Care Home: Unity Care

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What the care home does well People living in the home have the benefit of a home that is domestic in style and more homely than many larger homes. People living in the home have lived there for a long time, the home is staffed by members of one family which means that staff know the people well. Staff interactions with people were observed to be good and one issue of potentially challenging behaviour was talked through well and calmly to enable the person to make a more reasoned response. Medication was administered well and this helps to ensure that people`s health conditions remain stable and people remain as well as possible. What has improved since the last inspection? People living in the home have had all their information updated in the assessment and this helps the home identify if there have been any changes in the person`s health and social care. The service has acted on most of the requirements made at the last inspection to help ensure the home is better managed. There is a record of when people attend key health appointments with GPs, Consultants, opticians, chiropodist and so on. This helps to ensure that people living in the home have the appropriate health checks to ensure that health problems can be spotted quickly. There were care plans in place to ensure that medication prescribed had information about what it was for. There was a fire risk assessment in place and this helps to identify the hazards there may be in the building. Food that required storing in a fridge was in date and labelled appropriately and this helps to ensure that people do not become ill from out of date food or food that has been left open for a longer time than is safe to do so. What the care home could do better: Although there had been action on the requirements and recommendations made at the last inspection some did not result in improved systems to ensure that the problem would not happen again. The systems rely on the family knowing what the people need. For example daily records were not completed for a number of days, staff were recording that a person was having seizures that were longer than 5 minutes on seizure charts (which would indicate that paramedics needed to be called) but in daily records indicated the seizure was small, a person`s weight record showed that their weight had increased by 9 pounds in a week without explanation or investigation and outcome records from health appointments were not detailed. Records are therfore not sufficient or consistent enough to get a clear picture of how people are helped, what has happened to them and how the service has responded. People`s goals, aspirations and interests are not recorded in enough detail to ensure that planning care, education, leisure and activities reflect them. We were told that the service is undertaking some person centred planning but this was not in place at this inspection. A care plan indicated that a person needed significant help with managing their finances but they were deemed to be capable of managing their money. There was no assessment of their difficulties, training needs, records of money or safeguards put in place. Serious consideration should be given to providing an independent person to be contacted should people in the home feel there are only members of the family who run and operate the home to talk to. This could provide valuable feedback for the home so they can make adjustments and improvements to the way the home is run for the benefit of people that live there. Issues about the poor recording had been raised by the manager in supervision with staff on numerous occasions but this did not result in an improvement in this area of performance and has led to the a lack ofin the overall monitoring and planning of people`s care. We were told at the inspection in September 2009 of an intention to refurbish people`s bedrooms, change the cooker, retile and change the downstairs shower room. None of these had been completed when we visited this time. People`s bedrooms were not of a sufficient standard to provide quality adn homely comfort. The management of the refurbishment did not ensure people were not moved from one poor environment to another, or that the office and sleep in areas were not cluttered and a health and safety risk. Rotas of staff working in the building were not accurate to reflect who and how many people were available to care for the people living in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Unity Care 90 Gravelly Hill Erdington Birmingham West Midlands B23 7PF     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: Jill Brown     Date: 1 0 0 2 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 33 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 33 Information about the care home Name of care home: Address: Unity Care 90 Gravelly Hill Erdington Birmingham West Midlands B23 7PF 01216864406 01216864406 enquiries@unitycare.co.uk Unitycare.co.uk Mrs Sylvia Hamilton Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Wayne Hamilton 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: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Date of last inspection Brief description of the care home 90,Gravelly Hill is a large terraced style property, lying back from a busy main road close to Spaghetti Junction on the M6 motorway. The area is well served by public transport links, with a bus stop immediately outside and rail station close by. The home is registered to provide personal care, support and accommodation for up to three adults who have a learning disability. Staff are on duty at all times and sleep-in night cover is provided. There are three bedrooms on the first floor. Bathing facilities Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 3 2 9 0 9 2 0 0 9 Brief description of the care home and toilets are situated on both ground and first floors. At the front of the house is a communal lounge. There is a bedroom on the ground floor that is currently unoccupied. Towards the back of the house is a dining area leading into the kitchen. Doors from the kitchen give access to the rear of the property where there is a paved area to the side and a steeply inclined lawn to the back. There is limited off street parking at the front of the house, and parking restrictions apply on the road outside. The house sits in an elevated position from the road making access difficult for people with restricted mobility. It is recommended that information about current fees and charges is sought directly from the care home. Care Homes for Adults (18-65 years) Page 5 of 33 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: We visited the home unannounced on a day in February 2010. We were unable to immediately start our inspection but returned an hour later when the person on duty had returned from taking a person living in the home to college. We were at the home for over six hours. The home was rated as a poor service in September 2009 and we were visiting to look at the core National Minimum Standards again to see if the home had made improvements. During the inspection we case tracked one persons care. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedroom. We also looked at parts of the other person resident care file and also looked at their bedroom and medication administration. We looked around parts of the building and garden. We observed interactions between staff and people living in Care Homes for Adults (18-65 years) Page 6 of 33 the home. We also looked at other records about the safety of the building, complaints and accidents. The manager was not available during this inspection and information was given to us by the manager of the sister service who had been on sleep in duty overnight and was on duty alone until 1pm. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Although there had been action on the requirements and recommendations made at the last inspection some did not result in improved systems to ensure that the problem would not happen again. The systems rely on the family knowing what the people need. For example daily records were not completed for a number of days, staff were recording that a person was having seizures that were longer than 5 minutes on seizure charts (which would indicate that paramedics needed to be called) but in daily records indicated the seizure was small, a persons weight record showed that their weight had increased by 9 pounds in a week without explanation or investigation and outcome records from health appointments were not detailed. Records are therfore not sufficient or consistent enough to get a clear picture of how people are helped, what has happened to them and how the service has responded. Care Homes for Adults (18-65 years) Page 8 of 33 Peoples goals, aspirations and interests are not recorded in enough detail to ensure that planning care, education, leisure and activities reflect them. We were told that the service is undertaking some person centred planning but this was not in place at this inspection. A care plan indicated that a person needed significant help with managing their finances but they were deemed to be capable of managing their money. There was no assessment of their difficulties, training needs, records of money or safeguards put in place. Serious consideration should be given to providing an independent person to be contacted should people in the home feel there are only members of the family who run and operate the home to talk to. This could provide valuable feedback for the home so they can make adjustments and improvements to the way the home is run for the benefit of people that live there. Issues about the poor recording had been raised by the manager in supervision with staff on numerous occasions but this did not result in an improvement in this area of performance and has led to the a lack ofin the overall monitoring and planning of peoples care. We were told at the inspection in September 2009 of an intention to refurbish peoples bedrooms, change the cooker, retile and change the downstairs shower room. None of these had been completed when we visited this time. Peoples bedrooms were not of a sufficient standard to provide quality adn homely comfort. The management of the refurbishment did not ensure people were not moved from one poor environment to another, or that the office and sleep in areas were not cluttered and a health and safety risk. Rotas of staff working in the building were not accurate to reflect who and how many people were available to care for the people living in the home. 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 33 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 33 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. There have been no admissions to this service since the last inspection. People have their information updated and this helps to ensure that the service can identify any changes in needs. Evidence: There have been no new admissions since last inspection, and the home continues to have one vacancy. Both of the men currently resident have lived there for several years. People have contracts with the home and these were up to date at the last inspection in September 2009. there have been no changes to the contractual arrangements for people living in the home. As the home has one vacancy, we asked to see the homes admission procedure but were told that this was being updated. The new admission procedure needs to ensure that a determination is made about the persons willingness to come to the service and their capacity to ensure that their liberty isnt being deprived without proper safeguards. This is in order to comply with new legislation and ensure peoples human rights are respected and protected. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: There is a service user guide which gives some information about the admission process and what the fees cover. Information provided needs to be more accessible to people that may be admitted. We did not find the level of fees that the home charged in the service user guide. Assessment information on one residents file looked at had been re written this year. The reviewing of assessment information should help the service determine whether the persons physical, mental and social conditions have improved, stayed the same or deteriorated. Care Homes for Adults (18-65 years) Page 12 of 33 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. People living in this service cannot be assured that care plans and risk management plans are reviewed or sufficient information is available to ensure care is given in the way they need or wish. Evidence: We looked at the information provided to staff to deliver the care to people. We found that lots of information was collected but it was not organised in a way for staff to get information quickly so they can deliver the care quickly and effectively. We were told that the service had started developing person centred plans for people but these were not in place at this point in time. We were told that the service was looking at providing essential life plans which provide details that are essential to the care of people. People at the service have lived here for some time. The care is provided by people from the same family who have got to know the people very well. However the manager should consider that this lack of clarity of information does not ensure that if new staff were needed to provide the care that they could find the information quickly and deliver care well. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Information about what people like or dislike is not incorporated into the plan or goal setting. So for one person they had goals about keeping mentally well and for their epilepsy to be controlled and to have a shave 4 days a week on specified days which may not be the most important issues for the person. We discussed this matter with the manager of the sister home and found that the person wanted to visit Canada, likes drawing and painting. These aspirations and likes were not in his plan of care. We could not identify in the care plan supplied when peoples care had been reviewed to see if it was working, or when people had a review from a social worker from the funding authority. At the last inspection we found that risk assessments had been carried out recently. Information was collected but not always put in the risk management plan or added to the care plan for the person. This means for example although there were risks of the person over eating it is not in the care plan and there were no details of what to do in this event. Similarly there was information that a person could express racist thoughts and although we heard this being dealt with well on the day this was not in their risk management plan. There are intervention plans in place for managing people when they demonstrate anxiety, aggression and so on. There were separate recordings of interventions that had been made. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to spend time with relatives and people that are important to them. People cannot be assured that wider goals and interests influence the education, activities and leisure pursuits arranged. People have the opportunity to be involved in the preparation of meals. Evidence: When we visited the home one person was on their way out to college and the other person and the one member of staff on duty were accompanying them. When we returned we were told that one person does not attend college and during the inspection they made it clear they did not want to attend. They were taken out to the pub when the second member of staff arrived. When a person returned from college Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: both people were taken out. We looked at the records for one persons educational, leisure and daily living activities. The care plan indicated that they like going to the pub, going for a walk and the service was looking for an outside activity to replace college this had yet to happen. We found a weeks programme for them that included pub lunches, disco nights, going to the cinema, karaoke, bowling, board games drives and walks, sorting out clothes to be washed and tidying their room. We looked at the daily records to see what activities the person had actually had since 01 January 2010 and found that the daily records remained poorly completed. There were gaps of several days where there were no records. (See staffing outcome area) Records didnt necessarily indicate what people were doing and on one record indicated that a person didnt go to a disco due to a lack of staff. It was difficult to evidence that people had the opportunity to be involved in a range of activities. We could not see how activities related to peoples wider interests for example a person wanting to visit a foreign country. We noted that the care plan indicated that a person would have to pay for a holiday independently although the standards state that each person should have a seven day holdiay within the contract price. Information in plans, and evidenced in Medication Administration Records showed that people have a chance to maintain relationships with their relatives and spend time with them. We looked at the food available in the home and found that there were not large supplies of food. As there are only two people living in the home supplies can be brought in fresh on a daily basis. We found that food kept in the fridge had a date on when it was opened and that food stuff sampled was within its sell by date. Peoples care plans needed more information about food likes and dislikes, any behaviour associated with food and how this was managed. We looked at one persons weight record and noted that a persons weight had increased 9 pounds in one week and this had not provoked any action or plan or medical check for health concerns. Information from the last inspection indicated that people are involved with planning and preparing meals. Care Homes for Adults (18-65 years) Page 16 of 33 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. People can be assured that they have routine appointments with health professionals and have their medication administered appropriately. This helps to ensure that peoples health and well being is maintained. People cannot always be assured that their day to day care is reviewed to ensure that changes in health result in changes in care planning. Evidence: People living at the home have staff from the same ethnic background and gender delivering their care. This enables people to have staff they can relate to. However all the staff in the home are related and this could cause difficulties. (Please see complaints and safeguarding and staffing outcome areas). Guidance is given to people about undertaking their personal care and where necessary some prompting is given. People are given goals about their personal care where this is necessary. At the last inspection in September 2009 there were no health records available for us to look at. This gave us cause for concern that people may not be having