Care Home: The Hamlet

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What the care home does well Staff did not change much, so it was easy to get to know them. They were kind and friendly.During the day, staff helped people to go out and do things.People were kept safe as new staff were recruited properly. What has improved since the last inspection? The living/dining room looked much better after being decorated.New easy to read words, symbols and pictures were being put up around the home, helping people feel more included. What the care home could do better: People thinking of living or staying at the home still did not have the right information to help them decide.The manager still needed to show us how he made sure everybody who was in the home at same time got on with each other.More information still needed to be helpful and easy to understand.Care plans needed checking more often to make sure they were still right.People should have help to be more independent with their money.People needed a key worker to help them enjoy living or staying at the home.More and better things to do inside were needed. More help to go out and do things on an evening was needed too.Ways of making mealtimes nicer and more relaxed should be tried.To keep people safe, medicines must only be given out by staff who have been trained.More repairs and changes were still needed to make The Hamlet feel homely. This included no noisy equipment and a clean and warm kitchen.To keep people safe, the manager and staff needed to make sure water was not too hot.The new group meetings needed thinking about more because people were talking about private things and staff who needed to talk privately could not.New staff needed more training and support to help them do a good job.The manager still needed to be registered with us.The manager still needed to find out what everybody thought about the home.The owners and manager need to work together so things kept getting better. Key inspection report Care homes for adults (18-65 years) Name: Address: The Hamlet 21 Cromwell Road The Links Resource Centre Eccles Manchester M30 0QT 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: Sarah Tomlinson Date: 1 4 0 1 2 0 1 0 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 44 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 44 Information about the care home Name of care home: Address: The Hamlet 21 Cromwell Road The Links Resource Centre Eccles Manchester M30 0QT 01617078856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Abbotsound Limited care home 9 Number of places (if applicable): Under 65 Over 65 9 9 0 0 learning disability physical disability Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD Physical disability: Code PD The maximum number of people who can be accommodated is: 9. Date of last inspection 2 1 0 1 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 44 A bit about the care home The Hamlet is a care home for up to 9 people with learning disabilities. People might also have physical disabilities. Some people live in the home all the time. Other people just come and stay for short breaks. Everybody has their own bedroom. Nobody has to share. It costs from £112.19 to £256.25 per week to live or stay in the home. Care Homes for Adults (18-65 years) Page 5 of 44 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 Care Homes for Adults (18-65 years) Page 6 of 44 How we did our inspection: This is what the inspector did when they were at the care home The home did not know we were coming. The inspector was there for 2 days. An Expert by Experience also came on the 2nd day. This was a person who had used learning disability services so he could help the inspector understand what it was like to live in the home. We met and talked to people who lived in the home. Care Homes for Adults (18-65 years) Page 7 of 44 Two relatives told us what they thought about the home in our surveys. We talked to the manager and some of the staff. We looked around the building. We looked at some of the paperwork. Care Homes for Adults (18-65 years) Page 8 of 44 What the care home does well Staff did not change much, so it was easy to get to know them. They were kind and friendly. During the day, staff helped people to go out and do things. People were kept safe as new staff were recruited properly. Care Homes for Adults (18-65 years) Page 9 of 44 What has got better from the last inspection The living/dining room looked much better after being decorated. New easy to read words, symbols and pictures were being put up around the home, helping people feel more included. Care Homes for Adults (18-65 years) Page 10 of 44 What the care home could do better People thinking of living or staying at the home still did not have the right information to help them decide. The manager still needed to show us how he made sure everybody who was in the home at same time got on with each other. More information still needed to be helpful and easy to understand. Care Homes for Adults (18-65 years) Page 11 of 44 Care plans needed checking more often to make sure they were still right. People should have help to be more independent with their money. People needed a key worker to help them enjoy living or staying at the home. Care Homes for Adults (18-65 years) Page 12 of 44 More and better things to do inside were needed. More help to go out and do things on an evening was needed too. Ways of making mealtimes nicer and more relaxed should be tried. To keep people safe, medicines must only be given out by staff who have been trained. Care Homes for Adults (18-65 years) Page 13 of 44 More repairs and changes were still needed to make The Hamlet feel homely. This included no noisy equipment and a clean and warm kitchen. To keep people safe, the manager and staff needed