Care Home: The Oaks Care Home

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What the care home does well The assessment process helps people to decide if they want to live at the home and ensures that people`s assessed needs can be met at the service. People who use services are able to make choices about their lifestyle, social, cultural and recreational activities meet individual`s expectations. The health and personal care needs of people living at the service are assessed and in most cases met. People who use the service are able to express their concerns, and have access to an effective complaints procedure. Staff who work at the home are trained and in sufficient numbers to support the people who use the service. What has improved since the last inspection? There have been various improvements to the accommodation since our last visit as part of an ongoing programme of refurbishment. New boilers have been fitted, the service has been re-wired, a new lounge carpet has been fitted and new flooring in some corridors. An upstairs bathroom has been refurbished with a new shower and bidet. New covering has been fitted to flat roofs, parts of the service have been redecorated, a new washer and tumble dryer have been provided, pipework has been boxed in, the garden has been improved, the conservatory tiled and air conditioning has been fitted. These improvements have made a positive impact and the parts of the home which have been redecorated look fresher and cleaner. Staffing levels have increased and there are more staff on duty, including weekend cleaners which means that care staff can concentrate their efforts on the people living at the service and their needs. What the care home could do better: Care plans could be better and could offer clearer guidance to staff on how to meet people`s needs. The plans could be more pesonalised and focused on independence. The plans on health care needs could offer much better guidance to staff about how to meet these needs. The people working at the service could have a better understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards through training and they could use it more effectively in supporting people to make informed decisions. The written risk assessments could be better, to demonstrate that individual risks are identified and that these are balanced against the benefits of decisions and actions for that person. The manager could look at how staff are deployed to encourage and motivate people living at the service in accessing a range of activities and community facilities to expand their social and support networks.Recreational plans could reflect the current needs and interests of people living at the service so that staff can motivate and encourage people to engage in activities and groups they may enjoy. The administration and recording of medication could be much better, and there could be better checks on medication to make sure people receive this as their Doctor prescribed. The manager could look at the arrangements for making sure staff check on people who are not well so they get the care and support they need. The manager could be more proactive at making safeguarding referrals when incidents occur rather than being reactive when other agencies make referrals. Improvements are still needed to some areas of the environment, and the cleaning staff need to be more closely supervised to make sure the home is kept clean and hygienic. The manager could be more careful to check he has the information and documents needed on staff to make sure that people who live at the service are protected from those who may not be suitable to work with vulnerable people. The frequency and content of supervision sessions with staff could be improved so the manager can be sure their performance meets his expectations. The management overall needs to improve as does the monitoring by the people who own the service. The fire safety testing could be done at the required intervals to protect people living at the service from the risk of fire. Key inspection report Care homes for adults (18-65 years) Name: Address: The Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Hirst     Date: 1 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: The Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY 01159621075 01159621075 theoaksrch@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Shobhi Tiwari,Dr Prem Tiwari Name of registered manager (if applicable) Mr Lee Stuart Hackett Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The Oaks is a large converted Victorian house situated close to Nottingham city centre. The home is on a quiet road with no through traffic, it has a garden to the front of the property and a hard standing area to the side and rear. The home is within walking distance of local shops and places of worship and has good local transport links, especially into the City Of Nottingham. The home provides care for younger adults with mental health issues. The accommodation comprises of two lounges, a conservatory area and a dining room with a designated smoking area within the home. Smoking is not allowed in other areas of the home. The home is not fitted with a lift and has several flights of stairs, making it unsuitable for people with mobility problems. The current weekly fees for the service are £356.11 plus additional one to one payments if required. These fees do not include hairdressing, holidays, cigarettes, newspapers, personal toiletries or clothing. The registered manager gives all of the people who Care Homes for Adults (18-65 years) Page 4 of 35 0 1 0 7 2 0 0 9 22 Over 65 0 Brief description of the care home want to live at the service a copy of the service user guide and the statement of purpose and a copy of the last inspection report are displayed on a notice board outside the registered managers office. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We brought this inspection forward as there was a recent inquest into the death of someone who lived at the home. The staff at the service were criticised by the Coroner for not taking action when a Doctor failed to visit and for not doing hourly rounds when people are unwell. We looked in detail at all of the records to do with this situation. We also looked at all of the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. Care Homes for Adults (18-65 years) Page 6 of 35 The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by, observation, reading their records and asking staff about their needs. The people living at the home are from a variety of ethnic communities and we case tracked a person from a minority ethnic group to make sure their needs are being considered and provided for at the service. The staff team come from a wide variety of backgrounds and experiences. We spoke with two members of staff to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care plans could be better and could offer clearer guidance to staff on how to meet peoples needs. The plans could be more pesonalised and focused on independence. The plans on health care needs could offer much better guidance to staff about how to meet these needs. The people working at the service could have a better understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards through training and they could use it more effectively in supporting people to make informed decisions. The written risk assessments could be better, to demonstrate that individual risks are identified and that these are balanced against the benefits of decisions and actions for that person. The manager could look at how staff are deployed to encourage and motivate people living at the service in accessing a range of activities and community facilities to expand their social and support networks. Care Homes for Adults (18-65 years) Page 8 of 35 Recreational plans could reflect the current needs and interests of people living at the service so that staff can motivate and encourage people to engage in activities and groups they may enjoy. The administration and recording of medication could be much better, and there could be better checks on medication to make sure people receive this as their Doctor prescribed. The manager could look at the arrangements for making sure staff check on people who are not well so they get the care and support they need. The manager could be more proactive at making safeguarding referrals when incidents occur rather than being reactive when other agencies make referrals. Improvements are still needed to some areas of the environment, and the cleaning staff need to be more closely supervised to make sure the home is kept clean and hygienic. The manager could be more careful to check he has the information and documents needed on staff to make sure that people who live at the service are protected from those who may not be suitable to work with vulnerable people. The frequency and content of supervision sessions with staff could be improved so the manager can be sure their performance meets his expectations. The management overall needs to improve as does the monitoring by the people who own the service. The fire safety testing could be done at the required intervals to protect people living at the service from the risk of fire. 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 35 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 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process helps people to decide if they want to live at the home and ensures that peoples assessed needs can be met at the service. Evidence: We looked at the files of three people who live at the service to check that they have been properly assessed before coming to live at the home, and to check their needs are able to be met there. All three of the files we saw contain pre admission and ongoing assessments and reviews written using the agreed Care Programme Approach (CPA) arrangements. The last two people who were admitted into the home had their needs assessed by their Community Psychiatric Nurse, we saw evidence that this assessment had been shared with the home. The assessment includes a record of their main health and social needs, their goals and issues that are important to them. For example, we saw an assessment that said one person wants to continue to visit and help out at a local allotment. Although we did not see a care plan about how the person would be supported to do this, the daily handover record shows that the visits to the allotment have continued since admission so the assessment information provided to the home was being used to support this preference. All of the files we Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: saw contain a statement of terms and conditions of occupancy but only one includes the fee details. One of the people we spoke with told us they visited the home before deciding to move in. The person said it was their choice to move to the home and that they were supported to make the decision by the doctor and community psychiatric nurse (CPN). Another person we spoke with told us they have a key worker and that this is a member of staff, who supported them when they moved into the home. One member of staff we spoke with has good knowledge about the physical health needs of a person who lives at the service but less about the persons mental health diagnosis and support needs. Another staff member described the general routines of the home to show how these support individual preferences but knew less detail about peoples physical and mental health diagnosis and needs. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning is not robust and effective enough to ensure peoples needs are met in a consistent way and that they are enabled to make decisions, balancing risk and the benefits of different courses of action. Evidence: We looked at the care plans of three people who live at the home to make sure their needs are identified and that the staff have good guidance to follow so they can meet these consistently and in line with peoples wishes. The files contained a copy of the single care plan written by the care coordinators. This information is updated regularly through the care programme approach reviews. We saw evidence in the files that people have been involved in the planning of their care and some of their preferences were recorded. The care plans are arranged in a consistent format to help staff access information more easily. However, we found that the care plans do not always fully explain to the staff the Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: action they should take to support people and meet their individual needs. For example, the majority of records seen in the file of a person who had been admitted five weeks before the inspection remained blank. We also found that some sections of the persons care plan contain exactly the same information as in other peoples care files. This shows that peoples needs are not always considered individually. We noted that one care plan tells the staff that the person needs (their) mental health and well being to be monitored because on ongoing problems. The plan does not identify the nature of the ongoing problems or give staff guidance on how to manage these. A range of needs, identified in the assessment information provided by the care managers have not been incorporated into a useful working care plan