Care Home: The Peacocks

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What the care home does well Once we had accessed the home the registered manager and registered provider were cooperative throughout the inspection. What has improved since the last inspection? The registered manager had undertaken some cleaning of the home and most areas, including the bathrooms and toilets looked cleaner. The registered manager had gathered her own training certificates into the staff training file and tried to access details of staff training. The upper floor window has been restricted to reduce the risks of falls or injury to people using the service. This immediate requirement has been met. The smoke alarm identified at the previous random inspection as requiring attention has been addressed. This immediate requirement has been met. What the care home could do better: The Statement of Purpose and Service User Guide must be updated to accurately reflect the facilities and service provision of the home. To not do so would mean that prospective people to the home would not have correct information about the service provided. The management of risk assessments must be developed to ensure that all areas of identified risk are assessed and an appropriate plan put in place to manage the risk safely. The immediate requirement was partially met. The development of care plans must be undertaken to ensure that all areas of assessed need had an appropriate plan of care for staff to follow. The immediate requirement was partially met. All records must be stored securely in the home to ensure that peoples personal information is only accessible to people who need it. This is needed to ensure peoples privacy an dignity is maintained. The registered person must ensure that all people using the service have an agreed daily routine and that this is recorded in the persons care plan. This must include any risks and how these are measured and managed to ensure that people are safe. The registered person is recommended to further develop the risk assessments for all areas of the home both inside and outside. There must also be development of risk assessments for animals in the home to include risks of cross infection, hygiene arrangement and management of dog and other animal waste. The registered manager must undertake a review of medication management to include all the areas identified in the body of the report. The poor management of medication currently being undertaken may place people using the service at risk. The standard of hygiene at the home must continue to be addressed to ensure that there is no risk of cross infection and no significant malodour.All areas of the home accessible to people using the service must have a Portable Appliance check to ensure that they are safe. The Portable Appliance testing undertaken so far had identified that a heater in a persons bedroom was no longer working and had to be removed. This means that two bedrooms now have no heating facility. This must be addressed to ensure that each room has suitable heating. There is no daily rota maintained to indicate how staffing and supervision are managed and how often the volunteer staff work at the home. This is recommended to ensure that there is a clear audit trail of when staff were at the home and the supervision provided. Recruitment and training records for staff at the home are incomplete. Not all recruitment checks are in place and not all areas of mandatory training have been undertaken by all staff. This may place people using the service at risk. Quality assurance reviews have not taken place and so the registered manager cannot evidence if the home is meeting peoples needs. Policies and procedures need to be updated to include current practice at the home and also best practice for high standards of care. The registered manager must ensure that all substances hazardous to health are stored securely to ensure that there is no risk of accidental ingestion. Hot water outlets are not monitored to ensure that they do not exceed the Health and Safety Executive`s recommended upper limits. This is recommended to ensure that there is no risk of burns and scalds to people using the service. We noted that to attract attention of the staff by people using the service would mean that they would have to shout or go downstairs to access help. This arrangement is required to be included in the the homes Service User Guide. Key inspection report Care homes for adults (18-65 years) Name: Address: The Peacocks 10 Stithians Row Fourlanes Redruth Cornwall TR16 6LG     The quality rating for this care home is:   zero star poor 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: Gail Richardson     Date: 1 6 0 6 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 39 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 39 Information about the care home Name of care home: Address: The Peacocks 10 Stithians Row Fourlanes Redruth Cornwall TR16 6LG 01209218271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mhinchliffe3@aol.com Ms Margaret Hinchliffe Name of registered manager (if applicable) Ms Cheryl Ann Dean Type of registration: Number of places registered: care home 3 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 Peacocks provides care for three people with learning disabilities. The registered persons live on the premises with their son. The house is a terraced cottage, just outside the village of Four Lanes, between Helston and Redruth. Residents have access to the lounge and kitchen / diner. There is a bathroom / toilet upstairs, and each resident has their own bedroom. The front garden has a pond, and tables and chairs for people to use. The building and garden is not accessible to wheelchair users. The inspection report is not available at the home and it is suggested a copy is requested from management or via the CSCI website if required. The range of fees at the time of the inspection is 302 pounds-322 poundsper week. 1 5 0 9 2 0 0 9 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 39 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: zero star poor 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: This was an unannounced inspection, which took place on the 16th June 2010 by Compliance Inspectors Gail Richardson and Lynda Kirtland. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 15th September 2009. We spoke with the registered manager by telephone on 22nd October 2010 when she confirmed that they, the registered manager and provider, were working on all areas of the report. We visited the service on the 1st June 2010 to review how the home had managed the Statutory Requirements made at the key inspection. We found that the registered provider and registered manager had not addressed any of the statutory requirements or good practice recommendations. We made 7 immediate requirements which addressed the areas of our concern. Care Homes for Adults (18-65 years) Page 5 of 39 We spoke with the registered manager by telephone on the 9th June 2010 who advised us that all the immediate requirements had been met. We revisited the home to undertake a random inspection to review these areas. We found that two of the immediate requirements had been met fully, two had been met partially and the remainder had not been met. Due to the concerns identified we changed the random inspection into a full key inspection. A tour of the home took place and all of the bedrooms and communal areas were seen. There was one permanent resident currently residing at the home and one person receiving routine respite care. We were not able to speak with anybody living at the service about the care provided. We spoke with the registered manager and registered provider. We looked at records relating to care including two care plans, two staff files, medication , policies and procedures and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Adults (18-65 years) Page 6 of 39 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide must be updated to accurately reflect the facilities and service provision of the home. To not do so would mean that prospective people to the home would not have correct information about the service provided. The management of risk assessments must be developed to ensure that all areas of identified risk are assessed and an appropriate plan put in place to manage the risk safely. The immediate requirement was partially met. The development of care plans must be undertaken to ensure that all areas of assessed need had an appropriate plan of care for staff to follow. The immediate requirement was partially met. All records must be stored securely in the home to ensure that peoples personal information is only accessible to people who need it. This is needed to ensure peoples privacy an dignity is maintained. The registered person must ensure that all people using the service have an agreed daily routine and that this is recorded in the persons care plan. This must include any risks and how these are measured and managed to ensure that people are safe. The registered person is recommended to further develop the risk assessments for all areas of the home both inside and outside. There must also be development of risk assessments for animals in the home to include risks of cross infection, hygiene arrangement and management of dog and other animal waste. The registered manager must undertake a review of medication management to include all the areas identified in the body of the report. The poor management of medication currently being undertaken may place people using the service at risk. The standard of hygiene at the home must continue to be addressed to ensure that there is no risk of cross infection and no significant malodour. Care Homes for Adults (18-65 years) Page 7 of 39 All areas of the home accessible to people using the service must have a Portable Appliance check to ensure that they are safe. The Portable Appliance testing undertaken so far had identified that a heater in a persons bedroom was no longer working and had to be removed. This means that two bedrooms now have no heating facility. This must be addressed to ensure that each room has suitable heating. There is no daily rota maintained to indicate how staffing and supervision are managed and how often the volunteer staff work at the home. This is recommended to ensure that there is a clear audit trail of when staff were at the home and the supervision provided. Recruitment and training records for staff at the home are incomplete. Not all recruitment checks are in place and not all areas of mandatory training have been undertaken by all staff. This may place people using the service at risk. Quality assurance reviews have not taken place and so the registered manager cannot evidence if the home is meeting peoples needs. Policies and procedures need to be updated to include current practice at the home and also best practice for high standards of care. The registered manager must ensure that all substances hazardous to health are stored securely to ensure that there is no risk of accidental ingestion. Hot water outlets are not monitored to ensure that they do not exceed the Health and Safety Executives recommended upper limits. This is recommended to ensure that there is no risk of burns and scalds to people using the service. We noted that to attract attention of the staff by people using the service would mean that they would have to shout or go downstairs to access help. This arrangement is required to be included in the the homes Service User Guide. 