Care Home: Weaver Court

What the care home does well Following the recent strategy meeting and a visit by the Health Care Commission to the home, the provider (Bradford District Health Care Trust) have swiftly responded to the findings of both. Senior Management have visited Weaver Court and developed a action plan which should improve the outcomes of people living at the home. So far they have increased the numbers of staff working at the home and are trying to secure a stable workforce. What the care home could do better: People who use the service must have a support plan which is regularly reviewed, written by competent staff and is in plain English, easy to follow, fully reflects the needs of the people using the service and provide all the actions necessary to support the person properly and safely. Also they must show that people who use the service are making choices about the way they lead their lives. This will make sure people are receiving care consistently and safely in the way they prefer. Staff must follow care plan guidance to make sure people`s needs are met and they are safe. Where a risk is identified a risk assessment must be in place. The risk assessments must be are reviewed and updated when any of their needs change. This is to help minimise any risks to people. To be sure that peoples health care needs are fully met. Staff must review peoples health care needs to make sure they are receiving the support and health care they need. Staff must protect peoples dignity and speak to people respectfully. Incident forms and behaviour charts must be reviewed regularly to identify any changes and where changes are found identified these are reported to the appropriate support agency.This will help people identify and act upon any changes to improving the care provided. All staff must follow the safeguarding adult procedures for all allegations of abuse and alert both the adult protection and the Commission. This is to make sure people are protected from abuse. There must be a sufficient number and skill mix of staff working at the home to meet the needs of the people who use the service. The people who live at Weaver Court have very complex needs and staff who support them must have sufficient knowledge about their needs and be suitably experienced to provide the right care. If the assessments identify people have nursing needs the home must either find alternative placements or apply for immediate registration as a care home with nursing. We have written a letter to Bradford District Care Trust requiring them to inform us by the 3rd April 2009 the outcome of the assessments and how they will meet peoples nursing needs. An alternative must be found for the baby monitors. These devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside the home. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Weaver Court Moorfield Place Idlecoft Road Idle Bradford BD10 9TL one star adequate service 19/11/2008 The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Caroline Long Date: 1 8 0 3 2 0 0 9 Information about the care home Name of care home: Address: Weaver Court Moorfield Place Idlecoft Road Idle Bradford BD10 9TL 01274615538 01274612708 julie.hillam@bdct.nhs.uk 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) : Bradford District NHS Trust care home 22 Number of places (if applicable): Under 65 Over 65 0 8 0 0 dementia learning disability physical disability sensory impairment Conditions of registration: Date of last inspection Brief description of the care home 1 22 22 2 1 9 1 1 2 0 0 8 Weaver Court is a Bradford District NHS Trust home situated in the Idle Croft area of Bradford. The home is registered to provide personal care for up to 22 people with learning disabilities. The home provides long-term and respite care. Accommodation is provided on two floors; there are 22 single bedrooms. Shared lounges are located on both floors. There are five bath/shower rooms, some of which have hoisting facilities. Weaver Court has a large enclosed garden and car parking is located at the front of the building. Local shops and bus routes are within easy access. Care Homes for Adults (18-65 years) Page 2 of 14 Brief description of the care home Care Homes for Adults (18-65 years) Page 3 of 14 What we found: Weaver Court is registered to provide personal care only. The Local Authority were made aware of a number of concerns raised by staff at Weaver Court regarding the care received by people living in the home. As a result of these concerns an urgent adult protection strategy meeting took place on the 6th March 2009 which involved the Commission for Social Care Inspection, the Primary Health Care Trust, the Health Care Commission, the Local Authority and Bradford District NHS Trust . An immediate protection plan was agreed to make sure people living at the home were safe and their needs were met. The meeting identified that some of the people living at Weaver Court had nursing needs. Therefore it was agreed as a temporary measure Weaver Court could continue to care for the people by bringing in nursing staff on a temporary basis and had people reassessed to decide if Weaver Court was suitable to meet their needs. This is to make sure people receive the nursing care they need. As a result of the strategy meeting two inspectors carried out two visits to the home in an evening and during the day, to look at how people are cared for . As part of these visits we examined three peoples records, talked to staff and observed staff supporting people in the home. This help us to look at whether the actions agreed at the strategy meeting are place and whether peoples health needs are being met and if people are being safeguarded from harm. When we visited Weaver Court it was specifically to look at whether peoples health needs are being met and if people were being safeguarded from harm. However we recognise there are other areas where improvements are necessary and we will be following these up at the next key inspection. The home has nineteen people with very different needs some who are not compatible to live together. The environment is very institutional, the walls did not have many pictures, the lounge has a TV and little furniture. One person has lived at the home for ten years and it was identified the home did not meet their needs in 1999, a review in March 2005 also indicated Weaver Court was not the best place for them to live and they were a risk to other people in the home. This person is still living at Weaver Court. However following the strategy meeting, people who live at Weaver Court are being reassessed to find out if they have nursing needs and if the home can meet their needs fully. The registered manager told us six people have been reviewed so far. Staff were generally kind to people, and some staff spoken with could describe peoples needs well and the care and support they give. However peoples privacy and dignity is not protected examples of this were:Staff were not always discreet or respectful of peoples dignity. One person was asked in a loud voice if they were wet and did their pad need