Care Home: West Drive

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What the care home does well There has been no permanent manager in post since the end of 2008 but staff spoke highly of the Acting Manager who has been temporarily promoted from Deputy Manager. The service is home to people with complex needs. Staff manage challenging situations well and have a good insight into people`s requirements. Morale appears high and staff clearly support each other well despite staff vacancies and the absence of a registered manager. People who use the service are provided with user friendly information about their home and have an assigned keyworker to oversee that their needs are met. People who use the service have structured activities and the opportunity to use space around their home. There is an ongoing training programme for staff to ensure that they are equipped to meet individual needs. What has improved since the last inspection? The service has experienced a calmer period and one new service user has moved in. The Acting Manager has maintained the service and overseen the admission of one new service user who appears to be settling in. The requirement made at the previous inspection has been met: Care plans have been reviewed to ensure that individual health needs are recorded and information is available how needs are monitored, managed and met. Although not yet in post, a manager has been recruited and the Operations Manager aims to ensure that they are in post once all the necessary documentation is received. What the care home could do better: The service would benefit from a registered manager to enable the issues that have been identified to be addressed. A protocol must be devised to reflect how staff are managing a restricted environment in line with the Deprivation of Liberty aspect of the Mental Capacity Act. The front door is locked and the kitchen and sensory room have restricted access. The medication system does not adequately protect people who use the service. There needs to be a formal system in place when medication leaves and returns to the service and an agreement about administration when away from the home. Copies of prescriptions must be kept. There are some infection control issues that need to be addressed: there is a crack in a kitchen cupboard and staff share a towelling towel in the staff toilet as opposed to using paper towels. Furniture is not suitable for the needs of some of the people who use the service. Some bedroom furniture is missing drawers and wardrobe doors. The TV cabinet discussed at the previous inspection has not yet been built. There was an altercation between staff that was not reported to the Commission and we must be aware of any situation that may impact upon people who use the service. Staff are working an increased number of hours which is not ensuring staff are well rested between shifts. Key inspection report Care homes for adults (18-65 years) Name: Address: West Drive 1 West Drive Arlesey Bedford SG15 6RW     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: Angela Dalton     Date: 0 4 0 8 2 0 0 9 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 33 Information about the care home Name of care home: Address: West Drive 1 West Drive Arlesey Bedford SG15 6RW 01462835490 01462734975 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.milburycare.com Milbury Care Services Ltd care home 10 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 10. The registered persons 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 are within the following category: Learning disability - code LD. Date of last inspection Brief description of the care home The Commission for Social Care Inspection (CSCI) registered West Drive as a care home for up to eight people with a learning disability in March 2007. The home is a detached property in a large secure garden in the Mid Bedfordshire village of Arlesey. The home is currently on the edge of a new housing development being built on the site of an old hospital. It is close to local shops and other amenities. There is a bungalow next to the main house which has a bedsit layout for two people and houses a third bedroom for sleep in staff. The home benefits from space, as in addition to each of the people using the service having their own large en-suite bedrooms there is a communal lounge, dining room, activity room, and quiet sensory room (with snoezelen equipment) The lounge opens onto decking and onto a large garden. There is an outbuilding for which there are plans to renovate it and make it a second activity Care Homes for Adults (18-65 years) Page 4 of 33 10 Over 65 0 Brief description of the care home room for the service users. There is parking inside the grounds and on the road outside. The home is close to a bus route. Monthly fees range from 1250.01 pounds to 1923.01 pounds. 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: One inspector conducted this unannounced site visit on 4th August 2009 between 10.15am and 5.25pm. Two people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service and members of the staff team and the Acting Manager. We sent out surveys to people who use the service, relatives and professionals. We received 2 surveys that were positive although no personal comments were made. Care Homes for Adults (18-65 years) Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 7 of 33 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. The necessary information is in place to enable people who use the service to make an informed choice about moving in. Evidence: The service has one new admission since the previous inspection in March 2009. The service has a new Acting Manager who was formerly the deputy and they conducted the assessment prior to admission. This contained an overview of information and the previous service provider had completed a comprehensive assessment with lots of information. This has formed the basis for the care plan which is still being developed. The acting manager confirmed that the admission to the home had been carried out with careful consideration to the needs of current service users. Initially, the service user was visiting West Drive for a respite stay but is now staying on a permanent basis. A contract has not yet been issued as the decision has been made recently. The statement of purpose had been reviewed in January 2009 to reflect that information is current. Each service user has a copy of the service users guide. This outlines what facilities Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: the service offers and what is available in the local area. It is in a user friendly format and contains pictures and large print text to ensure it is easily understood. Each person had a contract which outlined the terms and conditions of the home and what services could be expected whilst living at West Drive. The registration certificate reflected current details about the service providing up to date information to people who use the service. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are encouraged to make their own decisions and choices. Evidence: The Acting Manger has reviewed existing care plans to ensure that they reflect the needs of people who use the service. We looked at the care plan for the person who has moved in recently and where changes had been made to existing care plans. Risk assessments have been developed to illustrate how staff assist people to take risks and how they are monitored, managed and met. The acting manager has developed specific risk assessments to illustrate how staff support people with complex needs behaviours and potential risks e.g. infection control. The positive aspects we identified at the previous inspection remain in place. Information is recorded at the end of each shift to ensure that staff have a clear picture of individuals needs and what activities have taken place. It also enables staff to identify any current or potential issues that may require attention. Staff have a good awareness and insight into working with people with Autism and understand the Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: importance of routine and consistency. We observed staff carry out support in accordance with care plans. Staff were engaging with people on their own terms. Some people went out for a walk during the inspection whilst others enjoyed using the garden and decking area. Care plans were divided into specific areas. There was information to enable staff to meet daily living skills such as personal care and nutrition. Individual likes and dislikes were recorded for leisure activities and food. There was information to reflect how complex needs, including behaviour, are managed and monitored. Staff confirmed that they had adequate information to work alongside people and meet their behavioural needs. There were records to assist staff to identify behavioural triggers and enable them to use techniques and distractions to prevent escalation. Monthly reviews ensure any required changes are made and recorded. Some simple but effective changes had been introduced by the acting manager: it had been noted that one person spent a lot of time by the notice board and this resulted in some complex behaviours when people entered the house. The noticeboard has been moved into the lounge which has addressed the issue. People who use the service have better access to information because it is in a bigger space. Elements of Person Centred Planning featured within care plans to ensure peoples hopes, dreams and aspirations were recorded and incorporated into their daily care. The acting manager hopes that this will be developed with the appointment of a permanent manager to further support the long and short term goals that have been identified. Risk assessments reflected how individuals were assisted in managing risks, such as crossing the road. There are plans to review some risk assessments and practices, such as locking toiletries away and locking toilet doors in line with the Deprivation of Liberty aspects of the Mental Capacity Act. Staff have yet to receive training to enable them to assess current practices. Each person who uses the service receives family support but independent support could be sought from Advocacy Alliance if necessary. Important family information was recorded such as birthdays to ensure that staff could assist in sending a card or gift. Most families had signed care plans to reflect involvement and this had increased since the previous inspection. The acting manager is exploring ways to reflect how people have been involved in devising their care plan or if it has been explained to them. We observed staff communication with people in a way which they could understand, Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: using Makaton signs where appropriate. This supported information that was recorded in care plans 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and how they spend their leisure time. Evidence: The service has 2 vehicles; a people carrier and an estate. Some people went out for a drive and walk during our visit. One person was being supported to attend the gym and others went swimming. Some people spent time in the garden relaxing or exercising with staff whilst others watched a DVD or listened to music. As it was the summer holidays people who usually spend time at college were at home during the day. Staff told us that they were managing to ensure people were occupied and spending their time as they wished. One person is currently receiving one to one support to ensure that their needs are being met. However, this is not being funded and the staff are accommodating the changes in the level of support. The introduction Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: of one to one support has reduced some of the incidences of other people living at West Drive being injured but injuries still occur. One person has begun to visit a restaurant fortnightly and now looks forward to meals out. This has been a positive step enabling them to eat out with their family for the first time. Staff aim to ensure people go out each day, as remaining at home can quite often be counter productive and may result in people becoming agitated. Each person has a leisure and activity timetable. All the people who live at West Drive go on holiday with their families. There is also the opportunity to go on holiday with West Drive. Destinations have not yet been planned. For those people who choose not to go on holiday alternatives are available such as days out. People participate in the running of their home and assist with cooking and cleaning where possible. Cooking usually takes place in the dining room as the kitchen presents too many risks. One member of staff is usually responsible for preparing dinner between 17 and 18 people. This means that they are unavailable to support people for the length of time it takes to prepare a meal. Each person is supported to do their laundry and each person has 2 half days assigned. There is a computer for service users but this does not