their health care needs met. We were told that records had been stored on computer and lost. At Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: this inspection it was clear that the service had tried to rectify this. There were requests for annual health checks on each person living in the home immediately after the inspection although these appear not to have been due until December. There were records also of people seeing the Dentist, Optician, and Psychiatrist and each person also having a flu jab in October 2009. Since then there are records of visits of chiropody and reviews with mental health services. Although there are records of these visits, where possible appointment letters and outcome letters should be kept. Not all visits had the outcome of the visit recorded and this is useful for any further checks in health that may need to be made. We looked at the records for managing a persons epilepsy and found that there was information about the triggers to the seizure and types of seizures the person had and when paramedics needed to be called if the person had a and or several seizures. We looked at the seizure records for this person and found that staff were recording these events inconsistently. Some staff were recording the seizure lasting over 5 minutes without getting appropriate medical intervention. However the daily records indicated the seizures were small and in one case the seizure was not recorded at all in the daily records. This suggests a lack of understanding of staff completing these records including the importance to the persons ongoing care and well being. We noted that one person had put on a large amount of weight quickly and this had not resulted in any action. Another had a record of complaining of back pain without an indication if pain relief was given. There was an indication that theyre had been a discussion about losing weight with no follow up and this could have been a goal that the person may want to achieve. We looked at the medication administration and found that overall medication was administered well. The medication is dispensed in a monitored dosage system, in most cases, which has blisters packed so that medications are ready to be given at set times through the day. The medication in stock matched the medication record except for one medicine. This may be due to the lack of carrying forward from one Medicine Administration Record (MAR) to the next or because the non blister packed medication was not given to the person or sent with the person when they were on leave. There were good medication plans which detail what medications were for. Medication was stored in the kitchen area in a lockable filing cabinet. Medications are more safely stored in specially designed cabinets and not in kitchen areas which are subject to extremes of temperature. There was no signature list against the member of staff, signature lists enable anybody looking at the MAR determine who has signed to say medication has been given. One medicine was administered by a community psychiatric nurse and the date for the next administration was not on the MAR. Care Homes for Adults (18-65 years) Page 18 of 33 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 feel satisfied that they can raise concerns safely. Further safeguards were needed to ensure that peoples money was adequately accounted for. Evidence: We looked at the homes complaint procedure and it had been recently updated and gives the current address of the commission. In the procedure people are told that they can also contact their social worker if they have concerns. People living in the home have access to a complaints procedure as well procedures on abuse, confidentiality and fire. These procedures have some pictures but they are written from the homes perspective and consideration needs to be given to how these are worded so they enable people living in the home. There is a joint staff and residents meeting on a monthly basis. We were told that the service have had no complaints since the last inspection. We have received no complaints about the service provided in the home and no issues of safeguarding have been referred to us. We asked to look at the money records for people living in the service. We were told that the people in the service managed their own money. One persons care plan indicated that they needed assistance to collect their money from the post office, pay Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: their fees and count their money. There was no mental capacity assessment of the persons understanding and administration of money. The care plan described how they spent their money including giving money to a relative. There are inadequate safeguards on this persons money to ensure that the management can be confident that money is not being taken from the person. Care Homes for Adults (18-65 years) Page 20 of 33 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. People living in this home do not have a comfortable bedroom space that meets their needs. Further work is needed in the dining, kitchen and garden areas to ensure that people have safe acceptable place to live. Evidence: We were shown around the home by the manager of the sister home to Unity Care 90 Gravelly Road who was acting as a staff member on this inspection. We were told at the last inspection in September 2009 that there were plans to redecorate peoples bedrooms, change the cooker, retile and change the downstairs shower room. None of these had been completed when we visited this time. We found that one bedroom was in process of being refurbished. The person had been accommodated in another bedroom which was of a poor standard. This bedroom had the architrave removed from around the door, the room needed redecorating, the bed, bedding and furniture were in need of replacement. The second person was accommodated in a bedroom of a similar poor standard. As in the previous inspection we found that the service was using a number of Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: electrical adapters in both the lounge and in the office. These were documented in the homes fire risk assessment as potential risks. There had been no reduction in the number in use and no measures to ensure that the number of and type of electrical goods plugged into the adapters did not overload the system. We looked in the