to make sure water was not too hot. The new group meetings needed thinking about more because people were talking about private things and staff who needed to talk privately could not. Care Homes for Adults (18-65 years) Page 14 of 44 New staff needed more training and support to help them do a good job. The manager still needed to be registered with us. The manager still needed to find out what everybody thought about the home. The owners and manager need to work together so things kept getting better. Care Homes for Adults (18-65 years) Page 15 of 44 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Tomlinson CQC North West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 16 of 44 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 17 of 44 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. As there was still not the correct information about the home, people thinking about staying or living at The Hamlet did not have enough information. Compatibility needs about living or staying with others were also still at risk of not being met as admission criteria had still not been developed. Evidence: The home provided both long term, permanent care and short term, respite care. At this inspection, five people were living in the home - four people had long term, permanent places and the fifth person was staying on a semi-permanent basis (with their respite agreement being renewed on an ongoing basis). With regard to respite care, four people regularly stayed, usually for long weekends. One new person had stayed at the home for emergency respite care over the Christmas period. At our last inspection, we had been concerned the mix of people living and staying in the home at the same time, some of whom had complex needs resulting in unpredictable and aggressive behaviour, was not given enough consideration. Since our last inspection there had been further conflict between one person staying for respite care and another who lived in the home. This matter had now been resolved, as the former person no Care Homes for Adults (18-65 years) Page 18 of 44 Evidence: longer stayed at the home. At this inspection, we again discussed how compatibility between people living and staying at the home could be better managed. The manager was aware he needed to be mindful of relationships between people living and staying at the home. Placements were also usually planned and usually limited to 4 known people. However, by its nature, the mix of permanent and short stay places created an inherent difficulty, as people were coming to stay in another persons home. The expert by experience said he would not like it if people came to stay in his house. At our last inspection we had asked for a clear admission policy to be developed (including how long and short term care was managed within a shared environment). This had not been done. A summary of the homes admission policy should be in a formal document called a Statement of Purpose. This tells us and any commissioning or referral body (i.e. Social Services) exactly what type of service the home provides. At our last inspection we had asked for the existing Statement of Purpose to be revised as most of the information required was missing. This had not been done. People thinking about staying or living at the home also needed clear and helpful information to help them make an informed choice. At our last inspection, we had asked for the homes brochure (the Service Users Guide) to be revised to be more meaningful. This had not been done. We had also discussed about it being in a more suitable format one which people with learning disabilities would find helpful and easy to understand, e.g. with photographs, pictures and easy to read, large print text. Our latest inspection report (with its easy read summary) should also be available for people (including those already living or staying at the home and staff). We were concerned there was not a copy available. Our registration certificate also needed displaying in a public place in the home (it was currently in the managers office in the main building). When people came to stay for respite care, we looked at how the manager and staff found out about any changes in their health and care needs since their last admission. The wife of one person updated staff at the start of each stay. With regard to the other three people, as they all used the nearby day centre (in the same building), the manager and staff relied on day centre staff to inform them of any changes. We discussed a more proactive approach would be more appropriate, particularly as people had complex, specialised needs and communication difficulties. Care Homes for Adults (18-65 years) Page 19 of 44 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New methods of working were being introduced, helping people living and staying in the home be more involved in home life. However, their personal needs and goals were at risk of not being met as care information was not regularly reviewed. Evidence: We looked at the care files of two people - one person who lived at the home and one person who stayed for respite care. These provided staff with detailed information about their care and support needs. Risk issues were also recognised, with guidance about how to reduce or manage these. However, it was unclear how much of this information was up to date. Much of it had not been reviewed for some time (some risk assessments dated from 4/2009; information about self harm triggers from 1/2009). Also, when care information had been reviewed, it was unclear how well needs were being met and goals achieved as no changes had been to the care plan in over two years. We discussed the need for care information to be reviewed more regularly (a six month minimum frequency is needed to meet our