Care Home: Victoria Court

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What the care home does well People live in a warm, comfortable home with a support staff team who generally know them very well, and with whom they feel safe. One person commented `I think this home does very well for the standard of living and the organised things. I am highly satisfied`. A relative commented `my relative is in such a wonderfully caring environment where all the staff are committed to providing the best possible care`. There is a loyal staff team, who work extra shifts when necessary, so agency staff who wouldn`t know the people there, are rarely if ever used. Being around familiar staff also helps people to feel safe. Having well trained and supported staff is seen as very important. All the staff either have a National Vocational Qualification Level 2 in Care, or are working towards the award. Other training is also organised so that staff have the right knowledge to carry out their work. The manager works closely with them and also holds regular supervision meetings with individual support workers so their work can be discussed and monitored. The staff talk with people and listen to what they have to say. People are encouraged to be independent and to do as they please, and go where they wish. This promotes independence and encourages decision making, to improve self-confidence. One person said `I am quite happy as I am`. Staff at the home can recognise when people`s mental health is worsening and request help and guidance promptly. One healthcare professional said in their survey. `Urgent cases are always prioritised and the team uses a multidisciplinary approach to minimise risk and provide the best possible care`. People say the meals are very good. They are plentiful and hot. `I am satisfied with the food`, and `the meals are alright` and `there`s a good food service`. What has improved since the last inspection? The refurbishment of the dining room is complete and new furniture has been bought, to make a fresher environment for the people living there. The laundry room has also been redecorated, which makes it easier to keep clean to minimise the risk of the spread of infection. Most private rooms are now lockable and people have their own key if they choose. This means that individuals cannot go into other people`s rooms without being invited. One person said that this was the best thing that had happened at the home in the past year. New tamper-proof toilet roll dispensers, liquid soap dispensers and paper towel holders have been fitted in the bathrooms. This means this equipment is now readily available when people need it. People have been asked to become more involved in the way the home runs. Some people have agreed to keep their room clean and tidy and this is recorded in theirservice file. This encourages life skills and independence and helps people to feel valued. Some people`s risk assessments have been completed in much greater detail to ensure people will be supported in a safe, consistent way. This needs to be done for all the people living there. The home has bought a fire safety training system and the senior manager has attended training so that she can provide regular training `in house` to make sure staff remain knowledgeable about fire safety practices. The manager now keeps better records of when staff need to attend compulsory refresher training so that this can be planned and provided for in a more timely way. What the care home could do better: People could be assessed properly before they move to the home. Discussing people`s personal capabilities and goals can help to check that a person can be supported properly if they choose to move there. The way risk to people`s welfare is managed could be recorded in more detail in their service plan, to make sure support is provided in a consistent manner, regardless of who provides that support. This includes when people choose to look after some or all of their prescribed medicines. There could be improved record keeping to show how people have been supported to make decisions about how they live their lives. And to show that discussions have been held with individuals about work and educational opportunities and whether people want to get involved in this kind of activity. Health care plans could be written to show that people`s total health needs are being addressed, both to show that the care is being provided and also to inform staff that the care they provide is the right care. This could include details of discussions held with healthcare professionals to show that advice has been sought and followed appropriately. The home`s policy about abuse could be written in more detail, explaining the roles and responsibilities of the local authority and the manager of the home should an event take place which could be abusive. This would ensure that the correct procedure, as agreed nationally, is always followed. The staffing levels could be kept under review so that the home is able to respond more promptly when people`s care needs change. New staff who start working at the home before their full police check is available to look at must be supervised at all times. This contributes towards keeping people safe. The registered manager could have some hours each week when she is not counted in the staff numbers, to carry out her management duties.There could be more importance placed on getting people who live there to say what they think about how the home runs. Some people like the routines that the home provides and they need help to think up new ideas and suggestions. The manager needs to write an action plan saying how the home is going to change as a result of these ideas. Then people will know they`ve been listened to. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Victoria Court 39-41 Victoria Road Bridlington East Yorkshire YO15 2AT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Dobbin     Date: 2 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Victoria Court 39-41 Victoria Road Bridlington East Yorkshire YO15 2AT 01262676205 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Arthur Lindley care home 19 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 19 Victoria Court is a large detached double fronted property, originally two separate homes, and located in a residential area of Bridlington. It is conveniently situated for all of the main community facilities including the public transport network. Victoria Court is registered for people who have a mental health problem and require personal care and support and guidance. Accommodation is on three floors. The home is only suitable for people who can manage the stairs, as although there are ground floor bedrooms, the bathroom is on the first floor. There are ten single bedrooms and two double or shared rooms, two lounges on the ground floor, one of which is a smokers lounge, and a dining room. Limited parking is available at the rear of the building along with a small garden and patio area, and there is some outside seating at the front of the house. The home has a statement of purpose that explains the aims, objectives and Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home philosophies of the home. The most recent inspection report was not available at the home. The current fees at the time of the visit on 23rd April 2009 are 323 pounds per week. An extra charge is made for chiropody and portable appliance testing, when a person has more than two personal items. Because of TV Licensing Regulations people with their own television in their room are charged 7.50 pounds extra each year. Care Homes for Adults (18-65 years) Page 5 of 36 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: This is what was used to write this report. Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were taken and given to people who live at Victoria Court and to staff and sent to other professional people who visit the home. 10 were given to people at the home, and 7 were returned. 5 were given to the manager to give to staff and 1 was returned. 6 were sent to health and social care professionals Care Homes for Adults (18-65 years) Page 6 of 36 and 1 was completed and returned. A letter from a relative, sent to the commission after the visit to the home. A visit to the home by one inspector, which lasted about 8 hours. This visit included talking to people who live there, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Victoria Court. Information about what was found during the inspection was given to the registered manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The refurbishment of the dining room is complete and new furniture has been bought, to make a fresher environment for the people living there. The laundry room has also been redecorated, which makes it easier to keep clean to minimise the risk of the spread of infection. Most private rooms are now lockable and people have their own key if they choose. This means that individuals cannot go into other peoples rooms without being invited. One person said that this was the best thing that had happened at the home in the past year. New tamper-proof toilet roll dispensers, liquid soap dispensers and paper towel holders have been fitted in the bathrooms. This means this equipment is now readily available when people need it. People have been asked to become more involved in the way the home runs. Some people have agreed to keep their room clean and tidy and this is recorded in their Care Homes for Adults (18-65 years) Page 8 of 36 service file. This encourages life skills and independence and helps people to feel valued. Some peoples risk assessments have been completed in much greater detail to ensure people will be supported in a safe, consistent way. This needs to be done for all the people living there. The home has bought a fire safety training system and the senior manager has attended training so that she can provide regular training in house to make sure staff remain knowledgeable about fire safety practices. The manager now keeps better records of when staff need to attend compulsory refresher training so that this can be planned and provided for in a more timely way. What they could do better: People could be assessed properly before they move to the home. Discussing peoples personal capabilities and goals can help to check that a person can be supported properly if they choose to move there. The way risk to peoples welfare is managed could be recorded in more detail in their service plan, to make sure support is provided in a consistent manner, regardless of who provides that support. This includes when people choose to look after some or all of their prescribed medicines. There could be improved record keeping to show how people have been supported to make decisions about how they live their lives. And to show that discussions have been held with individuals about work and educational opportunities and whether people want to get involved in this kind of activity. Health care plans could be written to show that peoples total health needs are being addressed, both to show that the care is being provided and also to inform staff that the care they provide is the right care. This could include details of discussions held with healthcare professionals to show that advice has been sought and followed appropriately. The homes policy about abuse could be written in more detail, explaining the roles and responsibilities of the local authority and the manager of the home should an event take place which could be abusive. This would ensure that the correct procedure, as agreed nationally, is always followed. The staffing levels could be kept under review so that the home is able to respond more promptly when peoples care needs change. New staff who start working at the home before their full police check is available to look at must be supervised at all times. This contributes towards keeping people safe. The registered manager could have some hours each week when she is not counted in the staff numbers, to carry out her management duties. Care Homes for Adults (18-65 years) Page 9 of 36 There could be more importance placed on getting people who live there to say what they think about how the home runs. Some people like the routines that the home provides and they need help to think up new ideas and suggestions. The manager needs to write an action plan saying how the home is going to change as a result of these ideas. Then people will know theyve been listened to. 