Care Home: The Mews

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What the care home does well People have their individual and diverse needs well assessed in order to devise support plans and health care plans, but evidence beyond the actual plans is not available to verify this. People have good plans of care, support plans and health action plans in place that enable staff to meet their needs better. People have good opportunities to make choices about everyday life and have risks greatly reduced where possible. People enjoy good opportunities to take part in appropriate activities and pastimes in the home and in the community. They make and enjoy appropriate relationships, are respected and exercise their rights, and they benefit from good nutritious meals. People receive good personal care and support as they need it, have good, relevant health care plans in place to assist staff in meeting their needs and people benefit from robust and safe systems for handling medication. People have the benefit of good complaint and protection systems in place to enable them to make representations about dissatisfactions and to have their information or concerns passed to the appropriate organisation for dealing with issues of a safeguarding nature. People live in a satisfactory environment that is appropriate to their needs, is clean and comfortable, but needs upgrading and refurbishing to provide higher standards of living. People benefit from a good staff team in sufficient numbers to meet needs, and from staff that are appropriately recruited and well qualified. People benefit from an experienced but not yet registered manager in post, that uses a quality monitoring system to determine the service performance. The home is well maintained and safe working practices prevail, and these are evidenced in certificates and monitoring checks on safety that are well recorded. What has improved since the last inspection? The records for maintaining people`s finances in safe keeping have changed and improved since the last key inspection. What the care home could do better: The service could make all original and reviewed assessment of needs documents available for viewing, so people know their needs are properly assessed and can be met. The home`s assessment document could be resurrected and checked for relevance and be implemented when necessary. The service could make sure all staff receive initial or refresher safeguarding adults training every three years and that they are competence assessed annually on their understanding and handling of safeguarding issues. All of this should be recorded as evidence of training and competence, so people are confident they are protected from abuse. The service could develop the home`s key policies, including complaints, into a format that is more accessible to people living there, so they can understand their rights better. The service could make sure good practice is always followed in completing people`s financial records and simply cross through any error, sign and date it and then rewrite the correct information below, so people are confident they are being safeguarded against financial abuse. The service could ensure the company plans for refurbishment are carried out and in a timely fashion, so people have improved living standards. The service could make sure all staff undertake infection control training and to keep a record of this so people are confident they are protected from the risk of infection. The service could make sure all training identified for staff to undertake is completed and that records are kept as evidence, so people are confident they are supported by trained and skilled staff. There is room for improvement in ensuring staff have the right training skills to do their job well. It may just be a matter of the home maintaining good evidence of this. The service could consider employing a cleaner to reduce some of such responsibilities for support workers, and should make sure staffing levels are determined and set because of people`s needs, so people are confident they are cared for and supported by staff in sufficient numbers. The service should make sure the home manager submits an application to the Care Quality Commission to become the registered manager within the next two months, so people know the home is run by a registered manager that is fit to do the job. The service should develop the quality assurance system to include surveying of relatives and other stakeholders at least on an annual basis and to produce an annual report on the findings of the system, so people are confident their views underpin any self monitoring and inform the service of future changes etc. Key inspection report Care homes for adults (18-65 years) Name: Address: Mews The Main Street Bessingby Bridlington East Yorkshire YO16 4UH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Lamb     Date: 0 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Mews The Main Street Bessingby Bridlington East Yorkshire YO16 4UH 01262605340 01262605340 marianne@franklinhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Franklin Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Mews is owned and operated by Franklin Homes Limited and is registered to provide personal care and accommodation for up to five people with a learning disability. Most of the people living in the home have complex needs. The home is a large cottage building that has three single bedrooms, bathrooms, toilets, two lounges and one large kitchen dining room. There are two self contained flats that adjoin the cottage but these are only accessed via separate entrances across a shared courtyard. The flats have their own private lounge space and small kitchenettes. There is a large garden and private parking in the courtyard for a maximum of four vehicles for visitors and staff. 