Care Home: The Limes Blackheath

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• 10 Whitfield Avenue

What the care home does well The service has (and is continuing) to look at how it can make more information easily accessible to the people who live here. People are actively involved in planning how their care needs and personal preferences will be met. They are regularly consulted about the day-to-day running of the home. People are treated with dignity and respect. They are encouraged and supported to follow their own routines and participate in activities of their own choosing. They are able to receive visitors whenever they wish and maintain contact with family and friends away from the home. The best interests of people living in the home is being more fully protected by the service’s recruitment and induction procedures. All staff members are supported to attain recognised qualifications and provided with training to The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 enable them to meet the individual care needs of the people who live in the home. What has improved since the last inspection? People living in the home continue to enjoy some group activities as well as being better supported to participate in individual activities within the community. This shows us the service is continuing to implement a more person-centred approach to meeting people’s needs and preferences. The handling and administration of medication was reported on in the last key inspection report where some improvement was needed to ensure people’s well being is fully protected. The random inspection visit we made in August showed these had been addressed. Further improvements in practice and recording were seen during this visit. All staff members are currently undertaking further training in managing medication. They continue support people, where appropriate, to look after there medication. The service has produced a staff training matrix. This shows recent training has included basic food hygiene and managing challenging behaviour. It also identifies what training or training updates each member of staff requires. The manager has implemented a programme for staff to receive regular individual supervision. Discussions included practice and training and development needs. This is to ensure the staff member is competent and suitably trained to meet people’s needs. What the care home could do better: There is a range of formats for staff to complete about different aspects of a person’s care. However, these need to be completed in more detail for them to be effective monitoring tools to identify people’s progress and/or any issues of concern. Individual risk assessments have been carried out on some activities and tasks each person participates in. However, this should be carried out on all activities and tasks where the potential for harm has been identified. A suitable programme for ensuring all staff attend training, and periodic update courses, in the protection of vulnerable adults in a timely manner still needs to be identified.The Limes BlackheathDS0000063539.V377941.R01.S.doc Version 5.3 Night-time checks are carried out by staff for all people living in the home. The need for these should be re-assessed for each person against their care plan and daily records. Where these are considered necessary these should discussed and agreed as part of a multi-disciplinary team and documented on the individual’s care plan. This will ensure people’s right to privacy is respected. The service has improved its practices for ensuring medication is appropriately managed and how training is provided to staff. It is advisable for staff to be provided with information that may indicate a person who self-medicates may not be taking their medication regularly. Also where concerns arise, consideration should be given to ways in which a person can continue to be safely involved in managing some aspects of their medication. A system for responding to remedial repairs reported by the manager should be introduced to ensure these are addressed promptly. An annual renewal and re-decoration programme should also be produced. This will ensure people are provided with a safe and well-maintained environment in which to live. The manager should be fully supported in her role through regular meetings with a representative from company to discuss the service’s performance, future development and her own training needs. A comprehensive quality assurance system should be implemented and an annual development plan produced based on the findings for people to be fully confident their views about the service are listened to and acted upon. Key inspection report CARE HOME ADULTS 18-65 The Limes Blackheath 37 Avenue Road Blackheath West Midlands B65 0LP Lead Inspector Linda Elsaleh Key Unannounced Inspection 1 & 2nd October 2009 10:30 st The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 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 Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 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 Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service The Limes Blackheath Address 37 Avenue Road Blackheath West Midlands B65 0LP 0121 559 3935 0121 561 1333 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) United Care Homes UK Ltd Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 8 The maximum number of service users who can be accommodated is: 8 17th April 2009 Date of last inspection Brief Description of the Service: The Limes is registered to make provision for a maximum of eight people learning disability. The home is situated within easy travelling distance of Blackheath town centre and close to public transport systems. The service has its own transport. This is used for holidays, group outings and to take people who live here to appointments, as applicable. Accommodation is provided over two floors. There are eight single bedrooms, four of which have en-suite facilities. The communal facilities on the ground floor consist of a lounge/dining area, conservatory and kitchen. Toilets and bathing facilities are available on both floors. There is a garden to the rear of the building. The main entrance is at the front of the building and limited car parking facilities are available at the side of the property. Interested parties should make contact with the home in relation to obtaining the correct fees charged for living at the home. There are additional charges for toiletries, hairdressing and transport. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The service is required to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information about what has happened in the home during the last 12 months. An AQAA was returned to us, as requested, before the last key inspection April 2009. We looked at information we have received about the service since the last key inspection. We also made a return visit in August. Information and comments received since visit have been positive. The service has identified its plans for improvement and begun putting these into action. This unannounced inspection visit was carried out by one inspector on 1st & 2nd October 2009. We spoke to the manager, staff and the people living at The Limes. We looked at a selection of records and documents kept by the service and, in detail, at two people’s care files and two staff files. This was to help us to assess the quality of life for people who live in the home and the service’s performance in meeting regulations and the national minimum standards. The atmosphere in the home was relaxed and friendly. The premises are suitably furnished, clean and tidy. People we met appeared healthy and well looked after and told us they were happy living at The Limes. What the service does well: The service has (and is continuing) to look at how it can make more information easily accessible to the people who live here. People are actively involved in planning how their care needs and personal preferences will be met. They are regularly consulted about the day-to-day running of the home. People are treated with dignity and respect. They are encouraged and supported to follow their own routines and participate in activities of their own choosing. They are able to receive visitors whenever they wish and maintain contact with family and friends away from the home. The best interests of people living in the home is being more fully protected by the service’s recruitment and induction procedures. All staff members are supported to attain recognised qualifications and provided with training to The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 6 enable them to meet the individual care needs of the people who live in the home. What has improved since the last inspection? What they could do better: There is a range of formats for staff to complete about different aspects of a person’s care. However, these need to be completed in more detail for them to be effective monitoring tools to identify people’s progress and/or any issues of concern. Individual risk assessments have been carried out on some activities and tasks each person participates in. However, this should be carried out on all activities and tasks where the potential for harm has been identified. A suitable programme for ensuring all staff attend training, and periodic update courses, in the protection of vulnerable adults in a timely manner still needs to be identified. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 7 Night-time checks are carried out by staff for all people living in the home. The need for these should be re-assessed for each person against their care plan and daily records. Where these are considered necessary these should discussed and agreed as part of a multi-disciplinary team and documented on the individual’s care plan. This will ensure people’s right to privacy is respected. The service has improved its practices for ensuring medication is appropriately managed and how training is provided to staff. It is advisable for staff to be provided with information that may indicate a person who self-medicates may not be taking their medication regularly. Also where concerns arise, consideration should be given to ways in which a person can continue to be safely involved in managing some aspects of their medication. A system for responding to remedial repairs reported by the manager should be introduced to ensure these are addressed promptly. An annual renewal and re-decoration programme should also be produced. This will ensure people are provided with a safe and well-maintained environment in which to live. The manager should be fully supported in her role through regular meetings with a representative from company to discuss the service’s performance, future development and her own training needs. A comprehensive quality assurance system should be implemented and an annual development plan produced based on the findings for people to be fully confident their views about the service are listened to and acted upon. 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 Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 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 Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 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): 1&2 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. Information is made available to people before they visit the home so they can make an informed choice about whether to move in. The service should review its assessment procedures to take account of changes that have been made in the home. This will ensure the service can meet the needs of people who may move in. EVIDENCE: When we visited the service in April 2009 we looked at the Statement of Purpose and Service User Guide which contained information about the home and how the service meets people’s needs. The documents had been updated and produced with pictures. This enables people who may be considering coming to live at The Limes and those already living here to understand the information being provided. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 10 Two people we spoke to told us they had been given a copy of these documents, however, a number of changes had taken place since then. One person said “We have a new manager and some new staff” and another said recent changes in how the home is run means it is “loads better”. There are six people living at the home and two vacancies. The people we spoke to told us they had lived in the home for a number of years. Information provided by the service in March 2009 states there is a procedure for assessing the needs of people who may wish to come to live at the home. The procedure provided to us on this visit does not include a date for when this was last reviewed. The newly appointed manager told us, that since her appointment in July, she has been looking at how people are being supported and the day-to-day running of the service. She said the assessment procedure would be reviewed before future assessments are undertaken with people who may wish to come to live at the home. This will ensure a comprehensive assessment is carried out and the service is able to meet the person’s needs and preferences. We were unable to fully assess the service’s performance for the key outcome area, assessing the needs of new people moving in to the home, during this visit. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 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, 8 & 9 People using the service adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and personal goals are reflected in their care plans. They are encouraged to participate in decisions about their lives and the day-to-day running of the home. The service needs to ensure individual risk assessments are carried out for all tasks and activities where potential risks are identified. This is to ensure people are protected from harm and supported to take reasonable risks as part of an independent lifestyle. EVIDENCE: We looked at care plans for the people living at The Limes (two of these in detail). The plans have been developed with the community learning The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 12 disabilities team and contains picture illustrations to help the individual to understand the contents and participate in planning their care. The files show people’s care plans were reviewed earlier in the year with the funding authority. Two files we looked at did not contain details of what was discussed. Therefore, we were unable to see whether any changes to their care plan had been agreed. One person told us “I do go to meetings to discuss my care and to let people know what I think.” People we spoke told us they have a named key worker who regular meets with them to discuss their care plan and asks them how they feel about the support being provided to them. Records of these meetings are kept on the people’s files. The records contain details of what areas have been discussed and comments made by the individual. One person told us “I have seen my file and care plan, but I let my key worker look after it”. Another said “.…my key worker is very good. She will go with me when I want to buy new clothes.” A member of staff said they felt these meetings had improved communication between the people living in the home and the staff team. For example, individuals had begun to talk in more depth about different aspects of their lives and new activities they would like to try. The manager told us they had begun working with the Speech and Language team to enable them to support people to improve their communication skills. She told us communication passports are being developed for three people. We were told one person’s communication skills had “greatly” improved over recent weeks. This was evident in the interactions we saw between her/him and staff members. People are supported by staff to make their own choices and decisions. Two people we spoke to said they are able to make their own choices and decisions on a daily basis. For example, they told us they choose the meals they wish to eat and able to participate in activities that interest them. Throughout the day we observed staff supporting people to make informed decisions about what they would like to do. The records show the service has introduced planned group meetings to enable people to discuss day-to-day issues, such as meals and activities and any other issues they wish to raise. This shows us people are being more actively encouraged to participate in the day-to-day running of the home. The meeting in September discussed ways how people living at the home could be better informed about events and which staff members are/will be on duty throughout each day. People who commented told us the meetings are a good idea because “We can decide what activities we would like to do together and where and who we would like to go on holiday with.” One person told us they had asked if they could paint the garden fence and showed us how far they had progressed in this task. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 13 The service has carried out risk assessments to ensure people receive appropriate levels of support to enable them, where possible, to live independent lifestyles. For example, risk assessments have been carried out for people who like to travel on their own and for people who require support to handle their own money. One person told us they sometimes visit a relative and two people said they go to the local shop on their own. Staff told us the service operates a ‘no restraint’ policy. The records we looked at show staff have recently attended training for managing challenging behaviour. Risk assessments provide staff with guidance on how to support/respond to a person’s behaviour that may lead to her/him becoming frustrated or aggressive. The records show risk assessments are regularly reviewed by the key worker. All incidents are recorded on a ‘critical analysis’ sheet detailing what happened, action taken and outcome. The manager should implement a recording system for her monitoring of such incidents. This is to ensure appropriate and consistent action is being taken by staff and, where necessary, risk assessments and strategies are revised. There are some activities people participate in where there is no written risk assessment. For example, when a person is making drinks/meals or goes swimming. Staff we spoke to confirmed that some risk assessments have yet to be carried out, but where able to identify the support they give to individuals when carrying out these activities. Risk assessments should be produced for all tasks and activities where potential risks are identified. This is to ensure individuals receive consistent and appropriate levels of support that promotes their independence and protects them from harm. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 14 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, 14, 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 live in the home experience lifestyles that promote their independence. They are supported to take part in a range of activities and to maintain links with family and friends. The service respects people’s rights to choose how they spend their time. However, the practice of carrying out regular night-time checks should be reviewed to ensure their right to privacy is respected at all times. The service provides meals that meet people’s cultural and personal preferences. However, more detailed monitoring records should be kept to ensure appropriate advice and support is being given, where applicable, to individuals about their diet. EVIDENCE: The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 15 Five people living at the home regularly attend centres and colleges throughout the week. People we spoke to were happy to talk about the training and work they do. One person told us they have a gardening placement they go to twice a week. S/he said “I really enjoy this and Fridays I go to a computer class”. Staff told us another person has a placement working in the shop at a local college and has helped them to improve their money management skills. During this visit we saw people participating in different activities. One person was watching television in the lounge and another was doing artwork in the dining room. One person told us they enjoy playing on their game console in their bedroom. The service supports people to participate in a range of activities within the community. Two people told us they had been to Cadbury World this week and one commented “It was a good day out and I brought myself this mug.” They told us new activities had been organised for them. Discussions with the manager and staff highlighted improved practices for people to be better supported to participate in individual activities. These are arranged for them by their key worker and include going out shopping for personal items or a meal. There are some activities that people continue to enjoy as a group such as the weekly trip to the cinema and the monthly disco. We looked at the individual activity logs kept on three people’s files. The comments recorded by staff are brief and does not provide the reader with useful information about the activity or the person’s participation. For example, the care plan for one person states they need support in handling money. The activity log shows s/he was taken shopping for personal items but there is no comment about how the person handled their money. More detailed recording is required if the activity logs are to be a useful tool in assessing a person’s progress. As previously stated individual behaviour risk assessments are undertaken. The daily records and discussions held with staff show concern has been expressed about the behaviour one person is displaying at present. A risk assessment has been carried and strategies for managing this have been put in place. Staff we spoke to told this has affected the support being provided to other people in respect of their activities. Strategies put in place with respect to an individual’s risk assessment should consider the impact this may have on other people. We were told visitors are welcome at any time and people also like to go out and visit family and friends at their own houses. The service supports people in different ways, according to their needs, to maintain relationships with family and friends. The care plan for one person includes arrangements for her/him to keep in touch regularly with relatives by telephone. One person The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 16 showed us some photographs taken earlier in the year of her/him enjoying a visit to relatives living in Cornwall. S/he told us they will be visiting again next year to attend a family wedding. People are supported to follow their preferred routines such as the time they wish to get up or go to bed. The staff team respects people’s right to privacy and were observed knocking doors before entering bedrooms. However, hourly checks on all people living in the home are carried out by the night staff. The records show most people sleep through the night and no concerns have been raised. The manager is advised to consult with individuals about this practice. Any concerns should be identified in the person’s care plan and, if required, agreed plan produced for any night time checks. This was raised with the service at our visit in August. People are offered keys to their bedroom door and lockable facilities. One person told us s/he does not want a key. Another invited us to see their bedroom, using their own key to open the door and said, “I always keep my room locked.” A daily living skills programme is drawn up with individuals for various house keeping tasks. These include the support to be given to help people look after their own rooms, to make drinks, snacks, meals and do their own laundry. The plans we looked at individualised. For example, one person said “I tidy my room when I feel like it”. Staff told us s/he is able to do this unsupported, but sometimes is reminded if s/he has not been doing it