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 set out 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 10 of 36 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 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the manager tells us that people are assessed properly prior to moving to the home, this process is not always being followed. Evidence: One person has moved to the home in the last year and their records were looked at to confirm whether their needs had been assessed before they moved there. The individual was asked about their admission but they couldnt remember. The records contained a comprehensive care needs assessment completed by the individuals care manager. The person though visited the home for respite care, prior to deciding that they wanted to move there permanently. The manager explained that when coming for respite she relies mainly on the care managers assessment, carrying out a fairly basic assessment herself. If the person decides to move in permanently then this assessment is looked at again and more information is sought. This though did not happen on this occasion. A pre-admission assessment is important as it helps to Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: demonstrate that all aspects of the persons needs have been discussed with them, including their strengths and abilities. And also how they are likely to get on with the other people living there and how individual risk is to be managed. This information is used to produce a service user plan which is specific to that person. Poor information gathering does not promote a person centred approach, where one person has very different support needs from another. Seven surveys were completed by people who live there. Four said they were were asked if they wanted to move and received enough information about the home before moving there. One said. I said I wanted to come to this home to live because I lived here before. Three people answered no to the questions, with one person saying I had nowhere else to go. I didnt receive any information. A service user guide and Statement of Purpose are available in the entrance area for people to read. These though need to be updated. The senior manager has written new versions of these, but they are not yet displayed. It would be good practice for the service user guide to be produced in a format, which is inviting for people to look at. This could include photographs and comments from the people who live there. This would make it more interesting and relevant for people thinking of moving there. The person who moved to Victoria Court in the past year had a contract which itemised different aspects of their care. This is good practice as it helps people to understand exactly what is being provided by the service. The persons copy was stored with the original, as the senior manager said the individual did not want to keep theirs. It would be good practice to record that the contract had been discussed with the person and they signed to say they didnt want to keep their own copy. Care Homes for Adults (18-65 years) Page 13 of 36 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. Whilst people are supported and helped to make choices, the written records still do not provide enough information, so people may not receive the right support for them. Evidence: Three peoples support plans and other records were looked at during this visit. These are in place to describe the care and support people need to take control of their own lives as much as possible and to develop their independence and living skills. These records suggested that people had been consulted about what had been written down and there were monthly reviews where both the keyworker and the individual had signed their agreement. Whilst the manager said that these reviews were an opportunity to discuss what had happened in the last month, one person spoken with said that generally not much discussion took place. Some people have lived at Victoria Court for a number of years and they like the Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: structure and routine that it provides. Some members of staff also have worked there for some time, so people and staff know each other very well and the record keeping is not always as detailed as it should be. Peoples preferences are well known to the staff, but an unfamiliar support worker would have to learn these over a period of time as they are not well recorded. Each service file looked at contained an assessment from the care management team, describing the individuals care needs and their personal and social support requirements. People are supported and enabled to make decisions about their day to day life. Since the last inspection there has been a greater expectation that people will contribute more to the running of the home and this agreement is recorded. This was discussed with a person who recently moved to the home and recorded, and the manager says this will be the case with all people who move there in the future. Their service plan was detailed, describing short and long term goals. Discussions about how decisions have been made about peoples capabilities and aspirations need to be recorded. This will help to show that they are being supported in a person-centred way. External advocates could also be more regularly used to speak out for people who find decision-making difficult. Records relating to peoples monies were not formally looked at. Last year these were found to be robust and the AQAA reports that all except one person takes responsibility for managing their money each week. People are asked their views on a day to day basis about matters relating to the home. A poster displayed information about residents meetings, however the last one in February had been cancelled. There were no more dates advertised. One person wrote in their survey that the home needs to get residents more involved in planning how things are done in the home. At present the meetings are very few and far between. They added. They currently feel like they have been almost abandoned. People need to feel they are actively contributing to how the home runs and a meeting enables people to speak out about what matters for them. Having minutes and an action plan describing how these ideas are to be implemented helps to show people that they have been listened to. Peoples service files contain assessments of risk, relating to everyday activities, both in the home and the community. For example there were assessments of personal vulnerability, and road safety whilst out in the community, and for self neglect and Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: working in the kitchen. These were not recorded in much detail though, relying on the staffs learned knowledge. Detailed risk assessments need to be written down to show that this aspect of their support has been looked into properly. Staff spoken with were