standards). External, joint reviews were being held with Social Services, although these were usually on annual basis. Also, there was Care Homes for Adults (18-65 years) Page 20 of 44 Evidence: not always minutes of these meetings and the homes own record was too brief, with no clear action plan. With regard to people staying for respite care, as noted, we had discussed the need to confirm care information was still relevant at each admission. Staff also needed to monitor whether goals were being achieved, especially if a person stayed infrequently. We discussed staff attending reviews for people staying for respite care (to gain a better understanding of their changing care needs). As identified at the last inspection, we again discussed having information in formats that were accessible and meaningful to the people they concerned (e.g. an easy read, pictorial care plan summary). We discussed the key worker role and how it should support people living and staying in the home to achieve their goals and ensure their support needs were being met. However, both staff and the people living at the home were uncertain about the role. It was also not identified in care files. In care files it was not always clear what information had been produced by the home and what came from other services (e.g. the adjacent day centre). Staff needed to have clear guidance that was relevant for a residential setting. We discussed the need for all information produced by the home to be clearly identified as such (and also dated and signed). Staff would also find files easier to use if they were in better order, e.g. with old information either archived or held behind more recent updates. We discussed language in care files. At times daily records were unclear and inaccurate, e.g. when describing self harming behaviour. They also did not say how staff responded. Possible triggers were also not recorded, allowing preventative action from staff and the phrase no problems was regularly used. This was rather negative and also gave no indication of the persons wellbeing or care given. At our last inspection we discussed about people living and staying in the home being more involved in its running. Some positive changes had since been made. The selection process for new staff now had a second, informal interview when people living and staying there could meet candidates and give informal feedback. Further good practice was noted, as new signs, symbols and pictures were about to be used around the home. For example, staff photographs were to be used on a daily rota so people would know which staff were coming into their home to support them. A pictorial communal activities timetable was also going to start. These new methods would better meet the specialist communication needs of people living in the home, enabling them to participate more in home life. Group discussions had also recently started. However, we were unclear about their purpose. They were held jointly with staff and the people living and staying in the home, Care Homes for Adults (18-65 years) Page 21 of 44 Evidence: and had a mixed agenda. The minutes showed people living and staying at the home were sharing personal issues. We were unclear what boundaries had been agreed about this. Also, usual topics of interest were not being discussed, e.g. holidays, social activities, food, television. We looked at how people living in the home were supported to make decisions about their money. All their money was held by the home (the majority in the homes bank account, with small amounts of cash on site). We discussed financial vulnerability should not prevent people retaining as much control as possible and living an ordinary life. For example, people could have their money in individual interest bearing accounts with local building societies or banks. When money was needed, they would then go out into the local community to withdraw it (even if it still needed to be held by staff on their return). Care Homes for Adults (18-65 years) Page 22 of 44 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. People living and staying in the home were supported to lead ordinary lives, taking part in day time activities in the community. However, a lack of meaningful activities within the home and a lack of evening activities outside the home put this at risk. The way meals times were organised did not always make them relaxed and enjoyable. Evidence: With regard to how people living in the home spent their days, one person had a parttime job, whilst the other four people enjoyed going out in the local community, using public transport to visit cafes and shops. Nobody was doing any college courses or voluntary work. During our inspection visit, poor weather meant people living in the home were not going out as much as usual. We discussed how staff supported people to take part in stimulating indoor activities. The expert by experience felt there was not enough things for people to do, especially for the people who were more disabled. The television was on for much of our visit and the expert by experience felt no one was watching it a lot of the Care Homes for Adults (18-65 years) Page 23 of 44 Evidence: time. Staff did encourage several people to colour in pictures. The expert by experience felt this was something more suited to children than adults. We had difficulty confirming how often and what kind of indoor activities were provided. Individual daily records were completed but they were not always helpful, e.g. for 8 days in December the only entries for one person who had complex needs and required a high level of staff support was in lounge, with no details of any activities they had participated in. At our last inspection we had discussed the lack of evening activities as day staff finished work at 8pm (with a lower number of night staff then coming on duty). Staff did change their shifts on occasion to support people to go out. However, with a resident group of mainly younger adults, regular evening activities outside the home should be taking place. The present shift pattern continued to mean this was impractical and unrealistic. Some people living in the home also went to bed very early, a possible consequence of staff shift patterns and activity levels. Opportunities to develop practical life skills varied. Most of the cleaning and housework was done by care staff and a domestic. Although people living in the home were encouraged to help clean their bedrooms and some people also helped tidy up after meals. With regard to food, whilst people living in the home took part in weekly menu planning, staff did all the shopping, preparation and cooking. We discussed ways of involving people living in the home more. For example, staff could support people to make their own sandwich at lunch rather than doing it for them. People could also plan, shop and prepare their own lunch with their key worker once a week. We joined people living in the home for lunch on both days of our inspection. We discussed about staff and people living in the home eating together. This is good practice as it allowed any assistance to be given discreetly and helped make meals a more social, enjoyable event, particularly if the preparation and cooking had been shared. The expert by experience thought staff should eat with people living in the home if possible. Some staff did do this. However, there was not always enough seats. During our visit some staff did not join in lunch, but sat on the other side of the lounge/dining room watching television. We felt uncomfortable with this and discussed staff should either stay and work, sitting and eating with people (having their break either before or after the meal), or they should take their lunch break and leave the lounge/dining room. The expert by experience felt the manager and staff needed to think more about how mealtimes worked. As the kitchen was at a considerable distance from the lounge/dining room, a small kitchenette area had been created in the dining area. However, as there was no sink, staff filled the kettle from the bathroom along the corridor. There was also no fridge to keep milk and other drinks cold. At our last inspection, it had been unclear how nutritious and varied meals were. Daily records were now being kept and showed a reasonable menu. We discussed to reduce Care Homes for Adults (18-65 years) Page 24 of 44 Evidence: duplication, individual separate records were not needed (unless there was concerns about a persons diet, which would be detailed in a care plan). One central record, with details of alternatives being served (to confirm people had a choice of what to eat), was acceptable. We discussed ways of introducing new and unfamiliar dishes, e.g. having meals with a combined social and culinary theme such as a Mexican night. Having a healthier diet could also be promoted, e.g. trying fortified white bread; and having a light hearted record about how well everybody (staff included) did regarding reaching their 5 a day target of fruit and vegetables. The manager confirmed all staff had completed emergency aid training, which included the management of choking. People living and staying in the home were supported to keep in touch with family and friends. Care Homes for Adults (18-65 years) Page 25 of 44 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living and staying at the home were generally well met. However, inappropriate medication practices put this at risk. Evidence: We spent time watching how staff spoke to cared for people who lived and stayed at the home. Staff were polite, patient and caring, and relationships were warm and friendly. The expert by experience thought the way staff helped people was good. He asked some of the people living in the home if they liked the staff that supported them, they said yes. We received feedback from two relatives, who both felt people were usually well looked after. We discussed how staff needed to be more proactive in protecting the dignity of one person living in the home (and also reduce the embarrassment of other people living, staying or visiting in the home). Staff could also review the persons behaviour with their social worker regarding other ways they could be helped to express their feelings. Both male and female staff worked at the home. Good practice was noted, as intimate personal care was usually provided by staff of the same gender. Information was available for staff about peoples preferred routines and likes and dislikes. As noted, in order to be most useful this needed to be kept up to date. Care Homes for Adults (18-65 years) Page 26 of 44 Evidence: The health of people living in the home was promoted. Healthcare needs were monitored; health checks offered; and a range of healthcare facilities accessed (e.g. GP, dentist, community dietician, specialist epilepsy nurse). However, some health services (e.g. optician) were visiting the home unnecessarily. We discussed whenever possible, people living in the home should be supported to access health services outside, improving community participation and helping them lead ordinary lives. Accident records were being completed appropriately. We discussed the manager needed to develop a system that would allow him to monitor accidents and incidents, e.g. for possible patterns regarding certain times/staff/situations, enabling preventative action to be taken. Since our last inspection we had been informed of some of the accidents and incidents we are required to be told about. However, we had not been informed about all (e.g. A&E visits/hospital admissions). We