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home The Mews is located in the small village of Bessingby and within a few minutes driving distance of the coastal town of Bridlington and its amenities and leisure facilities. The home has its own transport. The current scale of charges is between £1334.00 and £3369.00 per person per week and extra charges are made for transport, hairdressing and newspapers. Information about the home is available in the statement of purpose and the service user guide which can be obtained from the manager on request. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Key Inspection of The Mews has taken place over a period of time and involved sending a request to complete an annual quality assurance assessment (AQAA) in July 2009, containing information about people who use the service and support workers and details of the homes policies, procedures and practices. The Commission received the requested information in early September 2009, though after the site visit, and survey questionnaires were sent to all five people living in the home, to three health care professionals and six support workers working there. Of these surveys five were returned from the people in the home and four from support workers, though none were received from health care professionals. All of the information obtained from surveys, from notifications received and information already known from having had contact with the home since the last key inspection was used to suggest what it must be like living there. Care Homes for Adults (18-65 years) Page 6 of 32 Then on 1st September 2009 Janet Lamb made a site visit to the home to test these suggestions and to interview people, support workers, visitors and the home manager. Some documents were viewed with permission from those people they concerned and some records were also looked at. The communal areas of the home were viewed along with all five bedrooms. There were no people who use the service interviewed but the manager was interviewed and three support workers were spoken with during the site visit to seek information. No relatives were spoken with. What was said was checked against the information obtained through questionnaires and details already known because of previous information gathering and contact with the home. Judgements were made using the information and some of the evidence used at the last inspection to say what it is like living in the home. This report shows those findings and judgements. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The service could make all original and reviewed assessment of needs documents available for viewing, so people know their needs are properly assessed and can be met. The homes assessment document could be resurrected and checked for relevance and be implemented when necessary. The service could make sure all staff receive initial or refresher safeguarding adults training every three years and that they are competence assessed annually on their understanding and handling of safeguarding issues. All of this should be recorded as evidence of training and competence, so people are confident they are protected from abuse. Care Homes for Adults (18-65 years) Page 8 of 32 The service could develop the homes key policies, including complaints, into a format that is more accessible to people living there, so they can understand their rights better. The service could make sure good practice is always followed in completing peoples financial records and simply cross through any error, sign and date it and then rewrite the correct information below, so people are confident they are being safeguarded against financial abuse. The service could ensure the company plans for refurbishment are carried out and in a timely fashion, so people have improved living standards. The service could make sure all staff undertake infection control training and to keep a record of this so people are confident they are protected from the risk of infection. The service could make sure all training identified for staff to undertake is completed and that records are kept as evidence, so people are confident they are supported by trained and skilled staff. There is room for improvement in ensuring staff have the right training skills to do their job well. It may just be a matter of the home maintaining good evidence of this. The service could consider employing a cleaner to reduce some of such responsibilities for support workers, and should make sure staffing levels are determined and set because of peoples needs, so people are confident they are cared for and supported by staff in sufficient numbers. The service should make sure the home manager submits an application to the Care Quality Commission to become the registered manager within the next two months, so people know the home is run by a registered manager that is fit to do the job. The service should develop the quality assurance system to include surveying of relatives and other stakeholders at least on an annual basis and to produce an annual report on the findings of the system, so people are confident their views underpin any self monitoring and inform the service of future changes etc. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their individual and diverse needs well assessed in order to devise support plans and health care plans, but evidence beyond the actual plans is not available to verify this. Evidence: Discussion with the manager and staff and viewing of documents with permission where possible, shows the home uses a combination of placing local authority community care assessment forms, its own assessment of needs forms and other information gathered from other sources, to determine what peoples needs are and if they can or cannot be met. Because people have been in the home some years assessment forms have been archived and are unavailable for viewing. Information from one of the senior staff having worked at the home for about five years reveals everyone was assessed before they moved into the home and records of these were made. Evidence of East Riding of Yorkshire Council assessments is available for those people more recently admitted, but the homes documents are still unavailable. The manager needs to resurrect the Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: homes assessment document, check it for relevance to admitting someone to the home today and review it if necessary. It should be available for viewing in blank format or as completed for all people living in the home. Someone should also retrieve from the archives those assessments relating to people currently living at The Mews and place these on individuals files to show how and when their needs were determined. There should also be evidence of peoples needs being reassessed where drastic changes have taken place over time. These are recommendations of this report. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good plans of care, support plans and health action plans in place that enable staff to meet their needs better. People have good opportunities to make choices about everyday life and have risks greatly reduced where possible. Evidence: Discussion with the manager and staff and viewing of case files with permission where possible, and observation of interactions between people and staff, shows there are improvements being made for people regarding their individual needs and choices. There are care plans in place but these are being reviewed and their format is being changed. There are two type of plans on the go at the moment - one is in an old written format with risk assessment documents being intertwined amongst the action plans, and the other is in the style of individual support plans, which deal with separate areas of support needed and look at the strengths, needs and action elements of each area. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: There are also health action plans in place as separate documents. There are also still some old individual personal plans in place that need to be reviewed and changed to the new format. Altogether there is a wealth of information in care plans and every area appears to be covered. However, the manager needs to come to a decision on consistency and ensure all people in the home have the same format for their documentation on support plans and action plans so staff are able to work more effectively with such documents. Work is on-going and will soon be completed to ensure everyone has a new format care plan in place. Individual support plans contain information on what support is needed for, and who is responsible to support people with such as communication, behaviour and distress, medication administration, mobility, nutrition, oral hygiene, personal care, leisure and general wellbeing. Health action plans look at medications, physical and psychological support and also have such as health screening information. There are also new risk assessment documents being set up that relate to the support people may need. Some people may also have a behaviour management plan in place, covering incidents, risk of violence and challenging behaviour. Decision making is down to people as much as possible, but they may need guidance and information to be able to make informed decisions. Sometimes staff have to steer people towards a particular decision due to the disabilities they have. Observation of people on the day of the site visit shows they are encouraged to make decisions and choices in everyday life, such as when to rise and bathe, what to eat, whether or not to help clear away after meals, whether or not to go to the shops or just for some air, etc. People were seen listening to music, watching television, walking in the garden, going to the chemist and shops, and going to the GP and dentist surgeries. The manager is trying to encourage people to take up more pastimes and activities to offer them a better quality of life and to have more choice in their lives. This is improving with time and trying out of new things. Records in diary notes show what choices people make and how they are encouraged to make them. With choice comes risk and where possible all activities taken up have the risks involved reduced through clear risk management strategies and assessments. People will be discouraged from doing things if the risks are too high, but they will also be actively encouraged if risks are lower and can be reduced or eliminated. People engage in a larger variety of pastimes now, which are listed in the next section of this report. Where incidents may occur people are merely guided and removed from the situation and encouraged to try again another time. Changes may be made the next time to reduce the risk of further incidents. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Staff spoken to and information provided in surveys shows there has been some great improvements in the meeting of individual needs and choices over the last few months, as between the last manager leaving post and the starting of the current one, there has been drastic changes in the way staff approach people, in broadening of peoples horizons and in addressing behavioural issues consistently to encourage improvements in peoples behaviour. This would not have been the case some six months ago and an inspection of the service then would probably have resulted in an overall quality rating of adequate. Care Homes for Adults (18-65 years) Page 15 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy good opportunities to take part in appropriate activities and pastimes in the home and in the community. They make and enjoy appropriate relationships, are respected and exercise their