aware of behaviours and responses that may cause an individual to become upset, or angry. They also knew how to calm the situation in a non threatening way. This information also needs to be recorded in greater detail, so that a new or unfamiliar support worker could check how best to manage a situation. One person at the home has displayed some difficult behaviours in the preceding months and their support plan for managing this, and other risks are comprehensively recorded. This sort of detail though needs to be in other peoples support plans too. Although this was a requirement in the last inspection a year ago, only one individuals records have been reviewed and rewritten to provide this extra detail. Care Homes for Adults (18-65 years) Page 16 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are generally happy with their lives and the way the home runs, peoples routines are fairly predictable from one week to the next. Evidence: Victoria Court provides a safe, comfortable environment where people are able to come and go as they please. Some people were out in the town on the morning of the visit, returned for lunch, then went out again afterwards. None of the people living there undertake any paid or voluntary work. No one is undertaking any training, though one person has completed a first aid qualification in the past few years. People spoken with however, do not want this level of commitment and are happy to occupy their time as they choose. There should however be evidence in peoples support plans to show that these sort of options have been discussed. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Four people have been away to Scotland in the last year. Two enjoyed the experience but the others missed the routine and familiarity of their home life. There have been a few more local day trips in the past year and people have said they enjoy regular organised visits to the local library, where they are helped to choose items that interest them. One person can access their emails from there. Another person is a member of the conservative club and attends meetings there. Whilst people say they would like to get out more and do things they are interested in, they did not really know what these might be. One person said theyd like to have more meals out in Bridlington, particularly in summer. However the home has to work within their finances, as agreed with the local authority, and many of the people living there choose to spend their own money on personal items. People were observed being spoken with courteously and respectfully. There was a lot of gentle banter and people spoke fondly of the staff working there. The majority of peoples rooms are now lockable, which provides improved security and privacy. One person said that they were much happier because now only staff could enter their room, when they werent there. However even staff should not be going into peoples rooms in their absence unless the individual has consented to this. One relative wrote to the commission following the inspection. They said the personal touches provided, such as birthday cakes, treats and outings make the place like a real home. Peoples visitors are welcome at the home anytime. And people are supported if appropriate to maintain their religious beliefs. One person goes by public transport to the next town to attend Quaker meetings. In the last year the support staff have encouraged people to take a more active role in the day to day running of the home. Some people now take responsibility for keeping their rooms clean and tidy. This is recorded in their service plan. One person who has moved there in the last year agreed to this responsibility when they moved there. People have also been asked about becoming more involved in kitchen tasks, including shopping. Although several people have expressed an interest in this, and it is recorded in their support plan, those spoken with said this had rarely happened. The manager says people are only allowed in the kitchen when a staff member is present, because of the risks to the safety of people living there. And so this limits peoples opportunities. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: The manager needs to promote a culture in the home where within a risk assessment framework, people are regularly able to contribute to helping in the kitchen. This will provide more partnership working and improve peoples life skills and self esteem. The dining room has been redecorated in the past year. The next meal is written on a chalkboard in the dining room, so that people can check what they are going to be eating. There is only one main meal, but support staff know people well and have a written record of peoples likes and dislikes, so can offer alternatives in advance of the meal. People spoken with said the meals were very nice and I am satisfied with the food. The lunch on the day of the visit was corned beef hash, carrots and cabbage, with sponge and custard for dessert. People were offered a cold drink with the meal, and a cup of tea afterwards. Cooked breakfasts are available on some days each week and people had been consulted about whether the breakfast experience could be improved by changing the times they were available. People though said they didnt want changes to be made. Care Homes for Adults (18-65 years) Page 19 of 36 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. Peoples personal and healthcare needs are generally being met, however the recordkeeping underpinning that support needs to be in more detail to show that people are receiving the right care and support Evidence: Generally people speak positively about living at Victoria Court. One person had written a letter to the home, saying how much theyd enjoyed staying there for a short spell, and asking if they could move there permanently. There was little opportunity to observe staff interacting with people living there, because of the number of staff working that day, although those seen were observed speaking respectfully and politely. There was a very relaxed and calm atmosphere and people were moving around the home as they chose. Currently all the support staff at the home are female of varied ages and backgrounds, though the manager recognises the need to have male staff to provide choice for the people living there. A male support worker has been recruited and the home is waiting Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: for the recruitment checks to be complete, before