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 8 of 39 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 9 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A Statement of Purpose and Service User Guide is available to provide details for any prospective person using the service. The document is not an accurate reflection of the services and facilities available. Each person should have a contract with the home which details the terms and conditions of residency. This is required to ensure that people know the services they are agreeing too. Evidence: There have not been any new admissions to the service. The home provides a Statement of Purpose and Service User Guide for all prospective people using the service. This document was last reviewed on 1st April 2010. We looked at the detail of the statement of purpose and found it was not an accurate reflection of the service provided. The Statement of Purpose says The range of needs is adults with mild to moderate learning disabilities. Some of the people currently Care Homes for Adults (18-65 years) Page 10 of 39 Evidence: accessing the service have a higher dependency. The guide told us about the qualifications and experience of the staff. It said that staff received some training, which the staff training records could not confirm. The Statement of Purpose says there are two female volunteers both with a National Vocational Qualification, there is no evidence of this in the staff training records. The Statement of Purpose tells us that both volunteers have medication training and experience in dealing with adults with learding disabilities. However, there is no evidence of this in either volunteer recruitment and training files. The guide also told us locks are provided on bedroom doors for privacy but is double sided for safety . Only one bedroom has a lockable facility from the inside and this was not accessible for staff in the case of an emergency. The other locks seen were only lockable from the outside. The Statement of Purpose told us Personal records are secure and locked away,confidential correspondence is locked in filing cabinet. We saw evidence that some records had been accessed by an inappropriate source. The statement of purpose says, service users are involved in care planning process, there is no evidence that this is the case. The format was not available in easy read or alternative formats. Prospective people using the service should know that the home they choose will meet their needs and aspirations. They should be aware that staff both individually and collectively have the skills to deliver the service and care that the home offers to provide. There is no detail included of the qualifications and experience of staff to ensure that peoples needs will be identified and met. The people using the service do not have a contract supplied by the home and uses the contract supplied by the Commissioning Authority. Therefore the terms and conditions of residency are not signed as agreed by the person using the service and so people and or / their representatives, may not be fully aware of the terms and conditions of residency. At the last inspection it was recommended that each person residing at the home has a signed contract with the provider to ensure clarity about the terms and conditions of residency. This recommendation was not undertaken and a statutory requirment has now been made. Care Homes for Adults (18-65 years) Page 11 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are limited and lack sufficient detail to ensure that person centered care is provided. Risk assessments are not accurate and need to be more regularly reviewed and updated. Records are not stored in an appropriate manner to ensure there is no access by other parties. Evidence: At the previous key inspection we made statutory requirements that risk assessments and care plans be developed to ensure that peoples needs and risks were identified and that appropriate assessments and care plans be put in place to meet those needs and risks safely. We required that these be undertaken by 30/10/2009. We visited the home on the 1st June 2010 following concerns having been raised. We found at that time that care plans were poor and lacked sufficient detail to ensure that all areas need would be met. We made an immediate requirement, that the registered Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: provider was required to ensure that all people using the service have a detailed care plan in place which identifies all areas of assessed need and how those needs are to be met. This care plan should be in line with the National Minimum Standards and must also be regularly reviewed and updated. The registered manager advised us by telephone on the 9th June 2010 that the immediate requirement had been met. This was also confirmed in writing on 16/06/2010. We visited the home at this inspection and reviewed two care plans. We found that the care plans had been developed but lacked sufficient detail to ensure that people were safe. One care plan lacked detail about physical conditions and how they would be managed and another care plan lacked detail in how to support peoples independence to ensure that choices and preferences were being met. At the same visit on the 1st June 2010, we found that risk assessments were poor and lacked sufficient detail to ensure that all areas of risk would be managed safely. We made an immediate requirement that risk assessments must be undertaken for all people using the service to identify areas of risk and actions to be taken to manage the risks safely. The registered manager advised us by telephone on the 9th June 2010 that the immediate requirement had been met When we revisited at this inspection we looked at the risk assessments for one person. We were told by the registered manager that the risk assessments for the other person were with another health professional. The risk assessments seen did not identify all areas of risk and did not detail ways to manage the risks safely. This is needed to ensure that staff at the service are clear about how to manage areas such as behavior and physical illness. This lack of clear direction may