changing. Another said, again Care Homes for Adults (18-65 years) Page 4 of 14 in a loud voice, Lets get those soiled clothes out of your bag. Baby monitors were used as listening devices, these devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside the home. We saw at 7:45 pm when we arrived most people were in their pyjamas, they did not have dressing gowns on and parts of their bodies were exposed. On arrival one person who was ready for bed, was wearing a pyjama top and boxer shorts. They did not appear to fit properly and they were clutching at the waistband of them to prevent them falling down. They did fall at one point and they were left exposing their lower abdomen. We asked staff how they maintain peoples dignity with their clothing. One staff member said they use belts and braces when peoples clothes are too big for them. They were not aware of any reasons as to why people wore clothes that were too big for them. Another person, a wheelchair user had their night attire on. It was very warm in the home and they appeared to be too warm, and they had undone their dressing gown which left their thighs exposed. One person was helped between a bedroom and a bathroom covered only by a towel. When people asked for help or support they were told two minutes but staff did not give any explanation about what this meant. People were provided with drinks in mugs that were chipped. Some of the chairs were very marked and grubby. We looked at two peoples health care records in detail to find out if their health care needs were being met, we found:Most of the records were not dated or signed so it was unclear if they were current or who had completed them. There was no evidence that people who live at the home or their representatives had taken part in the drawing up of the plans. There were some gaps in care and support needs, and general terms were used for example, Full support which does not accurately describe the sort of help or assistance someone may need and could lead to care and support needs being overlooked. There were inconsistencies in the way care was being given because staff were working differently and not always aware of peoples care plans. This puts people at risk from having their needs missed or overlooked. For example:Care plans and risk assessments said one person was at risk from aspiration and choking however there were two contradictory instructions for staff about the way the person should receive their meals. These were food should be blended and cut into small pieces, this lack of clarity makes it difficult for staff to follow and unsafe. Also one staff member was not aware the food should be blended. The records showed this person has a history of unexplained vomiting, which could lead to them being Care Homes for Adults (18-65 years) Page 5 of 14 nutritionally at risk and a monthly weight chart was in the care plan however they had not been weighed since August 2008. The persons care plan showed their fluid intake was to be recorded. Some staff thought this was the case and went to look for the chart however they were told it had been discontinued on 27/2/09. A care plan said a person had a visual impairment and to always approach them from the right side. Staff seemed to be unaware of this and how to enable the person to make the best use of their vision. Staff told us one persons behaviour could be challenging especially in a evening and at night and more against women staff than men. The triggers and specific actions staff need to take was not reflected in the persons care plans or risk assessments. Also when an incident did occur although an incident form was completed by staff and it was logged in their daily notes, and the registered manager told us that the senior staff read the care plan to identify the changes, we could not find any evidence how this information was being used. Also where a health plan asked for the person to be weighed each day before breakfast, and if their weight increase over two to three days to report to the doctor, they had not been weighed each day. One person had very long and untrimmed finger nails. One person uses a moulded seat in their wheelchair, they looked uncomfortable with their head leaning forward, this looked to be a strain on their neck. The harness they wear to support them in the chair was dirty. The records showed that no contact with the physiotherapist since 2006. The registered manager and staff did not seem to notice that this position looked uncomfortable and they told us, They can hold their head up themselves if they want to. This person had also had a recent deterioration in swallowing ability, they had been seen by the speech and language therapist. However, records showed they had not been weighed from August 2008 until February 2009. One person had commenced antibiotics for a possible urinary tract infection. However they still attended their regular day centre placement on that day and we could not find any indication staff had given any consideration to the fact that they may have felt unwell. We observed this person on return from the day centre, they were distressed and this resulted in an episode of challenging behaviour. Before we visited the home we were provided with information which told us that the home had not followed the correct safeguarding procedures and people were put at possible risk because of this. When we looked at whether people were safeguarded from harm we found:Staff said the more vulnerable people in the home were at risk from the unwanted attentions of other people who live at the home and went on to say that people were mismatched and didnt always get on. Examples we were told of were:One person regularly sits on another persons knee, without their consent and scratches the back of their neck, when they become irritated they will push the person Care Homes for Adults (18-65 years) Page 6 of 14 away and this has resulted in bruising. However we found nothing in their risk assessments to show how they are protected from one anothers behaviour and although staff said this person, plagues him to death, this behaviour was allowed to continue. During the visit we observed a number of incidents where people were vulnerable and unprotected. One person had drinks taken from them, three in a row and staff did not intervene. Another person was touched around the hair and neck by another person. One person took a cup of hot coffee near to a person in their wheelchair, who is unable to move and split it by their chair. Staff also told us that peoples property was unprotected and that some people regularly went in to other peoples rooms and took their property. One staff described it as someone getting their room trashed. Staff said they had received training in safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. Some staff were not aware of the whistle blowing policy but said they would know where to look for it. Staff gave the correct response in that they would report any safeguarding issues, no matter of the scale of them. For example, hair pulling. However safeguarding referrals from the home are limited and