they start work. People are encouraged to be as independent as possible, both in their day to day lives and in maintaining good health. People said they would make their own healthcare appointments or ask the staff to do it for them. Each person has a keyworker, who is a staff member with whom they have stronger links. One person said they had visited their family doctor that morning and a support worker had gone with them. One health care professional completed a survey as part of the inspection process. They commented that staff at the home always recognise and prioritise peoples care when urgent support is required. They liaise well with other healthcare professionals to provide the best possible care. However they also commented that peoples psychological support needs were not always immediately recognised so that support could be promptly sought. There were records in peoples personal files to show that healthcare professionals had been consulted about their care. However this only provided the date and the name of the person, and did not record the reason for the consultation or the outcome of the visit. This does not provide a detailed enough record to show that the home is referring people appropriately for advice, and then following the advice that is provided. For example one persons care plan said they were to use an aid to help with walking around. The person was not using it because they didnt like it. The manager said the physiotherapist had said that if they didnt want to use the aid, then that was alright. However this information wasnt recorded anywhere. A small staff team means that staff will be informed of changes verbally, but an unfamiliar support worker would not have information to refer to, so it needs to be recorded. Another person had fallen at the home, requiring hospital treatment and the manager said they had introduced a system to minimise the risk of this happening again. This though wasnt written down. If ways of working are not recorded then the individual may get different levels of support , dependent on who is providing it. Some people have lived at the home for a number of years and are developing needs associated with older people. The manager must be able to anticipate these needs and make sure the staff have the skills and the home has the facilities to support the individual in a safe way. These care needs must be clearly recorded so that all staff provide the support in the same way and in a safe way. The home uses a NOMAD medication system, where the pharmacist dispenses the Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: tablets into individual named cassettes, which staff then administer the tablets from, each day. These medicines are securely stored in the home. The manager has attended extra training so that she can provide in-house training to staff until they can attend accreditted external training. One recently employed support worker was already working on a distance learning medication course. Medication record sheets were completed correctly but some processes, outside the homes control, were making the homes medication practices more difficult. Following the inspection a request was made for a community pharmacist to contact the home to discuss some of the issues. One person looks after their own medicines and a risk assessment is in place, which is reviewed regularly and signed by both the individual and the manager. One person keeps their own inhaler and this decision should also be risk assessed as they are being responsible for some of their prescribed medicines. Two prescribed drugs have to be kept cool and these are stored in the general fridge in the kitchen. It is good practice for homes to have a separate lockable drugs fridge with an integral minimum/maximum thermometer. If drugs are to be stored in the ordinary fridge then the manager needs to carry out a risk assessment of this continued practice. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are taken seriously and whilst staff are alert to the need to protect people from harm, the policy still doesnt support that process. Evidence: Five of the seven surveys completed by people living there said they knew how to complain if they were unhappy about something. The manager must continue to remind all the people living there to speak out if they have concerns, so that the home has the opportunity to put things right. The home also has a comments/suggestions book which contains a number of comments, including some written by the people who live there. Whilst the commission has not received any complaints in the past year, the home has received one. One resident complained about the behaviour of another person living there. As well as speaking with the individuals the manager also wrote to the complainant telling them how she was dealing with the matter. This is good practice and follows the homes complaints policy. However the letter said that she would write again to the complainant when she had fininshed her investigation, and this she did not do. it would also be good practice to ask the complainant to sign that they are satisfied with the way the complaint has been managed. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: Over the past year there have been several incidents at the home where one person has been put at risk of harm, by the actions of another person. The manager has reported these promptly and liaised with the local authority, the commission and other agencies to protect peoples safety. However the homes policy on Abuse states that an allegation is to be reported to the proprietor/manager who will conduct an investigation. This does not follow national and local safeguarding policies, which states that the local authority have the responsibility to take the lead with any investigations. A recommendation was made at the last inspection a year ago for the homes policy to be expanded and the correct process to be recorded. This has not been done. One recently employed staff member confirmed they had attended training in safeguarding adults soon after starting working at the home . When questioned they recognised the need to keep people safe and how this could be achieved. They also knew that they had to pass on information immediately if people could be put at risk, even if asked to keep the information secret. This is good practice and means staff recognise their role in protecting people from harm. Care Homes for Adults (18-65 years) Page 24 