place people using the service at risk. Staff at the home did not demonstrate that they provided people living there with the information, assistance and communication support they needed to make decisions about their own lives. There was no plan to ensure that peoples choice and preferences were supported and there was no audit trail to demonstrate how individual choices had been made. There was no evidence that people participated in all aspects of life in the home. We are told that one person liked to help with the cleaning. This help was not detailed in how it was managed or developed and is not detailed within the service user guide as a responsibility for housekeeping tasks. The registered manager has an office upstairs. This office is not locked. We found at the random inspection on the 1st June 2010 that some records had been defaced with colored pen and some pages had been torn out. We require that this areas be addressed, however the random inspection report had not arrived at the time of this inspection. The office door was unlocked when we visited at this inspection. All records Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: must be stored securely to ensure that peoples privacy and dignity is maintained. Care Homes for Adults (18-65 years) Page 14 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had access to placements but there is no evidence of why these were not undertaken regularly. There is no evidence of any leisure activities or how people choose to spend their time. Evidence: We did not have the opportunity to speak with people using the service to discuss the opportunities for personal development. We spoke with professionals who have a supporting role with the people using the service. They told us that placements are set up for people to access. People using the service do not attend regularly. The people using the services care plans, do not reflect the support needed to access these placements and do not indicate any reason for absence. No body at the home has a work or educational placement and there is no evidence that people are active within the community. Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: People who live at the home have contact with their families and also have access to a caravan owned by the registered provider and manager for weekend breaks. There is no documented report of when this is undertaken and how risks and care are managed there. The care plans for people using the service do not detail peoples routines for daily living. They state that people can use a telephone and can be left for agreed periods of time. There has been no risk assessment or measuring of understanding to ensure that this is safe. On our arrival at the home one person was inside the home with the registered provider and nobody would answer the door. The telephone was not answered and access to the home was made by the registered manager through a ground floor window. The management of peoples care must be safe and their roles and responsibilities clarified to ensure that people who live at the home understand what actions they should take in certain circumstances. Peoples bedrooms have locks which are only usable from outside of the room. This means they can be locked in and cannot get out. Only one bedroom has a lock on the inside but this lock cannot be accessed from outside in an emergency. This area is reported in Outcome group Choice of Home. The home has many pets which include four dogs. People considering moving to the home must understand that the pets are a large part of life at the service. The registered manager had undertaken a risk assessment of the dogs and found there to be no risk. We require that further risk assessment be undertaken to include risks of cross infection, hygiene arrangement and management of dog and other animal waste.This is required to ensure that there is no risk to people using the service. We did not see any meals being provided. We saw a family kitchen and well stocked fridges and cupboards. Care Homes for Adults (18-65 years) Page 16 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not identify peoples preferences about the personal support they need. Medication management is poor and may place people at risk. Evidence: We looked at two care plans and neither identified how peoples care needs should be met. There was no plan of care to meet peoples physical needs, particularly in an emergency situation. This lack of insight or clear plan of action may place that person at risk. There was no evidence of any ongoing monitoring of potential problems such as people being weighed or ongoing dental and optical monitoring. This may mean that people do not receive the care and support to meet their health needs. One person had had a recent medical check. Any continence needs were identified but did not detail how this was to be managed and records were maintained weekly as a review of care provided. These were repetitive and limited. The management of medication is poor. One person who visits the home routinely takes prescribed medication. The Policies and Procedures of The Peacocks states that medications are stored in a locked cabinet. We looked at the storage facility and Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: found that this is a locked portable carry case. This is not appropriate and the registered manager must arrange appropriate storage which is in line with the Royal Pharmaceutical Guidelines. Medications were also seen to be stored in an unlocked facility in the kitchen fridge. Risk assessments must be in place to ensure that this does not pose a risk of accidental ingestion for people using the service. At the previous random inspection we looked at Medication Administration Records and found that they were inadequate and out of date. The registered manager is investigating a more suitable means to record medication. The home now has Patient