reminded the manager of Regulation 37 of the Care Homes Regulations 2001, confirming we must be told about all notifiable events. We looked at how medicines were managed. No person living or staying at the home were currently administering their own medication. We discussed, in accordance with the Mental Capacity Act 2005, the decision making process behind this now needed to be clearly documented for each person and regularly reviewed. There was a clear audit trail of medicines entering the home, being administered and any unwanted items returned to the pharmacist. We discussed storage space as there was not enough, with ordinary medicines having to be kept in the inner Controlled Drugs cupboard (leaving no space for any Controlled Drugs if needed). Medicine administration record sheets (MARs) were generally completed well. We discussed having a staff initial and signature list for audit purposes. We discussed how people were given their medication when they were out. Staff took medicines out of prepacked blister packs and put them in another container. This was secondary dispensing and carried a high risk of error. Also, we were concerned these medicines were then administered by staff who had not received medication training. This also meant the MARs were inaccurate, as the person who administered the medicine was not the person who was later signed the MARs. To avoid secondary dispensing, the persons pharmacist and GP might be able to change the frequency or timing of the medicine dose (avoiding the need for it to be given at this time). If this was not possible, staff should request the pharmacist to supply a separate container of medicines (e.g. just for lunchtime use). We discussed medication training as records were unable to confirm those staff who were authorised to administer medicines had received certificated training. We also discussed when additional specialised training was provided (e.g. administering rectal diazepam), a record needed to be kept to show who was authorised to carry out such procedures. Care Homes for Adults (18-65 years) Page 27 of 44 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding practices had improved, affording better protection to the people who lived or stayed in the home. Evidence: At our last inspection we had been concerned complaints were not always recorded and the homes complaints procedure was not properly followed. The manager now confirmed a full record was kept of any complaints made and a new complaint recording form was in place. We discussed how people living or staying in the home were encouraged and supported to make complaints, e.g. knowing about independent advocacy. Of the two surveys we received from relatives, one person knew how to complain, the other person did not. The manager and staff needed to be proactive in encouraging relatives and third parties to raise any complaints or concerns. The manager was planning to start a family forum to facilitate relative involvement. As noted, the home did not have a current brochure to tell people about how to complain and the complaints procedure was still missing from the homes Statement of Purpose. No new safeguarding alerts had been made since our last inspection. The manager had correctly informed us of several serious incidents, but these had not been safeguarding issues and the manager and staff had responded to them appropriately. Good practice was noted, as safeguarding training continued to be provided to staff. Criminal Record Bureau disclosure certificates for staff had also recently been renewed. We informed the Care Homes for Adults (18-65 years) Page 28 of 44 Evidence: manager of the new forthcoming additional legal requirement for staff to be registered with the Independent Safeguarding Authority before they can work. With regard to money held on behalf of people living or staying in the home, this was being stored safely with appropriate records kept. We discussed staff access to peoples finances (e.g. cash card numbers), with regard to having clear procedures limiting access and regular audit checks in place. We discussed the introduction of the new Deprivation of Liberty Safeguards (DOLs), which include a new specific legal role for care home managers. Good practice was noted, as the manager and senior care staff had attended DOLs training. The manager confirmed no person living or staying in the home was currently being deprived of their liberty. Care Homes for Adults (18-65 years) Page 29 of 44 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improvements had been made, further work, including routine maintenance and cleaning was still needed to provide a safe, clean and attractive home. Evidence: The home was part of a larger building that used to be Victorian swimming pool. The whole building (including the home) was owned by Abbotsound Ltd. The company runs several other services for people with learning disabilities in the building. There was another care home (Bath House); a large day centre; and a supported tenancy project. The Hamlet was a single storey extension at the rear of the main building, with access from both the main building plus a back door to the outside. There was a large lounge/dining room, 9 single bedrooms (none had en-suite facilities) and 2 bathrooms (1 assisted and 1 unassisted). There was back yard at rear of the home, reached by a ramp. At our last inspection we had been concerned about the lack of investment, with many parts of the home poorly maintained. We were also concerned about its institutional appearance (with long corridors lit by fluorescent lights; the large dining/lounge area; and a kitchen at the very other end of the home). Some improvements had now been carried out. The lounge/dining area had been transformed with wallpaper and paint, new flooring and