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable and changes made in the past year mean it is more suitable to meet the needs of the people who live there. Evidence: Victoria Court was noted to be clean, warm and comfortable. Five of the seven surveys completed by people living there stated that this was always the case and two responded that this was sometimes the case. The home employs a domestic who works five mornings a week. People are encouraged to keep their own personal rooms clean, with the domestic concentrating on the communal rooms and washrooms. The home has two lounges, one of which is a smoking room, and a dining room. There were no tobacco smells noticeable in other parts of the house. There is an outside sitting area at the front and back of the home. A new large awning has been fitted at the front which makes the home look cared for and provides some protection from the sun. Since the last inspection one year ago the owners have fitted new specialist toilet roll and soap dispensers, and paper towel holders in the toilet/washrooms. This means people no longer have to take their own equipment with them when they use these Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: facilities, which is a more dignified way of living. Most of the personal rooms also have had locks fitted and people can choose to have their own key. This means those people can be assured that others wont go into their room in their absense. A few doors are still to have this work done, however the owners prioritised the work according to individual needs. One person spoken with thought this was the best thing that had happened in the home in the past year. Bedrooms are on all three floors. One person commented that they had moved to a room downstairs, as their mobility had worsened. There is a toilet on the ground floor, but no bathroom. This individual was able to use the stairs when they wanted a bath. The visit from the fire safety officer over a year ago found fire safety systems at the home satisfactory. The Environmental Health Officer visit earlier this year was also generally satisfactory, noting general wear and tear of the units in the kitchen. The dining room was being refurbished a year ago and this has been completed, with new furniture and carpet. The laundry room floor and walls have also been renewed so that they can be easily washed, to prevent the spread of potential infection. Care Homes for Adults (18-65 years) Page 26 of 36 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. Whilst staff are well trained, some are working very long hours and peoples total needs may not always be being met. Recruitment processes are not robust so people may be at risk of coming to harm. Evidence: On the day of the site visit the manager and one support worker were at work. The Quality Assurance Manager and domestic were also present for part of the day. The manager had to prepare for the collection and delivery of medicines used at the home and the dinner, which was the main meal of the day, was also to be made. The rota confirmed that two people normally worked the day shift, two people worked in the evening and one person was awake during the night, carrying out mainly domestic duties. These staffing levels are the same as last year, when a requirement was made to review whether they were adequate to meet peoples social needs. The rota also showed that the manager worked ninety nine hours, over the two week period, with only two days off, and a support worker worked ninety hours, with three days off. This persons work needed to be supervised as their full police check was not available to look at, but on two separate hours this individual was the only worker in Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: the home. One member of staff is off sick. These staffing levels, and the expectation that staff will work extra hours, do not promote an effective and efficient staff team and may mean that peoples needs are not being met. A new support worker has recently been appointed, as long as their recruitment checks are satisfactory. The manager though has no protected hours, when she can deal with management matters. However working closely with the staff team does mean that she can informally supervise the way they work. Staff also receive regular supervision where their work can be discussed. Written evidence of these were seen. More than half the support staff at the home have achieved a National Vocational Qualification Level 2 in Care. This nationally recognised award helps to ensure there is a well-informed workforce, who know what good care is. The manager now has a training calendar in her office, where she can record peoples training needs and make sure they receive refresher training in a timely way. One support worker, who started work earlier this year had already attended training in the management of epilepsy, challenging behaviour and abuse awareness and dates were on the calendar for food hygiene, first aid, and health and safety. They said they were to attend a Train the Trainer course in Infection Control, so that they could train other staff members. Some of the people had lived at Victoria Court for many years and were now developing needs which are more often seen in older people. The manager must ensure that staff also have the skills and knowledge to support these individuals in a safe manner. People spoken with were happy living at Victoria Court. One person described the staff as alright. Another said they know the ropes, but theres not enough of them. They work too long shifts. All the surveys respond either always or usually to the questions do the staff and managers treat you well? and do they listen and act on what you say? Two staff recruitment files were looked at. Whilst the documentation was generally satisfactory one persons previous employment had been at a care home, however although the care home manager had been named as a referee, neither references were from the home. The manager was able to explain why the home had not provided a reference, but this information needs to be written down to provide a complete audit trail. Also as written earlier in this part of the report, this individual had at least two periods when they were alone with people in the home. If people start working at the home before their complete police check is available to look at, then Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: they must not work unsupervised. These recruitment systems are in place to