have internet access or an email facility. One service user regularly uses the computer in the office to gain access to the internet but this can be disruptive for the individual and staff. A request has been submitted to the company for internet access and a broadband connection is awaited. The service has a snoezelen (sensory) room on the ground floor which can be used for relaxation and this has been recently decorated. There is an activity room located in the garden with a pool table and karaoke machine. However, the room is not effectively heated and tends to be used more in the warmer weather. Although a request to make it more user friendly has been submitted no date has yet been agreed. The large garden can be accessed and there is equipment available to use such as a trampoline and ball pool but this was not assembled due to recent poor weather. The garden also provides an opportunity for people who use the service to let off steam. A new television and DVD player are awaiting a cabinet to be fitted to as previous items have been dismantled.This was noted at the previous inspection in March 2009. We observed dinner preparations and staff ensure that they eat with service users to Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: promote it as a social occasion. Individual likes and dislikes are recorded on care plans. There is a white board to display daily menu options so that people know what is being served for each meal. Service users go shopping locally for food and likes and dislikes are sought at house meetings or one to one work with staff. Where there are issues with meals and nutrition specialist input is sought. Families have good links with West Drive and visit frequently. The acting manager reported that everyone went home for weekend breaks or holidays at frequent intervals. Care Homes for Adults (18-65 years) Page 17 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. The medication system does not ensure the safety of people who use the service. Evidence: Service users have access to health and social care professionals and this was reflected in care plans and reviews. Staff regularly liaise with professionals to seek advice and support for people who use the service. They have access to professionals with knowledge of Autism to ensure that needs can be fully met and enable staff to work in a consistent manner. We looked at one care plan in depth and improvements that had occurred in a further two. Health needs have been identified and information is now available to reflect how needs are monitored managed or met. A requirement was made at the previous inspection - specifically in the case of one persons care plan to manage continence and epilepsy. Personal care guidance and preferences were recorded in care plans. There are now guidelines to reflect how staff assist a person to manage their continence needs. Staff were observed to be discreet and appropriate in their support. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: We checked 2 peoples medication and the amounts were accurate and clearly recorded. However, although there were records to reflect medication went on home leave with people who use the service, there was no record who the medication was handed over to or any record of whether or not it was taken during time away from West Drive. When medication returned to the home it was not possible to identify whether the balance was correct or not. We were told that not all families continue to administer medication. There is no medication protocol in place to reflect arrangements during absence from the home. Some of the medication that is prescribed works effectively because it needs time to build up and stopping and starting the dose could be detrimental to peoples health. A formal arrangement must be put in place to ensure that peoples health needs are assured. The service does not keep copies of prescriptions which act as a receipt of the G.Ps instructions. The acting manager plans to rectify this. Care Homes for Adults (18-65 years) Page 19 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 who use the service could be better protected from the risk of harm and abuse. Evidence: There have been no complaints received since the last inspection. The home has a calmer atmosphere which can be attributed to proactive measures taken by staff (as mentioned earlier). Each service user has a copy of the complaints procedure in an easy read format. There has been a situation between two staff that came to light during the inspection when a manager from another home came to visit to take a statement as part of an ongoing investigation. The incident had not been reported to the Care Quality Commission or to the Safeguarding team. Although people who use the service did not observe the incident it may have been overheard. We clarified the issue with the Operations Manager and Acting Manager. One staff member had been suspended whilst the other took time off. They have been redeployed to other services whilst the investigation is ongoing. The Safeguarding Team have been notified by the Acting Manager and CQC. We looked at the staffing rota. There are several staff who are working far more than their contracted hours. Although they have signed a waiver for the European Working Time directive (which enables staff to work more than 48 hours each week) some staff are working up to 78 hours each week. There was evidence that staff were working an Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: early shift (7am - 2pm) and returning for a waking night shift (9.30pm -7am) and then working a late shift (2pm - 9pm). This is not conducive for working with people with complex needs who require staff to be patient and tolerant and rested. We have received some notifications identifying that one person who uses the service is targeting others and injuring them. Staff are providing 1-1 to minimise the risk to others but additional funding has not been released to ensure that staffing levels meet the needs of all people who use the service. The acting manager informed us that all behavioural incidents between service users were reported to the safeguarding team. Staff had signed to state that they were familiar with the safeguarding policy. We checked two financial records and found them to be in good order. Care Homes for Adults (18-65 years) Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment could better meet the specialist needs of people who use the service. Evidence: The house was clean, tidy and odour free on the day we