for staff to follow. We spoke with the manager about these issues and he told us that he is aware that the care and support plans need further review to make sure they are more person centred. We spoke with two staff about the needs of the people we case tracked to check they understand their needs and know how to meet these. One person has a reasonable understanding of peoples physical health needs but knew less about their mental health needs. Another described meeting peoples needs in terms of the daily routines of the home but has less understanding of their individualised needs. We considered whether people are encouraged to make their own decisions about their lives and we found that there is an inconsistent approach towards making sure peoples capacity to make key decisions has been assessed. We found that this has been done in one of the files we inspected, but not in the other two, although there are key decisions about their lives they wish to make. One person who lives at the service told us that the staff refuse to provide for their dietary preferences. There are medical grounds for this decision but the persons capacity to make this decision (using the assessment in the Mental Capacity Act) has not been conducted. Although the manager has attended training on The Mental Capacity Act 2005, the staff told us this has not been cascaded down to them. People who work at the service are not clear about how to assess peoples capacity to make decisions and choices for themselves. That said, three people who live at the service told us they are happy living there and that they think their needs are being met. Two people told us the staff respect their privacy and dignity and they said they are able to make their own decisions. One commented, yes I can do what I want, and another told us, you can make your own decisions (the staff) dont force you to do anything. We saw from the records that people have opportunities to meet together to discuss the home. One persons file has information in it about local advocacy services. That said, the manager told us he does not have any information about the local Independent Mental Capacity Advocate Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: (IMCA). When we looked at the care plans we found that there is a information from the care management team about each persons risk history. However, this is not then translated into an effective care plan at the service. The risk assessments we saw sit alongside the care planning documents and are written in general and not specific terms, for example, all of the care plans we saw have a risk assessment identifying both mental health and general health as hazards. The action plan to meet these risks is the same in all cases. The information is too vague to provide staff with a useful tool to manage risk effectively and the information does not enable the person living at the service and the staff to weigh up the benefits of taking any identified risk. Care Homes for Adults (18-65 years) Page 15 of 35 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 who use services are able to make choices about their life style, social, educational, cultural and recreational activities meet individuals expectations. Evidence: None of the people who live at the service attend day services or go to college at the moment. One person attends a gardening scheme. That said, people told us they are able to make their own decisions about how to spend their day and they are able to be independent. For example they told us they are able to come and go as they please and receive support from staff when they wish. One person told us, we can do what we want another commented the staff dont make us do things we dont want to do. We saw people coming and going during the day. They access local facilities independently of the staff. The manager told us a new Music and Movement session is being provided in house Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: via Castle College and the people living at the service seem to enjoy these. A recreational therapist is employed and organises holidays, trips and parties. We saw him going out for a walk with one of the people who lives at the service. The manager told us that motivation is a major issue for people living at the service and it may be that staff need to be redirected from more practical tasks to undertake the essential role of encouragement and motivation. We saw a sheet in each persons file to record hobbies interests and preferences. We found that this was only partially completed in one file and had not been reviewed since it was written in 2008. The evidence we saw in care plans, from observations and from talking with people living at the service, indicates that the staff encourage people to maintain links and relationships with those who are important to them. They identify if peoples sexual health is at risk and liaise with the Community Nurse to arrange appropriate support. One of the people we case tracked maintains a relationship with their partner. We noted that there are some preferences for daily routines within care plans. Equally, there are some restrictions on smoking on the grounds of health and safety and this mainly relates to smoking in rooms. People are expected to leave smoking materials in the office when they go to their rooms and one person told us that access to their room is restricted at times during the day. The manager explained the circumstances when this occurs and the problems keeping people safe from the risk of fire due to people smoking in their rooms. Where restrictions on routines exist these are clearly recorded and agreed with the person concerned. The care manager is also made aware of any restrictions. There is a four weekly menu in place, people at the service have requested certain foods regularly, but have been told that the food budget will not stretch to this. The menus indicate there is a choice every day. Occasionally hot food is provided at tea but sandwiches are provided a great deal of the time. We saw evidence of home made desserts and yogurt is also available as a healthy eating option. The people we spoke with did not make any comments on the food. Staff we spoke with told us the service provides as well as possible with the food budget they have. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are assessed and in most cases met. The arrangements for medication are not safe and people do not receive medication as prescribed by their Doctor. Evidence: We looked at care plans for the people who we case tracked, and found that the arrangements to support people with their personal care needs are not well recorded. However, when we spoke with staff we found that they are aware of the support people need in this area and we observed them treating people with respect for their personal dignity. One of the people who lives at the service told us she is helped when necessary because of a physical problem but that her privacy and dignity is respected. Since we last visited the service there has been an inquest about a person who lived at the service. The staff at the service were criticised by the Coroner for not taking action when a Doctor failed to visit and for not doing hourly rounds when people are unwell. We looked in detail at all of the records to do with this situation. The manager has taken steps to make sure staff chase up visits from the Doctor if they do not attend the home to see people living there. He has also surveyed every person living Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: at the service to see if they want to be checked through the night and is keeping a record of these checks. We did find, however that the staff could have been more diligent at checking on a person who was acknowledged to be unwell, making sure they fulfilled their duty of care however difficult the circumstances. We also found that the manager and staff do not have sufficient knowledge around issues of capacity and where the Deprivation of Liberty Safeguards may have relevance. We have been contacted by the person employed to provide free training on this subject and been told that no one from the home has attended this, despite letters and prompts. See also our comments in YA7. In general terms, we found that healthcare needs are being properly assessed and people do have treatment offered where appropriate. For example we saw evidence in one persons file that they have regular and comprehensive health reviews and they are supported to access preventative health care services. Equally we saw evidence that the staff respond to peoples health care needs by contacting the Doctor. The care plans we saw acknowledge that health care needs to be monitored and records indicate that staff should monitor to ensure people take their prescribed medication. However, we equally found there are no specific care plans in files we looked at, to address peoples individual health needs. This is in spite of these people having needs such as diabetes and Lymphoedema. One of the staff members we spoke with has a good understanding of the healthcare needs of two of the three people we case tracked, but is less clear of the arrangements in place to monitor blood sugar levels for a person with type 2 diabetes. Since our last visit to the home there has been an investigation following an error in the administration of medication by staff. The manager has introduced a system whereby staff are witnessed by other staff giving out medication to mimimise the potential for error. He also told us that the staff member has received medication training but when we looked at the persons staff file we found evidence that this training has not been completed. We looked at the latest inspection report from the Primary Care Trust about the medicines management. The report was positive and concluded the medication systems are safe. We looked at the arrangements in place to store medication, and found these to be safe, appropriate and secure. The medication files we saw are generally well organised and contain photographs of people who use the service so that any new staff can easily identify them. None of the people we case tracked have been formally assessed to take responsibility for the management of their own medications. A risk assessment has Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: been done, but not an assessment of their capacity to make a decision to self medicate. When we looked at the record of medication we found areas of concern. We found that although the staff are recording the quantity of each medication received into the service, they do not record any medication being carried forward onto the following sheet. This makes auditing difficult as only the current sheets are stored in the medication record folder. We found the staff are not recording the actual quantity of medication given on the medication administration record sheet when the dose is variable. When we audited the medication for the people we case tracked, we found that in three cases staff have signed the medication administration record sheet to indicate it has been given but we found the medication still in the blister pack. We also found more medication in one box than there should have been, given the quantity received and the records of administration. This means staff have signed to say they have given the medicine when they have not done this. When we spoke with the staff who administer medication we found that there is a lack of clarity and consistency in terms of which stocks of medication are used and what codes staff use. The manager said that the Community Nurse usually audits medication but has been off sick. This responsibility lies clearly within the management of the service. We found no clear evidence that medication auditing is taking place. As were were concerned about the safety of medication we left an immediate requirement form for the safety of the arrangements to improve. A full audit was done and staff have been given clear guidance as to how to administer medication properly. The manager has also arranged for staff to have further training on the safe administration of medication. The requirements we set have been complied with within the timescale we set. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to the complaints procedure. The manager is not proactive enough in terms of ensuring referrals are made under safeguarding to protect people from harm. Evidence: We saw the complaints procedure on display on the notice board along with a form to be completed by the person raising the concern. The manager told us there have not been any complaints made to him since our last inspection. We have received two anonymous complaints since our last visit, one about untrained staff giving out medication, and the other about the poor standards of cleanliness about the home. The second was about the quality of the manager, the standards of cleanliness and the quality of care. We received this shortly after the recent inquest (see YA19.) We have considered these comments as part of our inspection. (See YA19, 20, 30 and 37.) People who live at the service told us, I discuss my problems with the staff, they help me resolve them. I would go to the manager if I had a complaint. Another told us, I made my complaints to the manager when I moved in, the staff helped me get it sorted out. I feel confident complaining. We would have expected to see these complaints recorded at the service, but there is no record of this in the complaints record. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: There have been two safeguarding investigations led by the Local Authority since our last visit to the service. One concerning a medication error, (See YA20), the other following the recent inquest (See YA19.) In both instances the manager co-operated with the investigation, suspended staff from duty and took steps to prevent a reoccurrence of the incidents. That said, he could have been more proactive in reporting the incidents under safeguarding himself rather than being reactive. Both investigations are now concluded. When we looked at the training matrix, we found that some staff attended training on safeguarding last year. The manager knows this training is a priority need going forward. The supervision records we saw indicate that some staff have issues with their levels of understanding and attitudes (See YA 34,) but we also saw evidence that further training has been provided to address this. Care Homes for Adults (18-65 years) Page 22 of 35 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. The accommodation is improving, but is not clean comfortable and hygienic in all areas. Evidence: We did a partial tour of the accommodation to check that the home is warm, comfortable, safe, clean and well maintained. There have been various improvements to the accommodation since our last visit as part of an ongoing programme of refurbishment. New boilers have been fitted, the service has been re-wired, a new lounge carpet has been fitted and new flooring in some corridors. An upstairs bathroom has been refurbished with a new shower and bidet. New covering has been fitted to flat roofs, parts of the service have been redecorated, a new washer and tumble dryer have been provided, pipework has been boxed in, the garden has been improved, the conservatory tiled and air conditioning has been fitted. These improvements have made a positive impact and the parts of the home which have been redecorated look fresher and cleaner. However, some parts of the service still look tired, worn and unclean, particularly the smokers room, the dining area and some of the bedrooms. Some carpets in corridors are at the end of their useful life and look unclean with ingrained dirt. These areas Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: need to be prioritised going forward. Staff we spoke with told us that the home is not kept clean enough and commented that the cleaning staff are not thorough enough in their duties. One of the people we case tracked, told us they are unhappy with the room they have, and said there were problems with the heating. The plumber has been called in but the situation has not fully resolved. However, generally people told us they like the service and enjoy having a variety of places they can relax. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and in sufficient numbers to support the people who use the service. Staff are not recruited in a safe way and this places people living at the service at risk of harm. Evidence: The manager has developed a training matrix to help him identify what training staff have undertaken and when this needs to be renewed. Training undertaken within the last year includes; Coroners training, Controlled Drugs, Administering Medicines, Numeracy, Health and safety, Cultural Awareness, Nutritional Awareness, Level 2 Safe Handling of Medicines, Equality and Diversity, Risk Assessment, Person Centred thinking, Infection Control, Fire Safety, Common Induction Standards, Food Safety. 13 care staff are employed at the service, of these 4 people have already achieved their National Vocational Qualification Level 2, 2 people have completed National Vocational Qualification Level 3, and 4 have submitted their protfolios but have not yet received their certification. This means the service have not yet achieved their target of 50 in this area but provided those who have submitted their protfolios are approved they will have met the target for this training. The staff we spoke with showed that they have a good understanding of the general Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: needs of people living at the service and our observations show that there are many positive interactions between the staff and people living at the service. We looked at the staff files of three people employed to work at the service to check they have all of the necessary information and documentation required by Law to protect vulnerable people. We found one person has a previous caution which was disclosed on the application form, but we could find no evidence the matter had been discussed with the staff member, nor that the manager had conducted a risk assessment of the persons continued employment. We found evidence the person has been working at the service without checks with the Independent Safeguarding Authority and without a current Criminal Records Bureau check. We were concerned about this unsafe practice and we wrote an urgent action letter to the owners and the manager. They have either obtained or are in the process of obtaining all of the missing documents and they have written to say they are now complying with the Law. This means they have complied with the requirements within the timescale we set. We looked at the records of staff supervision. We found that this is not taking place as recommended (ie a minimum of six times a year,) though improvements have been made and the process is now more formal. Supervisions are carried out by the manager and the deputy together which cuts down on the available time for supervisions. We found that although matters of concern or for improvement are discussed with staff, action plans, timescales and targets are not always set, and there is often no evidence that performance issues have been followed up. One staff member told us they do not feel confident in raising issues of concern with the manager. Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not being managed in a way which ensures it runs in the best interests of people who live there. Evidence: The manager has achieved both his National Vocational Qualification Level 4 and his Registered Managers Award. There have been a number of areas of improvement in the service, however there are also a number of key areas which evidence that the service is not being managed as effectively as it should be. (See YA6, 7, 19, 20, 23, 24, 30, 34, 36, 39 and 42.) The manager and the service, from numerous comments made during our visit appear to rely quite heavily on the input of the Community Nurse, who seems to have assumed a number of roles traditionally undertaken by the manager of the service. Service limitations and changes are unlikely to allow for this in the longer term. People we spoke with told us they discuss issues with the staff and managerand they said there is a pleasant atmosphere when the people living at the service are with staff and the manager. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: We asked to see the most up to date Quality Assurance Audit of the service. The manager confirmed no audit has been done since the last inspection. We could not find any evidence of reports on the monthly visits by the provider. We have given the manager a pro forma for this purpose. Given the issues of concern raised by this report the owners need to demonstrate that they are regularly checking on how the service is being conducted. We looked at the evidence of servicing and testing of equipment to check that people are safe. The Portable Appliance Testing and Fire Extinguisher servicing were both due in the month that we visited, the manager assured us that this would be done within the month. It has since been completed. The Fire Safety tests are not being done at the required intervals and this potentially compromises the safety of staff and people living at the service in the event of a fire. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 26 The registered provider visit 31/08/2009 the home every month and prepare a report about how it is being conducted after seeking the views of people living there, staff and reviewing documents. A copy of this report must be sent to CQC until further notice So the owners can monitor the home and check it is being managed and run in the best interests of the people living there. This requirement is outstanding, previous timescale of 31/8/2009 not met. This requirement will be repeated for a final time. Failure to comply may result in further enforcement action being taken. Care Homes for Adults (18-65 years) Page 29 of 35 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 1 6 14 Care plans must reflect the current needs of people living at the service, giving staff clear guidance as to how these should be met. To ensure the staff have clear and consistent guidance about peoples needs and how they prefer care to be delivered. 26/06/2010 2 7 12 There must be a record to 26/05/2010 show that peoples capacity to make key decisions has been considered at the pertinent time. If it is suspected that they lack capacity an assessment of must be conducted using the guidance in the Code of Practice (Mental Capacity Act 2005). To ensure people have the right to make their own decisions about their life wherever possible. Care Homes for Adults (18-65 years) Page 30 of 35 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 3 19 18 All staff must have training 05/07/2010 on the Mental Capacity Act and the Deprivation of Liberty Safeguards and must apply this to their day to day practice To make sure that they can make sure that people have the information they need to make informed decisions in terms of their care. 4 19 14 Care plans, with clear 30/06/2010 guidance to staff on actions to be taken must be in place for all identified healthcare needs. To make sure staff have access to the key information they need to minimise risk, uphold choice and maintain peoples health and wellbeing. Safeguarding procedures must be followed in all cases, and appropriate referrals made to the Local Authority To ensure that people are protected from potential harm and abuse. 31/05/2010 5 23 13 6 24 23 The smokers room, dining area and peoples bedrooms need redecoration and upgrading 31/07/2010 Care Homes for Adults (18-65 years) Page 31 of 35 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 To provide a comfortable and pleasant place for people to live. 7 30 18 There must be appropriate supervision of the cleaning staff To make sure that the home is clean and hygienic. 8 30 16 Clean or replace the carpets in the corridors which are dirty or where odour is present To provide a clean and pleasant place for people to live 9 37 9 The management of the service must improve and the issues raised in this report must be addressed To ensure the service runs in the best interests of the people who live there. 10 39 26 The providers must provide a report of their monthly visits of the service. These must be sent to the CQC every month until further notice To provide evidence that the providers are fit and that the service is being conducted 31/05/2010 31/07/2010 31/07/2010 31/05/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 appropriately and is improving 11 39 24 There must be regular audits 31/07/2010 of the service being provided incorporating the views of people living at the service and their relatives To ensure the service runs in the best interests of the people who live there. 12 42 23 Fire safety tests must be 14/05/2010 conducted at the required intervals as stipulated by the Fire and Rescue Service To ensure equipment works correctly and that staff know what action to take in the event of a fire. 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 9 More detailed risk assessments should be written to demonstrate that individual risks are identified and that these are balanced against the benefits of decisions and actions for that person. Review how staff are deployed to encourage and motivate people living at the service in accessing a range of activities and community facilities to expand their social and support networks. Recreational plans should reflect the current needs and interests of people living at the service so that staff can motivate and encourage people to engage in activities and groups they may enjoy. Page 33 of 35 2 12 3 12 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 4 19 The arrangements for checking on people who are unwell should be reviewed to ensure the staff fulfil their duty of care to people living at the service. All concerns as well as formal complaints should be recorded to ensure that people have their views recorded, listened and responded to. Where there are concerns about staff performance there should be clear target setting and evidence of follow up action being taken to ensure matters are addressed and the service is being managed effectively. Supervision of care staff should take place a minimum of six times a year to ensure they are performing in line with expectations. 5 22 6 36 7 36 Care Homes for Adults (18-65 years) Page 34 of 35 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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