new curtains. Missing covers on Care Homes for Adults (18-65 years) Page 30 of 44 Evidence: the corridor lights had also been replaced and stained ceiling tiles repainted. Bedrooms were being redecorated, with wallpaper now being used to make bedrooms more homely and attractive. Personalised, hand made, wooden wall plaques had also been fitted outside bedrooms. The back yard had been brightened by a mural along one wall and hanging baskets, with plans for a bbq area. All these changes had made a big difference. However, a continued, and more pro-active major maintenance and refurbishment programme was still needed. We found two serious problems during this inspection - water was running very hot in the unassisted bathroom and in some wash hand basins, with a risk of scalding; and a main fire door was sticking on a corridor carpet and not closing. These were both fixed before we left. We found a range of other repair and maintenance work - the laundry was still in a corridor cupboard (inaccessible to people living in the home and also unsatisfactory for staff handling soiled bedding); many doors banged loudly into their rebates and the extractor fans in both kitchen and assisted bathroom were very noisy, making it unpleasant to be in these rooms; it was very cold in the kitchen and the small corridor immediately outside, making it unpleasant to be in these areas; there were large splits in the kitchen work surfaces near the sink and cooker; the flooring was split in the assisted bathroom; the mattress in room 9 was lumpy and worn; in bedroom 7, the mattress was stained, the bedside cabinet worn and a small area behind the radiator needed repainting; the main exterior brick wall in the back yard and the rusty railings on the outer yard wall both needed repainting; and the back yard outer wall had a large vertical crack. Although bedrooms were personalised, the current Statement of Purpose incorrectly stated they met our minimum standards. This was not the case, e.g. armchairs were not provided in all and there was no lockable storage space for people living or staying in the home to keep private things. With regard to trying to make the building more homely and less institutional, we discussed a range of changes to be considered. For example, fluorescent lighting still needed to be replaced; wired glass panels in some communal doors and a wired glass observation window in the office could be removed or covered; staff notices removed from communal areas; both entrance/exit doors could be better identified (e.g. with a house number, name and letter boxes). As well as helping visitors (e.g. the expert by experience found it hard to find his way), these changes would also mean mail could be delivered directly to people living in the home (it was currently delivered as part of a general bundle to the main building reception). Staff could be vigilant at ensuring the internal exit door was kept locked at all times, with knowledge of the key code kept to an absolute minimum (so all visitors, including other Abbotswood staff and managers, had to ring the door bell to gain entry). Pipe work under bedroom sinks could be boxed in; replacement tiles in bathrooms did not match existing ones; and plants could be grown Care Homes for Adults (18-65 years) Page 31 of 44 Evidence: over the bare brick walls and railings in the back yard to soften their appearance. The expert by experience felt the walls in the lounge/dining area were also bare. As people living or staying in the home spent most of their time in there, he felt it was important it was a good room for them. In his home he had lots of photographs of himself and friends and family doing things together. As a building for people with both learning and physical disabilities we discussed other improvements that would better meet the needs of people who used wheelchairs. For example, magnetic fittings/automatic openers on all the fire doors leading to the kitchen would improve access; as would having lowered kitchen work surfaces. Good practice was noted, as raised garden beds were planned to enable people in the home who used wheelchairs to garden. We found the home smelt fresh and was generally clean and tidy. However, in the kitchen the extractor fan and some of the cupboards were very dirty; there were numerous fat splashes on walls and around the cooker; the bin was dirty and had no lid; and in the corridor outside, there were numerous large cobwebs and marks on the walls. With regard to promoting hand hygiene, liquid soap and paper towels were generally available in communal wash hand basins. However, there was none in the kitchen or in bedrooms (for staff use) where support with intimate personal care was provided. To support a more homely environment and ordinary living, we also discussed buying domestic cleaning products (e.g. washing up liquid), rather than using products ordered for the day centres industrial kitchen. Care Homes for Adults (18-65 years) Page 32 of 44 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who lived or stayed in the home benefited from a small, stable staff team who were safely recruited and generally trained appropriately. Evidence: Good practice was noted, as the staff team was stable, with little change. This meant people living or staying in the home got to know each other well. Staff were employed to work at both The Hamlet and Bath House, as a shared staff team. This team consisted of the manager, 4 team co-ordinators, 13 support workers and a small number of bank staff. At The Hamlet, there was a minimum of 4 staff during the day and 2 waking night staff. Two people who lived in the home had 1 to 1 support during the day, with one person having 2 staff to support them when they were out in the community. During our inspection enough staff