visited. There are plans to redecorate the kitchen which has water marks down the walls from a leak earlier in the year. One of the door frames and door in the kitchen was cracked which the acting manager will report as this presents an infection control risk.The toilet that staff use did not have paper hand towels and towelling hand towel was in use. Paper hand towels would minimise the risk of cross infection. This work is due to take place soon and people who use the service have been involved in choosing the colour scheme. The sensory room has also been painted. A lock has been fitted to ensure that people who use the service are supported by staff. This is because equipment is repeatedly broken and the walls are drawn on if the room is left open. The acting manager told us that the lock had recently been fitted and they were writing a protocol to ensure the room was available for everyones use. Bedrooms are personalised but not all furniture is suitable to meet the needs of people who use the service. This has deteriorated since the inspection in March 2009. Shower facilities have been repaired as at the previous inspection one person was using the Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: shower facilities in the staff sleep in room as they had removed the bathroom tiles and broken items of furniture in their bedroom. The doors from the wardrobe and fronts from the chest of drawers were missing as they had been broken. This has not been addressed. The furniture does not meet the specialist needs of people who use the service. Plans discussed at the previous inspection to research furniture that is more substantial and better suited to meet peoples specialist needs have not been implemented. Although there have been two quotes to to fit a more substantial television cabinet work has not yet commenced. A new television and accompanying equipment cannot be placed in the lounge until a suitable cabinet is fitted. People who use the service still have access to a television but a new one is not in use. The garden was tidy and garden furniture is used during the warmer weather. In addition to the main house there is also a bungalow which is home to 2 people and has a sleep in room. This was in good order. As stated earlier, the acting manager will review the locked door policies to ensure that the Mental Capacity Act is observed. Care Homes for Adults (18-65 years) Page 23 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. The amount of hours worked by staff may compromise their evident skills and competency. Evidence: There have been no new staff employed since the previous inspection.There are currently 6 vacancies: 1 Manager and 5 full time (35 hour) support worker. 3 staff are going through the recruitment process and interviews are taking place over the next week to fill the remaining 2 vacancies. Staff had been recruited at the previous inspection but they did not commence work. As discussed earlier in the report many of the staff work over their contracted hours. In some cases staff work more hours in overtime than their contracted hours. We looked at the staffing rota. Although staff have signed a waiver for the European Working Time directive (which enables staff to work more than 48 hours each week) some staff are working up to 78 hours each week with only 7 hours between the end of one shift and the beginning of the next. There was evidence that staff were working an early shift (7am - 2pm) and returning for a waking night shift (9.30pm -7am) and then working a late shift (2pm - 9pm). This is not conducive for working with people with complex needs who require staff to be patient and tolerant and rested. Agency staff are used occasionally and we were told that this had to be approved with the Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Operations Manager. As discussed earlier with regard to meals one staff member may be cooking for 18 people which means that they are not providing care and support whilst preparing a meal. This may be for some time, especially when preparing dinner. Recruitment records and the pro forma that is used are kept in individual files to reflect that all required checks to protect service users are conducted. The pro forma is in place following an historic agreement between Voyage and the Commission for Social Care Inspection that the Professional Relationship Manager for the Commission can check records at the head office. This agreement has been transferred with the new Commission. The acting manager told us that ideally 6 staff work on an early and late shifts with an additional member covering the middle shift where possible. Owing to sickness there were only 5 staff working on the morning of the inspection. 2 staff work waking nights with a member of staff sleeping in at the bungalow. Vacant hours are covered by staff or agency. There is a policy to ensure that agency staff do not observe personal care during the first week of work to ensure that service users dignity is observed. All staff are expected to complete the Learning Disability Qualification within 6 months and 11 out of 23 staff have an NVQ qualification: 1 at level 4, 2 at level 3, 8 at level 2. Staff appeared to have a good rapport with people they support. The atmosphere was calm but staff were clearly trying to meet all service users needs as they were short staffed.Staff were observed to be skilled at communicating with people who use the service, many of whom have limited verbal communication. A training matrix was in place to reflect that staff have completed all necessary mandatory training. All staff have access to electronic teaching sessions known as the L box, which provides them will a rolling training programme but this is independent of the internet. They have also completed specialist training to assist in meeting specialist needs such as Non Violent Crisis Intervention training. Staff receive regular supervision but this has been ad hoc due to the changes in management. The acting manager is on target to ensure all staff receive 6 supervision sessions annually. Care Homes for Adults (18-65 years) Page 25 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. A permanent manager would ensure people who use the service would benefit from a safe and well run service. Evidence: The service still has no Registered Manager in post but the Operations Manager told us that they have identified someone for the position. This post has been vacant since the end of 2008. Recruitment checks are in progress and a delay is being experienced because some information is needed from overseas. Once all the checks are completed they are expected to commence employment which should be within the next few weeks. The Deputy Manager is currently managing the service and is Acting Home Manager. They came in on their day off to oversee the inspection. None of the Senior Support Workers has been temporarily promoted to Acting Deputy so there has been no-one formally identified to support the Acting Manager in this role. Staff spoke very highly of the Acting Manager and had hoped that they would apply for the post of Manager. They told us that they had been supported and felt listened to. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: The atmosphere at West Drive was noticeably calmer on this visit and the minor changes that have been introduced seemed to have had a major affect upon service user dynamics. However, the staffing levels still result in service users hurting each other as 1-1 funding has not been formally agreed. They layout of the building means that staff do not always have sight of people and potentially avoidable incidents still occur. A Registered Manager would have the autonomy to deal with these ongoing issues and address the staffing issues referred to earlier in the report. The number of hours some staff work could impact upon the care people who use the service receive. Any incidents that occur are reported to the Commission in writing. The introduction of email could better facilitate this process. The Operations Manager conducts an operational review as part of their monthly visit and overview of the running of the home. This has identified the areas of the service which require attention and contributes to the quality assurance process. People who use the service are asked to submit their views and families are asked to complete questionnaires. The findings form part of the quality assurance report which family members are informed about. Family members can also meet the Operational Manager at the Annual Service Review as part of the companys Letting us know what you think policy. The Annual Quality Assurance Assessment (AQAA) was completed and returned to the Commission. Regular health and safety checks are conducted. A fire plan is in place and fire drills are conducted at night and during the day to ensure all staff employed are familiar with the procedure. Water temperature checks are conducted regularly and records reflected that temperatures are within the safe range. As discussed earlier in the report furniture does not meet the specific needs of people who use the service. This may compromise the health and safety of people who use the service as domestic furniture is not meeting their complex needs and places them at risk. Care Homes for Adults (18-65 years) Page 27 of 33 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 28 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 20 13 Records must reflect who 30/09/2009 medication has been handed over to and received from on exit from and return to the service. A protocol must be in place to ensure that individuals healthcare needs are met with regard to administration of medication on home leave. Records must be kept so that staff can monitor health care needs and if any improvement or deterioration is due to medication. It is not in the interests of people who use the service to start and stop medication without professional advice. 2 23 19 Staff must work a safe number of hours to ensure that people who use the service are not placed at risk. 31/08/2009 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 Staff who work up to 78 hours each week with a combination of day shifts and waking nights are not able to offer optimum care. 3 23 37 Incidents that impact upon 31/08/2009 people who use the service must be reported to the Care Quality Commission and the Safeguarding Team. This ensures that people who use the service are adequately protected and appropriate advice can be delivered as necessary. 4 23 13 Staff must work a safe number of hours to ensure that people who use the service are not placed at risk. Staff who work up to 78 hours each week with a combination of day shifts and waking nights are not able to offer optimum care. 5 23 13 Incidents that impact upon 31/08/2009 people who use the service must be reported to the Care Quality Commission and the Safeguarding Team. This ensures that people who use the service are adequately protected and 31/08/2009 Care Homes for Adults (18-65 years) Page 30 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 appropriate advice can be delivered as necessary. 6 24 16 Furniture must meet the specialist needs of people who use the service. Furniture is easily broken by people who use the service and is potentially dangerous and unsightly. It does not observe the dignity of people who use the service. 7 30 13 Infection control measures must be improved. Hand towels would lower the risk of cross infection. Cracks in kitchen furniture cannot be cleaned thoroughly. 8 33 19 The numbers of hours that staff work must ensure that staff are able to sufficiently rest and ensure the health and wellbeing of people who use the service. Staff who work up to 78 hours each week with a combination of day shifts and waking nights are not able to offer optimum care. 9 42 13 The health and safety of people who use the service must be ensured through fit for purpose furniture and alert staff. 30/09/2009 31/08/2009 30/09/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 31 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 Some staff work a high number of hours which is not conducive to meeting the complex needs of people who use the service. Domestic quality furniture is not meeting the specific needs of service users. 10 42 13 A protocol must reflect why people who use the service are restricted from entering areas of their home and have a locked door policy. The front door is locked and there is restricted access the kitchen, toilets and sensory room. A protocol would ensure service users are supported to use their home whilst recognising Deprivation of Liberty Guidance. 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 30/09/2009 1 2 14 14 The outdoor leisure room should be decorated and heated effectively for the use of people who use the service. Internet and email provision should be available for people who use the service independently of office facilities. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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