on a regular basis. There are no restrictions on people accessing communal areas, however, supervision and/or support is provided where necessary in ‘high risk’ areas, such as the kitchen. We saw one person making their own drink. Staff told us this person has difficulty lifting the kettle. We saw staff pouring hot water into the cup for them. As previously stated, a risk assessment for this activity is not available on the person’s file. Staff records we looked at show training has been provided in basic food hygiene and courses in nutrition has recently started. A menu board has recently been sited in the kitchen. It provides people with information about mealtimes, food options and shows snacks and drinks are available throughout the day. People offered us drinks throughout the day and we were invited to dine with them. These information is provided in text and illustrations, such as pictures and photographs. People told us the idea of the menu board had been decided during a group meeting and is being improved upon all the time. Staff told us the menu board has been ‘a great success’ and people continue to come up with ideas to improve it. For example, this week a clock face has been added which some people find easier to understand. One member of staff said it’s “the best idea the home has had” and “everyone has become more involved”. She told us one person’s verbal communication has improved because s/he is spending time looking at the board and repeating what they see. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 17 Mealtimes are regarded as social occasions where people and staff discuss the day’s events. Menus are discussed at group meetings and the staff team are aware of people’s likes and dislikes. People told us they enjoy their meals and are able to choose what they want to eat and where they wish to have their meal. For example, one person told us s/he chooses to have their meal in the conservatory with one or two other people. The majority of people choose to eat at the dining room. The minutes of the group meetings show people are encouraged to try new foods by occasionally having a cultural theme to their evening meal, for example by serving a Caribbean or Asian dish. Staff told us they keep individual records of meals taken for monitoring purposes. The entries we looked at are brief, for example “shepherd’s pie” or “packed lunch”. The do not show all the components of the meal or whether the person has had a dessert. More detailed information needs to be provided for these records to be effective monitoring tools, especial for people with specific dietary needs such as a person with diabetes or where weight concerns. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 18 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. People receive personal support in the way they prefer and require so that their physical and emotional needs are met. In general the service supports them, where appropriate, to retain and administer their own medication. The well being of people is promoted and protected by the services practices in dealing with medication. EVIDENCE: Information provided to us by the service shows most people require a low level of support with their personal care. The manager told us one person requires full assistance and this is detailed in her/his care plan. The people living in the home told us they choose the clothes they wish to wear, but often consult with staff about the suitability of their choice in respect of the weather. Staff told us people are able to bathe when they wish, but some need more prompting than others to follow good personal hygiene routines. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 19 Health care plans are available on people’s files. However, the quality of the recording on the files we looked at varies. The manager told us these are in the process of being reviewed. Individual record sheets are kept of people’s appointments with their GP and other health care professionals such as dentist and optician. One person’s record shows s/he had a problem with a tooth and an appointment to receive treatment was arranged. There is also a reminder for staff to ensure an appointment is made for the person’s annual health care check-up. Records are also kept of appointments with other health care specialists, such as the dietician and speech & language therapists. The manager said the service has good working relationships with all health care professionals. At present, work is being undertaken with the Speech & Language team to develop communication passports for three people. Three people’s care plans we looked at show a need for their weight to be monitored. The records show this carried out regularly, however readings are taken at different times of the day, for example sometimes in the mornings and at other times in the late afternoons. The manager is advised readings should be taken at the same time of the day for the records to be an effective tool for monitoring fluctuations in a person’s weight. Discussions with staff tell us they are familiar with people’s health care needs and the support they require to maintain good health. The training records show some of the staff team have attended training in oral health care and caring for people with diabetes and epilepsy. Our visit made to the service in August 2009 found the two requirements to be addressed by the service in respect of medication had been addressed. During this visit we looked in detail at arrangements for the safe handling and administering of medication for three people. The service continues to provide suitable facilities for storing medication. The medication policy and procedures are available for staff to refer to. The staff team are in the process of completing further training. Their individual work books were available for us to look at. We looked at the medication information kept on people’s files. Their care plans and risks assessments show they look after their own medication. We spoke to two of these people. One person