were on duty to meet the needs of people living or staying in the home. A random sample of rotas from the last 12 months showed these levels were maintained and increased when people came for respite care. At our last inspection, rotas were confusing as it was unclear which staff were working at The Hamlet (and which at Bath House). Rotas had now improved, enabling staffing levels to be confirmed. They also generally provided a clear record of who worked in the home, although we discussed the names of any agency staff needed to be recorded and when Care Homes for Adults (18-65 years) Page 33 of 44 Evidence: the manager worked to cover any shifts. As noted, a daily rota in a format suitable for people living or staying in the home was due to be produced. We discussed introducing a short overlap between shifts (e.g. 15 minutes for team coordinators). This would support communication by enabling a formal handover to take place. This was particularly important when supporting people with complex and specialised needs. As noted, we were still concerned the 8pm finish time for day staff did not support evening activities out in the community. Communication within the staff team also used to be supported by team meetings. However, as noted, we were concerned recent changes to their format (by holding them jointly with people living or staying in the home) prevented staff having the opportunity to confidentially discuss the needs and goals of people living or staying in the home (e.g. whether care plans were working or not; if review goals were being achieved). We also discussed maximising attendance. For example, team meetings used to be held in the day with night staff often not attending. We discussed occasional meetings could be held in the evening. Bank staff who were working near full time hours could also be paid to attend. Individual staff support took place through regular formal supervision. This was now accompanied by annual appraisals. We looked at recruitment records for three people. These were in order, with interview records now kept and all necessary checks in place. Although we advised a photograph must be kept on each staff file. We discussed improving induction training for new staff to ensure they had the basic skills and competencies to work with a group of people who had complex and specialised needs. For example, the induction checklist was often completed in a very short period of time and the shadowing they did had no structure, with it left to chance regarding what was observed. A checklist could be developed of the necessary tasks and skills to be observed and then demonstrated back (at a later time) with each person living or staying at the home, and on which the new starter would be assessed as competent. Earlier supervision would also be useful, as it was not taking place until the end of their probationary period (e.g. to give feedback on performance and provide an opportunity to discuss care practices). We also looked at training for existing staff. Generally good practice was noted, as staff completed a range of mandatory courses, e.g. moving and handling; fire safety; emergency first aid; and food hygiene. However, as noted, medication training could not be confirmed for all relevant staff and no record was also available of further specialist training attended. With regard to staff having the skills and knowledge specific to this client group, all staff completed challenging behaviour and restraint training. All staff were also in the process of undertaking epilepsy training. We discussed training about Care Homes for Adults (18-65 years) Page 34 of 44 Evidence: learning disabilities and advised the manager to check the content of courses currently attended was adequate. With regard to NVQ training, over 50 of the staff team had achieved at least a level 2 award. Commitment to staff achieving above this was evident as 10 had now completed the level 3 award (and a further 3 staff currently undertaking it). Care Homes for Adults (18-65 years) Page 35 of 44 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 current management arrangements did not support the effective running of the home. Evidence: The home was managed by Mr. Brian Booth (who also managed the other care home in the building, Bath House). Mr. Booth was not yet registered with us as the Registered Manager. At our last inspection we had required Mr. Booth submit his application for registration. Mr. Booth had started this process but it had not been correctly completed. Consequently, Mr. Booth needed to start this again. Mr. Booth had worked in the learning disability care field for approximately 10 years. He had now achieved the NVQ level 4 management award. and was aware he still needed to complete a NVQ level 4 award in care. As noted, Mr. Booth had not received a copy of our last inspection report and was therefore unaware of its content. We were concerned the owners had not shared the report with him. We were also concerned both they and Mr. Booth had not then devised an improvement plan about how they would meet the requirements and recommendations we had made in this report. The improvements Mr. Booth had since Care Homes for Adults (18-65 years) Page 36 of 44 Evidence: made were based on remembered discussions with us on our previous visit. We had raised the need for the owners to be involved in the running of the home at our last inspection, asking for monthly unannounced quality monitoring visits to take place. These had not started. As part of monitoring the quality of the service, we had also been concerned no feedback was sought from either people living or staying in the home or from relatives or stakeholders. As noted, group meetings had started with people who lived or stayed in the home. However, as also noted, the