rights, and they benefit from good nutritious meals. Evidence: Discussion with the manager and staff, viewing of documents in files with peoples permission and observation of interactions between people and between people and staff shows there are satisfactory opportunities for people to lead fulfilling lifestyles. Opportunities to engage in educational, occupational and community based activities are now much improved according to the manager and staff. There are now individual opportunities to do something of interest and with support. Everyone has a weekly activity plan and an activity record in place, as well as there being records in the form of separate one-to-one time carried out. People use the local area well and especially Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Bridlington town centre for entertainment and pastimes. Staff informed us relationships are getting better between people now they are mixing more at meal times and on outings. People go horse riding, swimming, bowling, out for walks, shopping, to Gateway Club, and away on holiday as well as away for the day to such as Dalby Forrest. People also do more in-house activities such as trampolining, cricket, barbeques, art work, craft work, television and music. Family contact is generally good for people, and the staff say they relate well to family members. We observed a visitor collecting her son and he was taken out for lunch. Evidence in diary notes shows people have access to family and friends and undertake visits with them. Daily routines meet needs and fit around peoples choices. Some people help staff with chores but mainly only keep their own rooms clean and tidy. Two people in the flats have a little more to do to help themselves, but while one is very capable the other is not so able. Meal times are relaxed and a social affair with people and staff sitting down together to eat. Of the five living in the home on the day of the site visit one was out all day and ate out, a second ate in her flat and the other three sat at table together and with the staff, though one was not really interested in food, kept coming and going and only picked at it. Food is prepared by staff in turn and is usually something like a salad and pasta or similar at lunch time and a hot cooked meal at dinner time in the evening. People make suggestions what they want to eat on a daily basis, depending on what is available, and staff will oblige them where possible. Shopping is done weekly at local stores and people assist in this task as an activity for developing their living skills. Healthy options are provided to ensure minimal weight gain or to encourage weight loss and to provide balanced meals throughout the day. There were no issues relating to food mentioned in surveys or on the day of the site visit. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good personal care and support as they need it, have good, relevant health care plans in place to assist staff in meeting their needs and people benefit from robust and safe systems for handling medication. Evidence: Discussion with the manager and staff, viewing of some records and documents with permission and observing people leaving the home to attend GP appointments and medication being administered shows people have good support with personal care, health care and with taking their medication. Personal support is provided according to details written in the person centred care plan, which show individuals needs as assessed against standards. Times for rising and going to bed, having meals etc. are flexible and meet peoples needs and routines. Choice of clothes, hair styles etc. are respected and how people are guided and supported is according to their preferences. Evidence is seen in diary notes and in key worker monthly reviews. Health action plans are being introduced but have not been completed for everyone Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: yet. Franklin Homes has been liaising with peoples GPs to seek information and to seek health screening for everyone in order to make sure the health action plans are produced and are current and relevant. Records are maintained of health practitioner visits, dentist visits, who supports people with medication administration, with nutrition and with general wellbeing, as well as for recording weight, behaviour, mobility and food and fluid intake etc. Once everyone has a full health action plan in place their needs will be more easily monitored and met. People also have a patient passport in place in the event they need to be admitted to hospital, containing all of their health details and personal needs. Health checks are carried out as necessary for general health, dental care, optical needs, and so on, and records are maintained. Medication is handled satisfactorily. Medicines are receipted into the home, stored in two locked facilities and administered according to the prescription instructions. The home has a Nomad monitored dosage system in operation and stores cassettes in either the office or a cupboard in the staff sleep room in one of the flats. There is a control drugs register, storage facility and practice is that two staff sign on administering these. The medication administration system is supplied by Allianze Chemist in Bridlington and two of the intended three seals are used. As and when needed drugs are stored in boxes only. Drugs in the monitored dosage cassettes are receipted into the home weekly and in boxes, monthly. Any returns are sent back to the pharmacy using the tagbag system, and they are recorded and signed for. Staff undertake medication administration training with Boots Chemist and after training undergo shadowing and competence assessing for a time. They are then considered capable of administering medications alone. Training records and training matrices evidence when and who are competent to handle medicines. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the benefit of good complaint and protection systems in place to enable them to make representations about dissatisfactions and to have their information or concerns passed to the appropriate organisation for dealing with issues of a safeguarding nature. Evidence: Discussion with the manager and staff, obtaining brief information from people in the home, and viewing of records and documents with permission, reveals there are satisfactory systems in place to enable people to complain and to refer issues of a safeguarding nature to the right organisations. A complaint procedure is in place and there is a complaint record held and there has been four formal complaints made in the last two years, two upheld, one not upheld and one outstanding. Staff in discussion demonstrate they know the homes procedure well and would not hesitate to pass on complaint information to the manager. People spoken to say they know who to go to if they are dissatisfied in any way. Surveys received also say people know how to complain and who to talk to. A recommendation to develop the homes key policies into a format that is more accessible to the people living there made at the last last key inspection has not yet been addressed. This remains a recommendation of this report. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: There is a safeguarding adults procedure in place and a record held though there have been no safeguarding referrals in the last two years. Staff in interview demonstrate good understanding of the procedure and the referral system and say they would not hesitate to whistle blow or to pass on any information to the manager. They know their responsibilities. They have completed various protection of vulnerable adults training courses over the years and five have done the Mulberry House awareness course while the rest are to have their papers accredited, but there is no evidence to show they have done recent training. One staff says they have worked in the home for two years and safeguarding training was done before that in another position. Another staff has been in post since March 2009 and has yet to do any such training. The new manager, as yet unregistered, is to do the managers safeguarding course with Hull & East Riding Safeguarding Adults Board in November 2009 and will be then cascading the training and information down to staff as a refresher. The manager must make sure all staff complete initial or refresher safeguarding adults training and that they then have their competence in handling issues and passing on referrals assessed each year thereafter. All of this must be recorded as evidence of training, understanding and competence. A requirement on the last key inspection report in 2007 says the home must ensure accurate records of peoples money held in safe keeping are kept. Though this has resulted in a new system being put in place, viewing of two peoples records on finances with their permission, shows there is now a poor accounting practice taking place. Where an entry is incorrectly made staff are crossing this out or over writing. Good practice requires staff to cross one line through an error, initial and date this, and then to make a new entry with the correct figures. This is a new requirement of this inspection report. Care Homes for Adults (18-65 years) Page 21 of 32 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. People live in a satisfactory environment that is appropriate to their needs, is clean and comfortable, but needs upgrading and refurbishing to provide higher standards of living. Evidence: Discussion with the manager and staff and viewing of the communal areas of the premises, and some private areas with permission, reveals the house is suitable for its stated purpose and is clean, comfortable and how people choose it to be. The premises are suitable for the stated purpose of meeting the accommodation and personal care needs of adults with a learning disability and challenging behaviour. The Mews is a set of cottages that have been adapted to make one residential care home for three people, with two small independent cottage flats across the courtyard. Five people in total can be accommodated and cared for there. There are no facilities or equipment to meet the needs of people with a physical diasability. The Mews has its own large rear garden that is secure and enclosed and provides good walking and recreational space for the people living there. People use the garden for barbecues, trampolining, ball games, etc. There is only car parking space for three to four vehicles and parking on the narrow lane outside the home is not ideal. The Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: internal decoration and furnishings of the home are now looking tired and worn and the home needs an overhaul in respect of refurbishment. To some extent this is being addressed by the new manager and the new company area manager, both of whom are planning to redecorate the house and supply some new furniture and equipment. Some issues have already been attended to such as a leak in the septic tank, resiting of one of the medication cupboards and fitting of new lounge carpets and new lounge settees. The two flats are satisfactory, though one is to have the toilet and bathroom relocated so that they are one room and separate to the persons bedroom. There are plans to redecorate all bedrooms and to refurbish the lounges. One final plan is for there to be a third flat created increasing the registered numbers to six people, but this and upgrading of the kitchen are long term plans. It is a recommendation of this report to ensure the company plans for refurbishment are carried out and in a timely fashion. The home is generally clean and comfortable though this is down to the care and support staff as no cleaner is employed. It may be prudent to employ a cleaner on a daily basis to maintain a desired standard of hygiene and cleanliness. The laundry is small and domestic in content though it is understood it meets the Water Supply (Water Fittings) Regulations 1999. Evidence that staff undertake infection control training is not available and so everyone is recommended to complete this and to keep the training records up to date. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a good staff team in sufficient numbers to meet needs, and from staff that are appropriately recruited and well qualified. However there is room for improvement in ensuring staff have the right training skills to do their job well. It may just be a matter of the home maintaining good evidence of this. Evidence: Discussion with the manager and staff and viewing of staff files with permission shows the systems for managing staffing levels, for safely recruiting new staff and for encouraging them to complete qualifications continue to be good. Systems for monitoring training and development have lapsed over the last year or so and are therefore lacking. Staff confirm in interview their qualifications taken and some say they wish and plan to do more. One has completed level 2 and one has completed level 3. There are currently 71 of staff with the recmmended qualifications. There are staff rosters in place that show the intended staffing levels to be fixed at a minimum of five staff on duty, as three people require one to one care while in the home and two people require two to one care whilst out in the community. There is often an apprentice in the home as well helping with support that is not of a personal Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: care nature. This was the case on the day of the site visit. The manager is supernumerary but does get involved in supporting people especially when someone is going out. Staff in interview say there are usually enough of them on duty to meet peoples needs and that they will cover shifts where staff are absent or ill etc. Sometimes staffing levels vary and it can be a struggle to make sure there are five or six on duty. Often new staff do not stay in the job very long, though there is a long standing core of staff. There could be a need for a cleaner to be employed and this is something the provider should consider. There is a recruitment and selection policy and procedure in place that meets the requirements of regualtion 18 and 19 and schedule 2. Evidence of how staff are recruited was viewed in two staff files and showed there is an application form, two written references, full security checks, initial security check for one, and induction records. There is also evidence of supervisions being held though these had lapsed during a period over the last year or so. The current manager is trying to implement supervisions on a regular basis. There are some good training and development opportunities now, but these had also lapsed over the last year. There is now a designated senior responsible to monitor all training and to set up refreshers for everyone as they need them. Staff say they have completed such courses as food hygiene, autism spectrum, health and safety, first aid, medication administration, safeguarding adults, behaviour intervention, learning disability awareness and fire safety. Staff say some of these courses are part of their induction as well. Clearly training monitoring and setting up of refresher courses has lapsed and so there is a need for the home to assess when everyone last updated their skills and arrange courses to suit. This must be completed and evidence of all training undertaken must be kept for viewing, and this is a recommendation of this report. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an experienced but not yet registered manager in post, that uses a quality monitoring system to determine the service performance. The home is well maintained and safe working practices prevail, and these are evidenced in certificates and monitoring checks on safety that are well recorded. Evidence: Discussion with the manager and staff and viewing of some of the homes records, documents and maintenance checks and certificates etc. shows there is a responsible manager in post, there is a satisfactory quality assurance system in operation and there are good checks on systems and equipment to ensure the protection and promotion of the health, safety and welfare of people and staff. There is a new manager in post since May 2009. He is as yet unregistered, but has the NVQ Level 4 Registered Managers Award from a previous post as registered manager and some years experience in managing another organisation service. He is well respected amongst the staff and appears to be liked by people living in the home. He is soon to undertake his managers safeguarding adults training in November 2009. A Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: recommendation is made in this report for the new manager to submit an application to become the registered manager within the next two months. There is a quality assurance system in place that consults people in the home via surveys and carries out quality audits on such as care plans and training etc. The home also keeps complaint and compliment forms for completion and two compliments that have been received in August 2009 were viewed. They show satisfaction with the way one person was assisted with a medical issue and with the way another person was assisted to settle into the home and to begin to make more choices. The quality assurance system needs to develop further to involve relatives and other stakeholders in completing surveys on at least an annual basis, and then an annual report on the findings of the systems needs to be published for