their staff record, along with a copy of their job description. These issues have been raised at the last two inspections. The manager and staff should be provided with job descriptions that describe their role and what is expected of them. This recommendation remains outstanding since September 2008. The company should ensure that staff have access to a comprehensive policy and procedures manual which covers the areas set out in Appendix 2 of the National Minimum Standards for Care Homes for Adults. They must also ensure that the staff are provided with the time to read and understand the policies. Where sound policies are in place, the staff are much better informed about how they should go about work in the best interests of service users. A risk assessment and any necessary control measures should be put in place to ensure that potentially hazardous substances, such as cleaning materials, are labelled appropriately and stored safely. Evidence should be provided to show that the bath hoist has been serviced and maintained in accordance with the regulations covering such equipment. 5 33 6 34 7 37 8 40 9 42 10 42 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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