purpose of these were unclear and we had concerns about boundaries and confidentiality. The manager was planning to seek feedback from relatives by starting a family forum. We advised feedback from community stakeholders still needed to be sought (e.g. surveys sent to involved social work and specialist health teams and GPs). With regard to safe working practices, the manager had confirmed before our inspection that safety and maintenance checks were up to date. During our visit we confirmed these were in order for fire extinguishers and the manual hoist and swivel chair over the bath. As noted, we found water temperatures were too hot at some taps, causing a risk of scalding. This was resolved during our visit, but we were concerned the current monitoring system had not detected these high water temperatures. Care Homes for Adults (18-65 years) Page 37 of 44 Are there any outstanding requirements from the last inspection? Yes  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 1 4 The registered provider must 01/07/2009 produce a statement of purpose and service users guide which is specific to the services at The Hamlet. The documents should be in a format which is suitable for the service users for whom they are written. This will mean that prospective service users, their family and placing Authorities will have clear and up to date information about the services available at The Hamlet 2 37 9 The registered person must make sure that the home is run and managed by a suitable person at all times. An application for registration must be submitted to us without delay. This will ensure that service users live in a home which is run and managed by a competent and fit person. 01/04/2009 Care Homes for Adults (18-65 years) Page 38 of 44 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page PAGE of NUMPAGES 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 Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 Care plans and risk assessments must be reviewed at least every 6 months. 31/05/2010 To ensure the changing needs, goals and aspirations of people living or staying in the home are identified and met. 2 20 13 Medicines must only be administered by staff who have received certificated medication training. 26/02/2010 To protect the health of people living and staying in the home. 3 24 23 The repair and maintenance work identified in this report must be carried out. 31/08/2010 So people living or staying in Care Homes for Adults (18-65 years) Page 40 of 44 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 Description Timescale for action the home have an attractive and comfortable environment. 4 30 23 The kitchen must be deep cleaned. 26/02/2010 So it was clean and hygienic. 5 39 26 The Responsible Individual or 31/03/2010 an appropriate person must make unannounced monthly visits to the home, interviewing staff and the people who live or stay there and inspecting the premises and records of events and complaints. A written record must be kept of each visit, with a copy forwarded to us each month. To monitor the running of the home. 6 42 13 The way hot water temperatures are monitored must be reviewed. 26/02/2010 To ensure water temperatures that are too high are quickly detected and then lowered, preventing a risk of scalding. Care Homes for Adults (18-65 years) Page 41 of 44 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 An admission policy should be developed to ensure needs and risks around compatibility with others living or staying in the home is formally considered. (This was asked for at our last inspection). 2 6 The key worker system should be reviewed so everyone is clear about this role (e.g. in actively providing 1 to 1 support; in keeping the care plan up to date; and in ensuring all staff know the persons current needs). To support people living in the home to make decisions and lead ordinary lives, the system of the home holding all their money, rather than most of it being held in individual bank or building society accounts, should be reviewed. To meet the specialist communication needs of people living and staying in the home, information for them should be in suitable and accessible formats. (This was asked for at our last inspection). 3 7 4 8 5 12 People living or staying in the home should be supported to take part in meaningful and stimulating activities when inside. People living or staying in the home should be supported to take part in regular evening activities outside the home. To help mealtimes be more relaxed and enjoyable, the way staff take part should be reviewed. To reduce the risk of error, medicines should only be dispensed from their original containers. To protect the health of people living and staying in the home, a record should be kept to show which staff are competent to carry out specialist medicine administration. Practical changes that would provide a more homely and domestic environment should be considered. To support staff communication and team working, staff should regularly meet as a team without people living or staying in the home. 6 7 8 9 13 17 20 20 10 11 24 33 Care Homes for Adults (18-65 years) Page 42 of 44 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 12 35 To ensure new staff understand their role and have the initial skills and knowledge to support people with complex and specialist needs, induction training should be developed. To gain feedback about the home, the planned family forum should start and ways of seeking the views of involved community stakeholders devised and implemented. 13 39 Care Homes for Adults (18-65 years) Page 43 of 44 Helpline: Telephone: 03000 616161 or 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 © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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