people and stakeholders to view and this is a recommendation of this report. There are some areas of the health and safety checks and maintenance that were sampled in order to determine whether or not the home is promoting and protecting peoples and staff health, safety and welfare. These were fire safety, gas and electrical safety, water temperature and legionella testing, and if risk assessments are carried out on the premises and health issues within the home. There is a fire safety system in operation in the home and it is checked each quarter by HR Fire & Safety. There is a fire risk assessment document in place last reviewed 29/07/09 that contains details of the plan of the building, sections of the house and shows photos of items that need to be checked. There is a weekly fire safety audit carried out on lights, alarms etc. and there are monthly fire safety drills held, though the last one to be held was Dec 2008. A staff member has been identified and appointed to ensure staff fire drills are held more regularly and these are soon to begin. Staff are given detailed fire safety instructions in their induction, which takes approximately 10 to 15 minutes and then they discuss fire safety in a joint staff meeting, which also includes a recap on the evacuation procedure. JG Fire also gives an annual fire safety instruction to all staff, which is certificated. All staff sign a document to say they have read and understood the fire safety within the home and that they are well aware the home keys must be held on their person at all times. The last Humberside Fire & Rescue Service inspection must have been some years ago as there is a letter from them that says they are due to visit on 21/09/09. There is a landlords gas safety certificate from British Gas dated 30/06/06 and so this Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: is now due for renewal and a recommendation is made to ensure it is done. There is a hard wire electrical test certificate dated 23/02/09. A legionella water test was last carried out on 25/06/07 and there is evidence of the water tanks being chlorinated. It was not determined whether or not the home carries out its own water temperature checks on outlets. This shall be checked at the next key inspection. There are risk assessment documents in place for various areas of safety within the home and these are now logged and documented. An asbestos survey report was also viewed dated 08/11/08. The home manager tells us that Mentor Health & Safety Legal Advice provide information and advice on all H&S issues and that any reportable accident goes to this company for logging and for passing to the Health & Safety Executive under RIDDOR. There are no serious accident records held in the home, but minor cuts and bruises are recorded on body map forms and held in individuals files. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 2 The registered provider should make all original and reviewed assessment of needs documents available for viewing, so people know their needs are properly assessed and can be met. The homes assessment document should be resurrected and checked for relevance and be implemented when necessary. The registered provider should make sure all staff receive initial or refresher safeguarding adults training every three years and that they are competence assessed annually on their understanding and handling of safeguarding issues. All of this should be recorded as evidence of training and competence, so people are confident they are protected from abuse. The registered provider should develop the homes key policies (including complaints) into a format that is more accessible to people living there, so they can understand their rights better. The registered provider should make sure good practice is always followed in completing peoples financial records and simply cross through any error, sign and date it and then rewrite the correct information below, so people are Page 30 of 32 2 22 3 22 4 23 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations confident they are being safeguarded against financial abuse. 5 24 The registered provider should ensure the company plans for refurbishment are carried out and in a timely fashion, so people have improved living standards. The registered provider should make sure all staff undertake infection control training and to keep a record of this so people are confident they are protected from the risk of infection. The registered provider should consider employing a cleaner to reduce some of such responsibilities for support workers, and should make sure staffing levels are determined and set because of peoples needs, so people are confident they are cared for and supported by staff in sufficient numbers. The registered provider should make sure all training identified for staff to undertake is completed and that records are kept as evidence, so people are confident they are supported by trained and skilled staff. The home manager should submit an application to the CQC to become the registered manager within the next two months, so people know the home is run by a registered manager that is fit to do the job. The registered provider should develop the quality assurance system to include surveying of relatives and other stakeholders at least on an annual basis and to produce an annual report on the findings of the system, so people are confident their views underpin any self monitoring and inform the service of future changes etc. The registered provider should make sure a new landlords gas safety certificate is obtained this year, so people are confident they are protected from the risk of harm from gas. 6 30 7 33 8 35 9 37 10 39 11 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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). 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