keep people safe, and not following them may be putting people at risk. Care Homes for Adults (18-65 years) Page 29 of 36 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. There is a culture of openness and respect in the home, however people with an interest in how the home operates need to be consulted more so that they can influence how it runs. Evidence: The registered manager is very experienced and has been in post for a number of years. She has undertaken extra management training to help her with her role. She showed in discussion that she had a good understanding of mental health issues and how these illnesses affect the people who live there. And telephone communications in the last year have shown that she recognises the needs of people living there. People describe her as friendly and approachable. One person said if someone was horrid to me then I would go straight to Sheila. The manager says that she normally finds time on a weekend to carry out her management duties, but has no rostered protected time. So when she is doing office work there are less staff to sit and talk with people or organise activities. She does not Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: have access to a computer or the internet to help her to keep up to date, both in her personal learning and in changes in social care legislation. This situation has not changed in the last year. The results of surveys were not available to look at. The Quality Assurance Manager agreed to send these to the commission to look at. These are still awaited. Some dates for residents meetings were displayed on a notice board, although the last one, in February, had been cancelled. No future dates are displayed. One person living there said that residents meetings were drying up. They said they would like to be more involved in how the home runs. People who have an interest in how the home runs must be regularly consulted and an action plan needs to be displayed, describing what is going to change as a result of peoples comments, and when the changes are to be made. Then people will be able to check whether they have been listened to. These records need to be available in the home for authorised people to look at. The whole quality assurance system needs to be more developed and the manager needs to have the time and resources to carry out her role properly. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, and safe moving and handling techniques. Fire safety records show that the staff have received training earlier this year, but records to confirm training last year were not available to look at. Fire alarm checks are carried out and one of the people living there confirmed this. Staff are required to update their knowledge by reading about health and safety policies, but it would be good practice for the manager to have some way of checking their knowledge and understanding. This was commented on at the last inspection, one year ago. Accident records are completed appropriately and the commission has been promptly informed of incidents where people have needed hospital attention. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 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 2 14 People must not move to the 14/06/2009 home before a detailed written assessment of all their needs is undertaken. This is to check whether the homes facilities and the staffs knowledge and skiils are able to meet their needs, should they choose to move there. 2 9 13 People looking after any of 30/06/2009 their prescribed medicines must have an assessment of risk of harm from keeping hold of the drug themselves. This is to check that they are safe and competent to keep the drugs thermselves. 3 9 13 Assessments of risk and how 30/06/2009 this is to be managed must be written down in sufficient detail to give clear direction to support staff. Care Homes for Adults (18-65 years) Page 33 of 36 This is so that people will be supported in a a safe consistent way. 4 19 15 Healthcare support needed and provided by support staff must be clearly recorded in a plan of care. This is so that this support is provided by all staff in a safe, consistent way. 5 23 13 The policy about Abuse and Whistleblowing must be expanded and amended to include clear guidelines about what staff at the home must do if they suspect or see an incident which may be abusive. This will make sure staff have an accurate record of what they need to do, in order to follow local guidelines. 6 33 18 The staffing levels at the home must be kept under regular review. This is so that as peoples needs change so there are sufficient staff to meet those needs. 7 34 19 Staff working at the home before their complete police check is available to look at must not work unsupervised. This will help to ensure people are not being put at risk by being in the care of 14/06/2009 14/06/2009 14/06/2009 30/06/2009 Care Homes for Adults (18-65 years) Page 34 of 36 someone who is not suitable to work in a care setting. 8 34 19 The home must be able to 14/06/2009 provide a robust audit trail to demonstrate that the background of someone who is applying to work at the home has been looked into properly. This will contribute to people being kept safe. 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 7 Support plan records should be able to evidence how people have been supported to make individual decisions about their abilities and goals. There needs to be evidence that local work and educational opportunities have been looked into and discussed with individuals to show that they have made a positive choice not to pursue these types of activities. It is recommended that a small lockable drugs fridge, with an integral minimum/maximum thermometer is used for the safe storage of medicines that need to be kept cool. The manager should have some supernumerary hours each week, where she can carry out her management duties without being called on to help with the day to day running of the home. There should be a more robust sytem of gaining the views about the home from people living there, or people with an interest in how the home runs. This needs to be done in a way that people living there can understand and contribute to. Results need to be displayed, so that people understand what is going to be changed and when. This will help them to know that they have been listened to. 2 12 3 20 4 37 5 39 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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