explained the importance of making sure they took their medication at the right time and why s/he needs to store it safely. Staff said this person is following the guidelines that had been discussed with them. The records show appropriate monitoring is being carried out. Another person told us, “I use to keep my tablets in my bedroom but staff said I was not taking it at the right time. So now they look after it for me. I am hoping to do it myself again.” This person’s care plan had not been updated and there was no information about signs staff should be aware to indicate this person may not be taking her/his medication regularly. The manager has been advised to produce this information for people who manage The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 20 their own medication. We also discussed the need to review and record current arrangements and, where possible, to identify ways a person could continue to be involved with handling their medication. For example, staff providing more of a supervisory role when dealing with medication. A random selection of medication administration record (MAR) sheets was looked at for people who do not manage their own medication. There were no gaps in recording and appropriate codes, where applicable, where being used. Staff responsible for managing medication told us they were confident with current practice and showed awareness in how errors should be dealt with. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 21 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 service has systems in place to ensure people’s views are listened to and acted upon that should safeguard them from the risk of harm. EVIDENCE: We were told that no complaints have been received about the service since the last key inspection which took place in April 2009 and none have been received by us, the Care Quality Commission (CQC). The service has an easy to understand complaint procedure and forms with telephone numbers of external agencies people can contact, if they wish. The people’s files looked at show this procedure has been discussed with individuals during meetings with their key worker. People we spoke confirmed they have been given a copy of the complaint procedure and identified the members of staff they would speak to if they had any concerns or where unhappy about something. They told us they were confident these would be “put right”. No safeguarding referrals have been made since the last key inspection. The training records we looked at show some staff have yet to attend training in safeguarding vulnerable adults. It is important for all staff to attend this The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 22 training to ensure they are aware of the issues and know how to respond to any suspicions or allegations of abuse. The recently appointed manager told us this is being addressed and will be provided as part of the mandatory training programme for new staff. People are provided with different levels of support to manage their own money. One person’s file shows they require support to make purchases and another stated s/he was capable of making day-to-day purchases unsupported. People who manage their own money are encouraged to kept receipts for large purchases so these can be returned easily if necessary. Records and receipts are kept for all transactions made by staff on behalf of people living in the home. Staff spoke about the progress some people are making in managing small amounts of money. One person proudly told, “I look after my own money now”. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean, comfortable and homely environment in which to live. However, attention needs to be given to addressing remedial work in a timely manner to fully ensure the environment is well maintained. Good hygiene and infection control practices are followed by staff. EVIDENCE: The Limes is situated near to Blackheath town centre. There are a range of shops, cafes, pubs and public transport routes within walking distance. This is important to the people who live here because they make regular use of these amenities. The home is suitable for its intended purpose, of providing smallscale domestic style accommodation and care in an ordinary environment. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 24 The communal areas consist of a lounge with a dining area and conservatory. All rooms are suitably furnished and during this visit we saw people using all these rooms, to watch television, do craftwork or just sit chatting. The kitchen is well equipped and throughout the day people were making drinks or helping to prepare meals. However, one of the ovens is not working. The maintenance work book shows this was reported four weeks ago, but to date no action had been taken. The service has eight single occupancy bedrooms, four with en-suite facilities. Three people showed us their bedrooms. These are adequately furnished and reflect their individual tastes and interests. There are family photographs, pictures and posters on display. There is also a range of entertainment equipment such as televisions, music centres and game consoles. One person’s bedroom has a leak in the en-suite and a small problem with damp. This was reported by the manager in July and is still to be addressed. Bathing facilities are provided on both floors and both are in need of attention. Again, the maintenance book shows this work was reported by the manager in July and no action has been taken. An annual renewal and re-decoration programme for the premises should be produced and include the refurbishment of bath/shower rooms. The garden area has a lawn and shrub borders with a small fish pond. Two people showed us were they had placed the plants they had chosen on their recent trip to a garden centre. They told us they would like to try growing their own vegetables. Overall the home is clean and tidy. There are adequate hand washing facilities which we observed these being used by staff and the people living in the home. The manager is advised to consider a sluice facility when it next purchases a washing machine. This is to ensure good infection control measures can continue to be maintained should the needs of the people living at the home change. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 25 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): 31, 32, 34, & 35 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 are supported by adequate numbers of competent and appropriately trained staff to ensure their needs are being met. They are protected by the service’s recruitment practices. EVIDENCE: During the past 12 months there have been a number of changes within the staff team. People continue to be supported by staff from different backgrounds and life experiences. The manager told us it no longer employs any agency staff because the staff team prefers to cover any shortfalls to ensure people living at the home receive consistent support from staff they know and who are familiar with their needs and personal preferences. People we spoke to told us the changes in the staff team have been positive. They particularly liked being involved in producing a picture notice board and menu board. Staff who have been in post over 6 months reported the The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 26 atmosphere within the home had improved. One commented the, “home is happier, brighter”. A number of staff members hold the National Vocational Qualification (NVQ) Level 2 and new staff are enrolled on to this course. One person told us they have been in post for 6 months and just completed this course. Another told us there has been an increase in training opportunities. Both staff said they are looking forwarded to commencing NVQ Level 3. Individual training records are kept on staff files and a training matrix is displayed in the office. The matrix enables the manager to identify appropriate training and when periodic refresher courses should be arranged for staff. We looked at the files for two staff. The information kept includes a completed application form, with full employment history, two references and a Criminal Record Bureau (CRB) check. The files show these were obtained before they commenced employment. One member of staff told us they visited the home and attended two interviews before being offered a post. A person living in the home said they were asked their views about prospective staff who visited the home and were involved in the interview process. The recruitment information for the most recently appointed member of staff contains interview notes from two people who live in the home. This shows people are involved in the process for employing staff and their well being is protected by the service’s recruitment practice. The manager has introduced a programme for individual staff supervision. The induction programme is discussed with newly appointed staff during these sessions. The agenda for all staff includes discussions about their practice, future objectives and training needs. A record is kept of each session and is signed and dated by the manager and member of staff. The manager is advised to hold annual appraisals with each member of staff to identify the individual’s training and development needs for the following twelve months. This will assist the manager to produce an annual team training programme to ensure they are able to meet the needs of the people living in the home. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 27 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): 37, 39 & 42 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. People living in the home benefit from a service that is run by a competent and experienced manager. They are provided with good opportunities to express their views. A comprehensive quality assurance system should be implemented and annual development plan produced. This is to enable people living in the home, their relatives and other interested parties can be fully confident their views underpin the service’s self-monitoring, review and plans for development. Policies and procedures are in place to promote and protect people’s health and safety. However, in order for people to be confident work identified by contractors or relevant authorities, has been carried out evidence should be kept available on the premises. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 28 EVIDENCE: The current manager has been in post since July this year and is experienced in working with people with learning disabilities in a residential environment. When we visited the service in August she told us she had spent time familiarising herself with the needs of the people who live here, observing practice and discussing these with them and the staff team. At this visit we found positive changes have been introduced. One example is people are being regularly supported to participate in more individual activities in the community. Another example is the introduction of group meetings which has led to staff and people living at the home working together in producing a menu and information boards that enables people to access information about what is happening in the home more easily. The staff spoke positively about recent changes and said the manager is always available to discuss any concerns, issues or ideas. People commented “the home is loads better” and said the staff team “help us to do more things”. At present there is no programme for the manager to meet with a representative of the company on a regular basis to discuss the service’s performance, future development and the manager’s own training needs. This should be implemented. The service has not implemented a fully comprehensive quality assurance system for monitoring its own performance. This needs to include obtaining the views of relatives and other interested parties as well as the people who live here. An annual development plan, based on the findings, should be produced and made available in order for all interested parties to fully confident their views about