staff at the home told us there were incidents most days. We noted that the size and layout of the building does not allow for adequate supervision of people who live at the home which means they are unsupervised for periods of time and therefore vulnerable from the behaviours of others. We saw the home is very big, it is on two floors there are six people on the first floor and eleven people on the ground floor. Staffing levels have recently been increased to ensure there are nine staff on morning shifts and eight on the afternoon shift. However, the majority of staff working at the home are agency and bank staff. Some of these staff are not familiar with the home or the needs of the people who live there. Staff said, It is more reassuring now when doing personal care in the bathrooms or bedrooms that there is someone out here in the main area. It can be hard with so many different and new faces about. There is a nurse on each shift to make sure the health care needs of people are met. Again, the nursing staff are currently from an agency and do not always have a background in learning disability. However the managers within the service said to provide a consistent approach they had recruited a nurse from the assessment and treatment unit which is run by the Trust. They said this nurse had a learning disability background and would be starting on a full time basis from 19/3/09. Weaver Court was visited by the Health Care Commission on the 12th and 13th March where they were accompanied by a representative of the Commission For Social Care Care Homes for Adults (18-65 years) Page 7 of 14 Inspection and where a number of concerns were raised. The concerns they raised reflect what we found during our visit. What the care home does well: What they could do better: People who use the service must have a support plan which is regularly reviewed, written by competent staff and is in plain English, easy to follow, fully reflects the needs of the people using the service and provide all the actions necessary to support the person properly and safely. Also they must show that people who use the service are making choices about the way they lead their lives. This will make sure people are receiving care consistently and safely in the way they prefer. Staff must follow care plan guidance to make sure peoples needs are met and they are safe. Where a risk is identified a risk assessment must be in place. The risk assessments must be are reviewed and updated when any of their needs change. This is to help minimise any risks to people. To be sure that peoples health care needs are fully met. Staff must review peoples health care needs to make sure they are receiving the support and health care they need. Staff must protect peoples dignity and speak to people respectfully. Incident forms and behaviour charts must be reviewed regularly to identify any changes and where changes are found identified these are reported to the appropriate support agency.This will help people identify and act upon any changes to improving the care provided. All staff must follow the safeguarding adult procedures for all allegations of abuse and alert both the adult protection and the Commission. This is to make sure people are protected from abuse. There must be a sufficient number and skill mix of staff working at the home to meet the needs of the people who use the service. The people who live at Weaver Court have very complex needs and staff who support them must have sufficient knowledge about their needs and be suitably experienced to provide the right care. If the assessments identify people have nursing needs the home must either find alternative placements or apply for immediate registration as a care home with nursing. We have written a letter to Bradford District Care Trust Care Homes for Adults (18-65 years) Page 8 of 14 requiring them to inform us by the 3rd April 2009 the outcome of the assessments and how they will meet peoples nursing needs. An alternative must be found for the baby monitors. These devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside 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 set out on page 2. Care Homes for Adults (18-65 years) Page 9 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13 The medication records must 31/01/2009 accurately show the quantities of medicines received, administers and in stock. This is to make sure that people are receiving their medication exactly as prescribed and the home knows, and can account for, the exact amounts of all the medicines in stock. Care Homes for Adults (18-65 years) Page 10 of 14 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Staff must follow care plan guidance to make sure peoples needs are met and they are safe. This will help to provide people with a consistent standard of support. 19/04/2009 2 6 15 People who use the service 19/04/2009 must have a support plan which is regularly reviewed, written by competent staff and is in plain English, easy to follow, fully reflects the needs of the people using the service and provide all the actions necessary to support the person properly and safely. Also they must show that people who use the service are making choices about the way they lead their lives. This will make sure people are receiving care consistently and safely in the way they prefer. You must make sure where a 19/04/2009 risk is identified a risk Page 11 of 14 3 9 13 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 assessment is in place. The risk assessments must be reviewed and updated if there are any changes in the persons needs. This is to help minimise any risks to people. 4 18 12 An alternative must be found 19/04/2009 for the baby monitors. These devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside the home. People must be treated with dignity and respect. This it to help maintain peoples dignity. 6 18 13 You must make sure incident 19/04/2009 forms and behaviour charts are reviewed regularly to identify any changes and where changes are found these are reported to the appropriate support agency. This will help people identify and act upon any changes to improving the care provided. The people who live at 01/04/2009 Weaver Court have very complex needs and staff who support them must have sufficient knowledge about their needs and be suitably Page 12 of 14 5 18 12 19/04/2009 7 18 18 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 experienced. This is to make sure people are provided with the specialist care they need. 8 19 13 Staff must review peoples 19/04/2009 health care needs to make sure they are recieving the support and health care they need. This is to make sure that peoples health care needs are fully met. 9 23 13 You must follow the 01/04/2009 safeguarding adult procedures for all allegations of abuse and alert both the adult protection team and the Commission. This is to make sure people are protected from abuse. 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 Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. Care Homes for Adults (18-65 years) Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!