bathroom and found this to be clean and fresh as was the downstairs lounge and bedroom. The lounge had a flat screen TV and a computer media centre for people to use and comfortable furniture. The office was being used to store all of the equipment paints and so on for the refurbishment. It was disorganised necessitating some climbing over objects to find documents and use the office for any purpose was difficult. The kitchen and dining area looked tired and dated needing refurbishment to meet expected standards. We looked in the garden and found a steep lawned garden which was on several levels. There was a handrail to assist people with the steps up to these levels, the hand rail was not secure enough to provide adequate support. As a result of this inspection we received information on behalf of the service which stated that the both peoples bedrooms would be completed by the beginning of 04 March 2010. However we are concerned that the refurbishment was not started sooner. Care Homes for Adults (18-65 years) Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive help from staff that know them well and this helps to ensure a continuity of support. Staff receive training but appropriate checks are not in place to ensure their continued competence. This can mean that peoples well being is compromised. Evidence: We looked at the rota of people working in the home on the day of the inspection and found that this was not an accurate record of people working in the home. On arrival at 09:20 the rota said that the manager of the service, the manager of the sister service (until 10am) and a member of staff would be on duty this was not the case. We found only the manager of the sister service on duty and this continued to be the case until 1pm. We noted that there were 5 people on the rota to cover all the hours needed in the home and this included the manager of the sister service. The service appears to run with one carer on duty and in addition the manager when they are on duty. We noted a recording that a disco had not been attended because there were not enough staff and one day where the managers hours were not recorded so it was difficult to see if all the hours are covered. People were observed to respond well to staff that were working with them on the day Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: of the inspection. The previous inspection also found that staff have known the people living there a long time and good interactions with them. There have been no new staff employed since the last inspection and one member of staff has left. All records of training records on staff files remain as at last inspection in September 2009 showing that most training being completed in 2008. We were told by the manager of the sister service that he completes training with all staff as he has the Train the Trainers award. A copy of this was not kept as this home with his training as evidence of his competency to deliver training or as he acts as a staff member his staff records. We were told by one staff member that they expected to complete there National Vocational Qualification Award in the next week which would ensure that all staff have a recognised level of training. The home was unable provide evidence of fire training or first aid training on a staff file at the inspection. However we were forwarded a copy of certificates of external training in basic first aid undertaken in 2009 by two members of staff and a grid showing when fire training had been undertaken. At the last inspection the manager accepted that fire training last took place in August 2008 and was due for renewal. The grid forwarded after this inspection told us fire training had been given June 08, December 08, June 09 and December 09. There was little information in staff files to evidence that staff understand the training, have continued competency and performance issues are dealt with. We looked at two staffs supervision records since the last inspection and found comments in December 2009 such as still poor on records there are to be no gaps in diaries(daily records) another staff file says needs better self motivation and days of diaries are missing. This poor recording was still in evidence in January and February 2010 when we looked at records. There appeared to be no training or sanctions to improve this situation. Care Homes for Adults (18-65 years) Page 24 of 33 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. Although there have been improvements in the service these are not backed up by systems that sustain good working practices. The service relies on all staff knowing the people living there a long time. The lack of independent review of peoples care and the service means that it is hard for the service to adapt to peoples needs as needed. Evidence: It was helpful that the manager for the sister home was available during the inspection. During the inspection we were unable to ascertain the managers own supervision arrangements and whether he felt this was sufficient to meet his needs to carry out the role. Finding information at the inspection was not always easy as the office lacked order and systems. It was clear that the service had worked on the requirements made at the last inspection but there were clear gaps in evidence trails, monitoring the service and facilities offered to people, acting on assessments and ensuring staff competence. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: We were told that the quality analysis had yet to be completed on the service. In November 2009 meetings included areas such as reviewing daily and writing up this has not resulted in improvement record keeping. The fire risk assessment had been completed in November 2009 and risks identified in storage of propane gas, use of extension leads and closures on significant doors. There was no evidence that these risks had been acted upon. There were no people living in the home that were subject to a deprivation of liberty authorisation at the time of the inspection. The home has yet to revisit their admission procedure to ensure that they have considered peoples rights in relation to the Mental Capacity Act. Records had yet to be organised, stored and updated in a way that was sufficient to ensure good working practices. We looked at other maintenance information including gas and electrical safety and these have been