the service are listened to and acted upon. The service provides staff with training in health and safety matters and they have access to the relevant policies and procedures. There is no record to show when the random selection of policies and procedures we looked were last reviewed. This should be done periodically to ensure, where applicable, information is updated to reflect any changes in regulations and good practice guidance. We looked at some of the records for appliances, equipment and the environment kept by the service. The check lists show arrangements are made for these to be maintained and serviced on a regular basis. Relevant paperwork was available for the annual testing and servicing of electrical and The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 29 gas appliances. The deputy told us work identified prior to the new manager taking up post had been carried out. The paperwork to verify this was not available on the premises. The manager was advised to discuss this with the company and ensure a copy of all relevant paperwork is kept on the premises. Fire safety records are well maintained and show when last checks were carried and fire drills took place. Two people living at the home told us an officer from West Midlands Fire Service is providing them with training and is arranging for them to visit the local fire station. A photograph of the officer is displayed on the notice board so people are able to recognise him when he visits. They also told us about a recent ‘impromptu’ fire drill. The staff said this was a false alarm. The member of staff on duty at the time told us everyone responded appropriately and commented “I was very proud of them all”. The deputy told us a request was made for an officer from the West Midlands Fire Service to visit the premises earlier in the year. She stated he was satisfied with the home’s arrangements; however a copy of this report was not available on the premises. The manager is advised to seek written confirmation and consult with the West Midlands Fire Service about any issues that may affect fire safety arrangements. People living in the home are aware that the business is in the process of being taken over by a new provider; as is the funding authority. The manager told us people’s relatives have also been notified. Application for registration by the new provider is being completed. The information provided by the company will be considered for approval by our Regional Registration Team. The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 30 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 3 2 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 1 X X 2 X Version 5.3 Page 31 The Limes Blackheath DS0000063539.V377941.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA6 YA9 Good Practice Recommendations Minutes of review meetings should be kept by the service to ensure care plans are updated in accordance with any agreed changes. The service should carry out individual risk assessments for all activities people participate in where potential risks are identified, such as cooking and swimming, to ensure they are protected from harm. The impact strategies for managing an individual’s behaviour may have on the lives of other people living in the home should be given due consideration. Records completed by staff should be more detailed for effective monitoring of progress of a person’s progress can be made against their care plan. The practice of hourly night time checks on all people living in the home should be reviewed. Where regular checks are considered necessary these should be discussed and agreed as part of a multi-disciplinary team DS0000063539.V377941.R01.S.doc Version 5.3 Page 32 3. 4. YA13 YA16 The Limes Blackheath 5. 6. 7. YA17 YA19 YA20 and documented on the individual’s care plan. Records kept, where required, of people’s dietary intake should be more detailed to enable effective monitoring to take place. To ensure effective monitoring can take place people should be weighed at the same time of day. The care plan for the person no longer looking after their own medication should be updated to reflect this change. Ways in which s/he can safely continue to be involved in managing some aspects of their medication should be identified. It is advisable for staff to be provided with information about what signs to look for that may indicate a person who self-medicates may not be taking their medication regularly. Arrangements should be made for all staff to receive training in safeguarding vulnerable adults. This is to ensure they are aware of the issues and how to respond to any suspicions or allegations of abuse. Repairs reported to the provider should be addressed promptly. This includes the en-suite in one person’s bedroom and the shower room on the first floor. An annual plan for the renewal and re-decoration of the premises should be produced to ensure people live in a well maintained and safe environment. An annual training and development programme should be produced to ensure the needs of people living in the home are met by a competent and trained staff team. The manager and representative of the company should meet regularly to discuss the service’s performance, future development and the manager’s training needs. A comprehensive quality assurance system should be implemented and an annual development plan produced based on the findings. This is to enable people to be fully confident their views about the service are listened to and acted upon. Evidence that work identified by contractors, West Midlands Fire Service or other relevant authorities, have been carried out should be kept available on the premises. This will enable people to be fully confident the home they live in is safe and well maintained. 8. YA20 9. YA23 10. 11. 12. 13. 14. YA24 YA24 YA35 YA37 YA39 15. YA42 The Limes Blackheath DS0000063539.V377941.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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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