Information Leaflets referring to the medication administered at the home. The registered manager and registered provider have undertaken medication training. No other people who work or volunteer at the service have the appropriate training to administer medication. This is concerning if the registered manager/ provider are not available. This training must be in place for all people who are left in a role of responsibility at the home. Care Homes for Adults (18-65 years) Page 18 of 39 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. No complaints have been recorded. No training has been undertaken to protect people using the service. Evidence: There is a basic complaints policy in the homes Statement of Purpose. No complaints policy was on display. . No complaints have been received by the home. No staff at the home have received any training in abuse awareness and this lack of insight may place people using the service at risk. We were told by the registered manager that both she and the registered provider had undertaken this training, however, there are no certificates to prove this training had been completed. This was recommended at the previous key inspection but no action to address this shortfall has been made. The home does not have a copy of the local area policy for safeguarding vulnerable adults and so cannot be sure of what action to take should an allegation of abuse be made. The registered manager has undertaken No Secrets training. Financial records were not inspected at this time. Care Homes for Adults (18-65 years) Page 19 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Peacocks is a domestic setting. The standard of fixtures, fittings are not well maintained. The level of hygiene is poor. Evidence: The Peacocks is a terrace property located close to the local village. Local amenities such as a shop, church and public house are within easy walking distance. The house is a domestic setting with the people using the service and the management of the home and their family all living together. People using the service have their own lounge, shower and toilet room and individual bedrooms. There is a shared kitchen, toilet and outside space. Access to the first floor is by stairs. There are steps to the front of the house and this would restrict anybody with any mobility difficulties. The home is not environmentally suited to people using a wheelchair within the home and the Statement of Purpose identifies this for all prospective people using the service. There is current building work taking place to build a conservatory at the front of the home. No risk assessments have been undertaken, the area is unsafe as there is building debris, childrens toys, animals and animal excrement in the garden. Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: Policies and Procedures last updated 01/04/2010 states There is a quieter garden at the rear of the house This is not the case and the registered manager confirmed that people using the service do not access the rear of the house. The homes policy and procedures also state that smoking is allowed in the front porch, this porch is no longer there and there are no details of any alternative smoking facilities. The homes Statement of Purpose states clearly that this home is suitable for people who like pets. One bedroom has a built in fish tank which we required a cover be provided to ensure there was no risk to people using the service. This was now seen to have been provided. We made a previous requirement that all areas of the home be risk assessed and copies of these assessments be forwarded to the Commission. This was in 01/11/07. This was never undertaken. A further requirement was made at the recent key inspection 15/09/2009, that an environmental risk assessment be undertaken to ensure that the environment was safe for people using the service. This also was not undertaken. An immediate requirement was made on the 1st June 2010 inspection that the registered provider was required to make sure that all areas are made free from risk/harm and risk assessments need to be put in place for all areas identified both internal and external to the home. This was required to be completed by 07/06/10. The registered manager advised us by telephone on the 9th June 2010, that this requirement had been met. When we visited at this inspection we found that whilst a short statement had been made about the perceived risks, these did not include how the risks around the home and the risks created in the communal garden would be managed. We had identified previously that the standard of hygiene was poor. It was noted that some effort had been made to clean the home and the bathrooms and bedrooms looked cleaner. There remains a significant malodour of animals. Bedrooms appear to be personalised. We had made immediate requirements on the 1st June 2010 that a fire alarm which was beeping to indicate that it needed attention, this had now been addressed. We also noted previously that within another room an unrestricted window identified at the previous inspection and an immediate requirement made, this had now been secured. We had made a previous requirement that the heaters and all portable appliances be tested to ensure that they were safe. We observed that these checks have not been Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: undertaken. We made an immediate requirement that the registered provider undertake this safety check for all of the homes portable appliances and confirm to us, in writing, its completion. This was to be completed by 07/06/10. We spoke with the engineer who undertook the work who advised us that the work has been undertaken for areas he was requested to inspect. We are advised by the registered manager that this does not include all areas of the home. The areas not included were the private accommodation for the family members and include their lounge area. The