Care Home: The Bungalow

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What the care home does well The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 People had the opportunity to increase their skills both in numeric, social, music, art and reading via the Chase Services Day Centre located within easy walking distance from the service. The service had a staff team, which was mixed in ages and experience; during the inspection this was observed to be suitable for people using the service. This ensures that the people’s lifestyle continues to benefit them. People are encouraged with the personalisation of their bedrooms. We observed the people access the small garden at the rear of the service, there was a small paddling pool and trampoline. People using the service were observed to be well cared for. The service provides a number of pictorial documents, it was suggested that one could be laminated for the complaints process and displayed in addition to the pictorial paper one kept on file. Arrangements were in place for the continued health care of all the people. We had received no complaints. No referrals had been made to the service or to the safe guarding team. Completed surveys seen told us that. ‘The home has an excellent standard, the staff are splendid’, ‘I can tell by my daughters behaviour that she is happy’, ‘Staff are always welcoming’, ‘I am pleased with the progress my son has made’. What has improved since the last inspection? The completed AQAA told us that the Statement of Purpose had been updated to reflect the recently appointed care manager’s details. The service had completed assessments following Mental Capacity Act training, these will be added to individuals personal plans and covered financial and medication. The completed AQAA told us that staff training had been improved. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Following an anonymous telephone call to us in respect of the night staffing arrangements. The provider has purchased a free standing alarm system so ensuring that the sleep in staff could be alerted if necessary. This was demonstrated during the inspection by the relief manager. What the care home could do better: To ensure that the AQAA was relevant to the standards and provided information about the service. To ensure that all the wardrobes were secured to the wall to prevent an accident, and to act in accordance with with Health & Safety guidelines. To review the arrangements for the responsible person appointee for the peoples finances ensuring that it is an independent person. To ensure via an audit that staff training is current at all times. This will ensure that people are not at risk. While the peoples personal bedroom space’s were suited to personal colour and taste, there were areas that would benefit from redecorating and replacement of carpets. We were aware that one corridor carpet was to be fitted the following day after the inspection. To provide an alternative window glazing in one person bedroom to replace the frosted glass, while ensuring the persons privacy. Key inspection report CARE HOME ADULTS 18-65 The Bungalow 1 Short Street Brownhills Walsall West Midlands WS8 6AD Lead Inspector Wendy Grainger Key Unannounced Inspection 29th June 2009 08:00 The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bungalow Address 1 Short Street Brownhills Walsall West Midlands WS8 6AD 01543 372333 01543 372308 admin.cch@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Chase Community Homes Kelly Victoria Richards Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th July 2008 Brief Description of the Service: The Bungalow is a Care Home that aims to provide specialised care, support and teaching for people with autism and allied conditions. Emphasis has been placed on a small group living enabling a high staff to resident ratio. The home opened in 2003, is domestic in nature and located at the centre of Brownhills very close to shops, markets, and post office, public houses and bus routes. The Bungalow is one of a number of homes that forms Chase Community Homes. The homes Statement of Purpose and Service Users Guide were reviewed at this visit. The documents did not contain the required information of the current fees. Readers of this report may wish to contact the home for up to date information regarding Fees. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 2 star this means the people who use the service experience good outcomes. This unannounced key inspection was carried out by one inspector who used the National Minimum Standards for Younger People (18-65), and outcomes for people using the service as a basis for the inspection. Prior to the inspection we had sent an Annual Quality Assurance Assessment (AQAA) to the service. This is a self assessment tool it had been completed and returned to us within the timescale. The completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. The AQAA was lacking continuity in parts and did not provide information in areas relevant to the standards. At the time of this inspection the registered manager was unavailable, a registered manager from one of the other homes in the Company and the deputy undertook the responsibility of providing us with information required for example care plans, staff training, menus, Statement of Purpose and Service Users Guide. On arrival we saw staff assisting people with their daily routines before breakfast. Our inspection was planned to ensure that people at the service and their routines were not disrupted, normalisation is important to their daily lifestyles. During the inspection we were able to observe staff interacting, while demonstrating their knowledge of people using the service. We had the opportunity to visually observe the daily routines, people at the service had very limited communication skills. Staff ensure that people are supported thus ensuring and respecting an individuals choice. What the service does well: The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 6 People had the opportunity to increase their skills both in numeric, social, music, art and reading via the Chase Services Day Centre located within easy walking distance from the service. The service had a staff team, which was mixed in ages and experience; during the inspection this was observed to be suitable for people using the service. This ensures that the people’s lifestyle continues to benefit them. People are encouraged with the personalisation of their bedrooms. We observed the people access the small garden at the rear of the service, there was a small paddling pool and trampoline. People using the service were observed to be well cared for. The service provides a number of pictorial documents, it was suggested that one could be laminated for the complaints process and displayed in addition to the pictorial paper one kept on file. Arrangements were in place for the continued health care of all the people. We had received no complaints. No referrals had been made to the service or to the safe guarding team. Completed surveys seen told us that. ‘The home has an excellent standard, the staff are splendid’, ‘I can tell by my daughters behaviour that she is happy’, ‘Staff are always welcoming’, ‘I am pleased with the progress my son has made’. What has improved since the last inspection? The completed AQAA told us that the Statement of Purpose had been updated to reflect the recently appointed care manager’s details. The service had completed assessments following Mental Capacity Act training, these will be added to individuals personal plans and covered financial and medication. The completed AQAA told us that staff training had been improved. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 7 Following an anonymous telephone call to us in respect of the night staffing arrangements. The provider has purchased a free standing alarm system so ensuring that the sleep in staff could be alerted if necessary. This was demonstrated during the inspection by the relief manager. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the 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 who choose to move into the service have information provided they require and that they are assessed so that they can be assured the service can meet their needs. EVIDENCE: The completed AQAA told us little of the assessment process, but told us that the Statement of Purpose had been updated. The relief care manager was able to provide details about the admission process during discussions. We saw that the Statement of Purpose however did not contain the current fees for the service, which should identify the lowest and highest cost. The layout of the service has changed, this needs to be reflected in the map provided in the Statement of Purpose. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 10 The details for us need to be reviewed and updated in the Statement of Purpose complaints procedure. We were told that assessments are carried out prior to any admission for people using the service. At the time of this inspection the service had one vacancy. We were told that it is hoped to accept another person to the service. We saw the assessment and admission process for one person, it was very detailed and provided the staff with information and possible risk areas that may affect the person lifestyle. The assessment process ensured that the needs of any individual could be met. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning is supported by individuals enabling people operating the service to have detailed information about the care needed to enable people to experience a chosen lifestyle. EVIDENCE: The completed AQAA told us that people’s care and development plans are contained with other information to ensure that peoples needs risks, choice and medical intervention were identified and met. Alternative methods of communication were offered this included Makaton, and pictorial methods. Each of the people have a key worker, the AQAA told us it is hoped to encourage staff to work with their person on a more one to one basis. This The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 12 would include more involvement in a person life book, making appointments for the person. This we were told must be discussed with the manager prior to arranging. We saw a care plan that was chosen at random by the relief manager. The plan was detailed and contained the personal details for the next of kin who would if applicable assist the service to formulate information. Medication, health needs, and dietary needs including a risk assessment for choking were part of the plan. The plan had a list of foods that may affect the person’s behaviour; the staff were aware of this and in the event of a change in behaviour have the guidelines to deal with the situation. Contact with family is encouraged, we identified the reviews involving the social worker and the care manager. The person was not able to contribute to the review she has limited communication and routines are important to her. We saw the minutes of the review on file in the event the family were unable to attend we were told a copy of the minutes would be sent to them. We identified that personal goals and objectives were encouraged, this may be in house or during attendance at the day centre located within walking distance and owned by the provider promoting consistency with staff and routines. We saw that people were offered a choice during the day, with routines of at home for lunch and at the day service during the day. We did not on this initial visit see the day service centre. We did see the report completed by the person who operates the centre as part of the review process. Details of the person’s skill and interest and involvement in daily life styles were identified. We discussed the need to expand the risk assessment completed to underpin the Mental Capacity Act where necessary and not restrict it to medication and finances. Within the care plan was information that was no longer relevant to maintaining a ‘live active’ care plan and would benefit from being streamlined. The person reviewed can however be assured that staff have information to ensure they are supported in their daily lifestyle. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13,15,16,17. People using the 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 who use the service are offered choice for their lifestyle, while being supported by experienced staff. EVIDENCE: The completed AQAA told us that the service support individuals independence and assist them develop their personal skills. The service is part of a three home company, owned by Chase Community Homes. The service has a private day centre within walking distance of The Bungalow. People at the service attend the centre three days a week and having a day to relax and experience other interests within the community and other people. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 14 People have the option to do personal shopping, or attend the local leisure centre, transport is available when necessary. Contact is maintained with families where possible. The people at The Bungalow have no or limited verbal communication, staff observe body language or an individuals Makaton signing. The completed AQAA told us that they want to encourage people to look a holiday brochures to ensure that it is suitable for them. We were told that the service does not go abroad because it would be too much of a disruption to peoples routines especially on an aircraft. We saw evidence of last years holiday on the East coast, and photographs of people enjoying the pleasure beach. The same private cottage on the East coast has been arranged for August 2009 for two weeks. Holidays are part of the provider’s contribution to the service. Personal spending monies are from the individual’s personal account. We saw in the care plan that this person liked to go swimming this would be on a one to one basis. Other options a social life included horse riding, which when clarified was grooming while building up her confidence to ride a horse. Staff were very aware that it will take time and accept the person rights and choice when they will ride. Opportunities in the day centre included numeracy, music and literacy. This formal education promotes learning and social skills. The service users guide has been updated, written in a pictorial form for people to understand. This format was also seen for the fire evacuation displayed in the hall; it was suggested that the complaints pictorial process should be laminated and also displayed. This would further enable the people to access information they may wish to use. We observed the meal at The Bungalow prepared when people return from the day centre. It offered choice, staff sat with the people to support if necessary, no person required assistance when dining. The menus were in a pictorial format. Home cooking was the cook’s priority where possible; records of food temperatures were current. This ensures that food is served at the correct temperature thus protecting the people. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 People using the 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 service meets the physical, emotional and general healthcare needs of the people using the service. The lack of protocols for medication could put people and staff at risk. EVIDENCE: Individuals personal support was recorded in the care plan and provided in a manner to suit the preference of the person. At the time of this inspection the service had one vacancy. It is hoped that a new person will be accepted in the future. Contacts are maintained with families and if appropriate friends. We saw within the care plan that health care needs were identified and followed up by the management. There was evidence of a speech therapist The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 16 being involved. At the time of this inspection no person was under the care of a psychiatric nurse. Evidence provided confirmed that people were registered with alternative general practitioners in the local practice. Consultants were available and the district nursing service can be requested when necessary. Arrangements were in place for the continued health care of people using the service including dentistry undertaken at the local hospital. The service has in house sight and hearing tests. The staff confirmed that they had received training for the safe handling of medication, this confirmed the details in the completed AQAA. We saw the storage of medication, we discussed the need to provide a medical fridge and a controlled medication cupboard. We observed the medication administration record which had a number of ‘gaps’ in the record with no evidence of why the medication had not been signed for. This puts people using the service at risk, the audit for medication should have identified the errors. The home does not have a protocol for the administration for ‘PRN’ ‘when required’ medication. This is required to safe guard the people using the service and needs to be agreed with the person general practitioner. We discussed the need that ‘as directed’ medication should not be accepted by the staff. This practice puts staff and people at risk in the event medication had been changed. No person has the ability to administer his or her medication. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the 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 who use the service are able to make complaints and will be protected by the services procedures. EVIDENCE: The completed AQAA was disorganised for these standards, it gave information not related to the concerns, complaints, and allegations sections. The service had a written complaints process within the Statement of Purpose and service users guide. We saw a very detailed and easily understood pictorial process for the people. We suggested that like the fire instruction it could be laminated and put in the entrance hall. The service had not had a complaint since 2008. These records confirmed the completed AQAA. There had been no referrals to the safe guarding team or to us. We were told and one person confirmed that they had attended Adult Protection training. He was aware of the policy, procedure and the whistle blowing process. The training records also confirmed training that his was on going and current. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 18 With the process and procedures in place people can be assured that they are protected from abuse. We checked at random the finances of two people, we were concerned that the service was holding an excess of funds for one person and that this may compromise the services insurance. The explanation for this was that the two staff members responsible for accessing these funds were no longer employed at the service. We were told that the company had tried to get them together without success. These people are the only who can access the account. The Building Society have now stopped the account but the service is unable to close the account without signatures. The service is also unable to change the monies over into an new account. We were concerned about the excess funds that were losing any interest for the person. We were assured that everything was being done to sort this problem out, the provider will write again and or contact them to discuss the situation and bring it to a close. The second person funds were again excessive, we were told that the person will require some fund for her holiday but agreed to ensure that necessary funds would be added to her account following the holiday. Both funds checked were accurate and records and receipts available. During discussions with the provider disclosed that he acted as the appointee for the people using the service finances. This was part of the inspection discussions that the provider should review this. The registered person shall ensure so far as practicable that persons working at the service do not act as the agent of the people. This should be the responsibility of the social service, family or perhaps and advocate. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the 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 who use the service were provided with a homely and comfortable environment. EVIDENCE: The completed AQAA informed us very little about the environment, recent changes and plans for the future. The Bungalow is located in a quiet street off the main road in Brownhills. The service is suitable for the registered purpose. In general the service is well maintained, during the inspection we were told and saw a person visit the service to measure for a new corridor carpet. We were told that it was possible that it could be fitted the following day. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 20 The lounge carpet was badly stained and would also benefit from changing. This has been identified in the monthly Regulation 26 visits by the operations manager. These visits were a process enabling the providers to identify any deficits, training and ongoing updating of the service. We looked at the service and the personal space used by the people. Decoration was plain in colour, but then walls were decorated with personal pictures, posters and paintings. All bedrooms had en-suite facilities, which further enhance a person’s privacy and dignity. We observed in one bedroom ‘frosted’ glass on a window that looked onto a large laurel bush. We were told that the person in this room has a tendency to remove her clothes and take the curtains down, so this type of glass was to protect her dignity. We discussed with the provider an alternative form of glass, which will also protect her privacy but allows her to have a view. This room did have another small clear window, which we were told had been created to provide light. This change while providing a more acceptable outlook will not compromise the person’s privacy or dignity, We saw in some bedrooms that the wardrobes had not been secured to the walls. In the interests of Health & Safety it is important that this is undertaken as soon as possible. Following the discussion with the provider this will be a recommendation in the report. The chest freezer in the small laundry area would benefit from being cleaned, if not, this should be included in the cleaning routine. A comment from a relative told us that ‘excellent standards are maintained’ The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32.34.35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced staff team support the people using the service. Overlooked training provision could leave people at risk. EVIDENCE: The service has developed a recruitment policy and procedure. The completed AQAA told us that training is apriority for the service. The service had managed to access Learning Disability Qualification training, all the staff have the National Vocational Qualification (NVQ) level 2, some staff have level 3 and others were in the process of completing level 3. The staffing levels for the day of the inspection consisted of three staff during the morning, this level was repeated for the afternoon; staff during the waking hours were supported by the catering staff, manager and a housekeeper one day each week for a few hours. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 22 Night staffing levels had changed since the last unannounced inspection, due to the reduction in people at the service the provider has one waking staff and one sleeping in staff. This provides adequate cover at this time. The provider is aware that if the vacancy is taken then the night staffing will return to two waking staff. This will protect the people using the service. The training matrix while it contained all the relevant training headings. A colour system was used to confirm training taken it did not however tell us when the training had been undertaken. We saw projected training dates and a list of training required in the office. From the records mandatory training with the exception of First Aid appeared to be current and on going. During the inspection of the training we identified that two staffs First Aid training had been out of date from 2003. These people were night staff and on duty together later in the week. The failure by management to identify this lack of current training could put people at risk. Further enquiries to the main office told us that these two staff were to attend training on the 24th July. We did not see the names of these staff on the projected training list. We discussed an alternative to the colour system with the provider who agreed that it was not clear and could lead to training being overlooked. We interviewed one member of the morning staff, he was aware of the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks that had been undertaken prior to his employment. He confirmed that he had undertaken an induction and received supervision, which was both confirmed in his personal file. He was waiting to enrol for the NVQ level 2, he confirmed and explained his understanding of the ‘whistle blowing’ policy. Two staff files were seen the appropriate checks and references were on file. We were told by the managers that they had received training in respect of the Deprivation of Liberties and Mental Capacity Act. This was confirmed in the care plan where a risk assessment was in place for the person finances and medication risks. The completed AQAA told us that the retention of staff had been maintained with no person leaving employment in the last twelve months. We are told in the AQAA that the plan for the next twelve months was to improve staff retention, which is a contradiction in terms and from evidence provided. The retention of staff will provide consistency for people with complex needs ensuring their lifestyle continued in a manner that suits them. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 23 The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 using the service are protected by in house systems and the experienced staff team. The service is operated to the best interest of the people. EVIDENCE: Since the previous inspection in 2008 the service has a registered care manager in post. We were unable to conduct this inspection with the registered care manager, she was on official leave and would return later in the year. The inspection was conducted by a relief manager from another home in the group. This manager had completed the AQAA sent to us. The AQAA was part of the The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 25 discussions and the inspection. It was not informative in parts to provide us with relevant information. Discussions during the inspection confirmed information we required and not in the AQAA. The completed AQAA told us that the service had policies and procedures that were updated when applicable. We saw records and certificates that identified regular servicing of equipment is carried out, GAS, heating, boilers, Legionella. The service has a formal quality assurance in place that monitors standards this would include the operations manager doing monthly audits. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x Version 5.2 Page 27 The Bungalow DS0000041185.V376074.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13.2 Requirement A written protocol should be in place to ensure that staff know how to administer medication correctly When medication is administered to people who use the service it must be clearly recorded this will ensure they receive the correct medication Timescale for action 01/08/09 2 YA20 13.2 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA24 YA24 Good Practice Recommendations For the service to ensure that the Statement of Purpose contains the current information. For the service to protect people by ensuring that wardrobes are secured to the walls To ensure that the person’s room referred to provide a better external vision an alternative glass should be considered. The Bungalow DS0000041185.V376074.R01.S.doc Version 5.2 Page 28 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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