completed. The electrical five year safety inspection was deemed unsatisfactory in May 2009 and was rectified in June of the same year. All fire tests, drills and fire safety servicing had been completed. The service needs to ensure that all the safety aspects included in the environment section of this report and the requirements shown by their fire risk assessment are acted upon. Care Homes for Adults (18-65 years) Page 26 of 33 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 37 18 The registered person must 31/12/2009 ensure that the registered manager receives regular, formal and recorded supervision to ensure he is appropriately supported to ensure the home complies with The Care Standards Act and Regulations. Unable to assess manager not at inspection. This will ensure the home complies with The Care Standards Act and Regulations and that evidence is available to support steps taken to ensure outcomes for people improve. Care Homes for Adults (18-65 years) Page 27 of 33 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 23 13 (6) Where people have difficulty with money management systems must be in place to account for peoples money. This is to ensure people are financially protected 16/04/2010 2 24 16 2(c) All bedrooms occupied must have an appropriate level and standard of furniture and furnishings This is to ensure that people have the facilities they need and ensure their rooms are comfortable. 26/03/2010 3 24 23 2(b)(d) All bedrooms that 26/03/2010 are occupied must be kept in a good state of repair, and reasonably decorated. This is to ensure that bedrooms are safe and remain pleasant to occupy. Care Homes for Adults (18-65 years) Page 28 of 33 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 4 28 23 2(b) 13(4)(c) Access to the 30/04/2010 garden must be improved to ensure that the steps and rails to access other levels are sound. This is to ensure that people are safe within the garden area. 5 33 17 (2) schedule 4(7). There must be an accurate record of staff and managers on duty. This is to ensure that the service is appropriately staffed, responsibility for the care and well being of people living in the home can be tracked. 31/03/2010 6 35 17 (2) schedule 4(6) There must be staff records for all people working in the care home including copies of certificates of training. This is to ensure that these are available for inspection. 31/03/2010 7 36 18 1(a) 12(1)(a)The 30/04/2010 management of the service must ensure the competence of the staff to perform all the required roles in their job description. This is to ensure that people have a safe service. Care Homes for Adults (18-65 years) Page 29 of 33 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 8 39 24A An improvement plan must be sent to us as to how these requirements and recommendations are to be met. Following the final report please note compliance date guidance and a date will be set on finalising the report. This is to secure improvement in this service. 05/05/2010 9 42 13 (6)Risks that are identified including those contained in the fire risk assessment Must have measures to minimise the risk. A record of these actions must be kept. This is to ensure that people living in the home remain safe. 26/03/2010 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 1 The Service User Guide should be updated to provide accurate information to people who live at the home and to people who may consider living at the home. (This should include the range of fees charged) Unmet from the previous inspection October 2008. Continue to develop care planning so that goals set are clearly measurable and evaluated regularly. This is to ensure that people get the guidance and support they need to make decisions about their lives and the things that are Page 30 of 33 2 6 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 important to them. Started but not met since the last inspection October 2008. 3 12 Continue to further develop care planning and recording to show clear links between peoples goals and their activity opportunities. Review activity recording regularly to ensure that written records are legible and appropriately detailed. Not met at last inspection October 2008. Educational, leisure and social activities should be provided that meet peoples goals, aspirations and interests. The service needs to have records that demonstrate this. Where peoples weight fluctuates, or where people need to lose weight to remain healthy a plan should be in place to effect this. Instructions, training and so on needs to be in place to ensure that records of seizures are accurate and meaningful. A list of staff and their signature on the Medication Administration Records should be kept to ease identification of who administered a medication. Medication storage should be in an approved cabinet for that purpose and re siting of medication storage to an area that has a more consistent temperature is recommended so that medication is always stored at the right temperature. Medication on the Medication Administration Record that is to be administered by a health professional should have the date that it is supposed to be administered. This acts as an extra check that medication has been administered as prescribed. Medication not in blister packs must have the number carried forward from Medication Administration Record to the next administration record. Where non blistered medication goes with the person on holiday then this should be counted prior to the holiday to ensure any problems can be identified. Where procedures and policies are issued to people in the home they should be written from their point of view. Consideration should be given to arranging meetings for people that live in the home with a person independent of the service. Page 31 of 33 4 16 5 19 6 19 7 20 8 20 9 20 10 20 11 12 22 22 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 13 14 15 16 24 24 40 41 You should ensure that sleeping and office accommodation is suitably clear of clutter to be fit for purpose. You should devlop plans for the refurbishment of the kitchen and dining area. The services admissions procedure must take into account the Mental Capacity Act considerations. Records must stored in a way that makes them easy to access when needed. Records must be kept up to date and be clear and consistent. 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