homes policy and procedures last updated 01/04/2010 states that The Peacocks offers 2 lounges for service users The home only has two lounges and so we interpret the providers lounge to be the second lounge .These rooms are part of the home and it is required that all areas be tested to ensure that people living at the home are free from risk. We are advised by the registered manager that areas identified by the engineer for remedial work would be undertaken. The testing had identified that a heater in a persons bedroom was no longer working and had to be removed. This means that two bedrooms now have no heating facility. This must be addressed to ensure that each room has suitable heating. The home does not have an internal call bell system. To attract attention of the staff by people using the service would mean that they would have to shout or go downstairs to access help. This arrangement is required to be included in the the homes Service User Guide. Care Homes for Adults (18-65 years) Page 22 of 39 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. The homes recruitment and training policies do not support and protect people using the service. Evidence: The home is a small service with the registered provider and registered manager being the main carers. We are told that one volunteer also works at the service when needed. There are periods of time when two staff are required to be at the home to provide agreed supervision. There is no daily rota maintained to indicate how this is managed and how often the volunteer staff work at the home. This is recommended to ensure that there is a clear audit trail of when staff were at the home and the supervision provided. We looked at the recruitment and training files of all members of staff who have unsupervised access to people using the service. The homes Statement of Purpose says that all staff have Criminal Record Bureau Checks in pace.Recruitment files remain incomplete with no written references for some staff and not all staff have Criminal Record Bureau Checks. Recruitment checks must be in place for all staff who work in any role at the home. Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: Job descriptions are in place but are not reflective of the role expected of staff at the home. The volunteer staff job description identifies that staff should follow the peoples activity plans, which are not available and also administer medication, which the volunteer staff have not received the training to enable them to do so. We looked at training records for people who work at the home. This included the registered provider and registered manager and the volunteer who works at the home. We had previously made a requirement at key inspection in 2006 and again in 2008.The registered person shall ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example such training must include training as required by regulation such as fire training.) Accurate records of training must be kept including a certificate of completion of training courses attended. At the key inspection 15/09/09 this requirement was found not to have been met. We visited 01/06/2010 and found that whilst the registered manager has undertaken some training, the registered provider and the two volunteers have not undertaken any training. Not all areas of mandatory training have been completed by any staff member. Not all staff members have undertaken fire safety training, no staff have undertaken moving and handling training or updated first aid training. Updated training in food hygiene , protection of vulnerable adults and deprivation of liberty have not been undertaken by any staff. This lack of training may place people using the service at risk. We made an immediate requirement that all staff must receive mandatory training which also includes abuse awareness training by 10/06/10. The registered manager advised us that this requirement had been met. This inspection identified that whilst the registered manager had attended some training sessions, the registered provider and volunteer had no evidence available to confirm attendance at any training sessions identified above. The Statement of Purpose tells us that all staff have received fire safety training. The registered provider and volunteer have not undertaken any fire safety training and the registered provider is currently undertaking all fire checks and drills at the home. This may place people using the service at risk. The registered manager has completed a National Vocational qualification in management. The Statement of Purpose told us that both volunteers at the home have a National Vocational Qualification. No other staff have evidence of completing a vocational qualification. There is no evidence of any level of supervision and support by senior staff to ensure Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: there is a good level of communication and feedback to support the needs of people using the service. Care Homes for Adults (18-65 years) Page 25 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is not effective in ensuring the health safety and well being of people using the service. Evidence: The registered manager is Cheryl Hinchliffe Dean and she has managed the home for several years. She has completed a National Vocational Qualification in management. There is no evidence that quality of care is monitored or reviewed. Previously surveys had been provided for people using the service to complete. This has not been undertaken within the last year. Therefore , it is not possible to evidence if the home is considered by people using the service to meet their needs. It is also not clear how the views and choices of people living at the home influence and direct how care is provided. Policies and procedures at the home are limited and need to be reviewed and updated to ensure that they reflect current best practice. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: The maintenance of a safe environment is not well managed, See standard 24 Outcome group Environment. Risk assessments are not adequate to ensure that risk within the home is managed safely. The management of safe working practices is not well maintained. We noted that cleaning chemicals including bleach, which are substances hazardous to health, are easily accessible in a kitchen cupboard. The risk assessment which was not dated or signed, says that Check on a regular basis that all hazardous chemicals are not put in the cupboard but in the appointed hazardous cupboard. The cupboard the chemicals we saw were stored in, was not signed or lockable. The substances seen must be stored securely to ensure that there is no risk of accidental ingestion. Hot water outlets are not monitored to ensure that they do not exceed the Health and Safety Executives recommended upper limits. This is needed to ensure that there is no risk of burns and scalds to people using the service. Care Homes for Adults (18-65 years) Page 27 of 39 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 5 5 The registered manager is 30/10/2009 required to ensure that each person has a standard contract for the provision of services and facilities by the registered provider. This is needed to ensure that people using the service are clear about the service they are paying for. 2 6 15 The registered manager is 30/10/2009 required to ensure that all care plans are reviewed and updated regularly to accurately reflect changes in the persons needs. Care plans should be detailed and include all areas of identified need. This required to ensure that the person has a clear record of care needs and how to meet those needs. 3 6 15 You are required to ensure 10/06/2010 that all people using the service have a detailed care plan in place which identifies all areas of assessed need and how those needs are to be met. This care plan should be in line with the National Minimum Standards and must also be regularly reviewed and updated Page 28 of 39 Care Homes for Adults (18-65 years) 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 This will ensur ethat peoples identified needs will be met. 4 9 12 The registered manager 30/10/2009 must ensure that all risks identified have a clear assessment of that risk and a plan of care to minimise and support the risk. This will ensure that the person is safe and the management of care supports independance. 5 9 12 Risk assessments must be 10/06/2010 undertaken for all people using the service to identify areas of risk and actions to be taken to manage the risks safely This will ensure that people are supported to manage risks safely. 6 20 13 The registered manager must ensure that all medications administered at the home are recorded and the records maintained accurately. This will ensure that here is a clear audit trail of medications adminstered and promote safe practice. 7 20 13 The registered person must 11/06/2010 ensure that all medications recieved into the home are stored safely in line with the Royal Pharmaecutical Society guidelines. Page 29 of 39 11/06/2010 Care Homes for Adults (18-65 years) 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 This means that medication are stored safely and correctly and do not place people at the risk of accidental ingestion. 8 26 12 The upper floor window must 10/06/2010 be risk assessed and appropriate window restrictor fitted. This will ensure that people using the service are free from the risks of injury from falls from these upper floor windows. 9 30 16 The registered manager must ensure that a satisfactory standard of environmental hygiene is maintained at all times. This will promote the safety of people using he service by minimising the risk of cross infection. 10 34 12 The registered manager 18/06/2010 must ensure that appropriate recruitment checks are in place for all people who have unsupervised access to people using the service. This will promote the safety of people using the service. 11 35 18 All staff must receive mandatory training which also includes abuse awareness training . 10/06/2010 11/06/2010 Care Homes for Adults (18-65 years) Page 30 of 39 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 This is required to ensure that staff have the skills to meet the needs of people using the service. 12 35 18 The registered manager 30/10/2009 must ensure that training is provided in all mandatory areas and is updated to reflect current good practice. This will ensure that the health and safety of people using the service is maintained. 13 35 18. 19 The registered person shall 01/02/2008 ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example such training must include training as required by regulation such as fire training.) Accurate records of training must be kept including a certificate of completion of training courses attended. (Timescale of 01/12/2006 not met 2nd Notification) 14 41 17 The registered manager must ensure that all records are well maintained and stored securly. 11/06/2010 Care Homes for Adults (18-65 years) Page 31 of 39 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 This will ensure a good standard of record keeping and ensure that peoples confidentiality is maintained. 15 42 18 You are required to make sure that all areas are made free from risk/harm and risk assessments need to be put in place for all areas identified both internal and external to the home. This is required to ensure that people using the service are safe from harm 16 42 13 You must ensure that the smoke alarm system is checked and made safe. This is required to ensure that people are safe. 17 42 13, 23 The registered person shall 01/11/2007 ensure that? (a) All parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety; Unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. (c) The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; (d) Equipment provided at the care home for use by residents or persons who work at the care home is 10/06/2010 14/06/2010 Care Homes for Adults (18-65 years) Page 32 of 39 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 maintained in good working order; (For example there must be: Evidence that a satisfactory health and safety risk assessment system is in place. Evidence of risk assessments must be forwarded to the commission within the timescale set. Gas appliances should be tested at least annually. Evidence of this must be forwarded to the commission within the timescale set. 18 42 13 You are required to 10/06/2010 undertake a safety check for all of the homes portable appliances and you confirm in writing its completion. This is required to ensure that the appliances at the home are safe for people to use. 19 42 13 The registered manager 30/10/2009 must ensure that all portable appliances are tested as safe. This is required to ensure that all portable equipment used at the home is tested regularly to ensure its safety. 20 42 13 The registered manager must undertake an environmental risk assessment of all areas of the home. 30/10/2009 Care Homes for Adults (18-65 years) Page 33 of 39 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 This is needed to ensure that all areas of the home have as little risk as possible to peoples safety. 21 42 13 We require that you complete a risk assessment for all areas of the home. This is required to establish any environmental risks and how any identified areas can be managed safely. 10/06/2010 Care Homes for Adults (18-65 years) Page 34 of 39 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 1 6 The registered person must ensure that the service users guide is regularly reviewed and updated to provide an accurate reflection of the services supplied by the home. This must include accurate details of facilities , service provision and staff training. This is needed to ensure that prospective people to the home can make a correctly informed decision about the home. 21/07/2010 2 16 12 The registered person must 29/07/2010 ensure that people have access to a lockable facility for their bedrooms. This lockable facility must be accessible by staff in case of an emergency. This is required to ensure that people can have the choice to lock their rooms Care Homes for Adults (18-65 years) Page 35 of 39 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 should they want too but also be accessible in any emergency situation. 3 16 12 The registered person must 29/07/2010 ensure that all people using the service have an agreed daily routine and that this is recorded in the persons care plan. This must include any risks and how these are measured and managed. This is needed to ensure that people using the service are confident about the daily routines of their lives. 4 20 13 The registered person must ensure that all medications recieved into the home are stored safely in line with the Royal Pharmaecutical Society guidelines. This means that medication are stored safely and correctly and do not place people at the risk of accidental ingestion. 5 20 13 The registered manager must ensure that all medications administered at the home are recorded and the records maintained accurately. This will ensure that here is a 29/07/2010 29/07/2010 Care Homes for Adults (18-65 years) Page 36 of 39 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 clear audit trail of medications adminstered and promote safe practice. 6 34 12 The registered manager must ensure that appropriate recruitment checks are in place for all people who have unsupervised access to people using the service. This will promote the safety of people using the service. 7 41 16 The registered manager must ensure that all records are well maintained and stored securly. This will ensure a good standard of record keeping and ensure that peoples confidentiality is maintained. 8 42 12 The registered manager must ensure that all substances hazardous to health are stored securely. The substances seen must be stored securely to ensure that there is no risk of accidental ingestion. 16/07/2010 07/07/2010 29/07/2010 Care Homes for Adults (18-65 years) Page 37 of 39 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 17 The registered person is recommended to further develop the risk assessments for animals in the home to include risks of cross infection, hygiene arrangement and management of dog and other animal waste. To attract attention of the staff by people using the service would mean that they would have to shout or go downstairs to access help. This arrangement is required to be included in the the homes Service User Guide. The registered manager is recommended to provide a designated smoking area. This area and detail of its management must be included within the homes Statement or Purpose / Service User Guide. Two bedrooms now have no heating facility. This must be addressed to ensure that each room has suitable heating. There is no daily rota maintained to indicate how staffing is managed and how often the volunteer staff work at the home. This is recommended to ensure that there is a clear audit trail of when staff were at the home and the supervision provided. The registered manager is recommended to risk assess all unguarded radiators and ensure that appropriate action is taken to ensure that there is no risk of injury from hot surfaces. Hot water outlets are not monitored to ensure that they do not exceed the Health and Safety Executives recommended upper limits. This is recommended to ensure that there is no risk of burns and scalds to people using the service. 2 24 3 24 4 5 24 33 6 42 7 42 Care Homes for Adults (18-65 years) Page 38 of 39 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. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 39 of 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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