Care Home: Willes Road

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What the care home does well Anyone wishing to move to the home has their needs assessed before they move in to ensure that their needs can be met properly. Care plans are in place for the people at the home and demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. People are supported in a respectful manner and their personal care needs are met. Staff are knowledgeable about the people who use this service. They have a good understanding of their roles and responsibilities. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. People are supported to get out and about to shops, local attractions, parks, church centres and other places they enjoy so that they take part in the like of the local community. The people at the home are encouraged to make everyday choices such as what they do and what they eat. People are involved in planning the menus so they can choose the meals they like to eat. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. Visitors are made welcome which supports people to maintain enduring relationships. The home has a complaints policy in place. Staff are aware of how people with limited verbal communication make their needs known. The home has a good system in place with regard to the appointment of staff. Records seen show that references are always obtained and staff are not appointed prior to safety checks being undertaken. What has improved since the last inspection? The people at the home are being provided with more opportunities to get out and about more in the local community. This is particularly important for supporting people`s good mental health. Care plans and risk assessment have been reviewed to provide more up to date information on the needs of the people who live there. Consideration has been made with regard to the management of finances to ensure all monies are auditable and people`s independence is promoted and protected. The two requirements made at the last inspection have been met. This should mean people are better protected through their staff recruitment processes and people are better protected from hazardous substances. What the care home could do better: People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. The manager must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to use of restraint and the administration of covert medication practices. This will ensure the appropriate actions in the use of restraint and covert medication practices are in place to safeguard the rights and wellbeing of people. The manager needs to ensure all staff have supervision and annual appraisals to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. A greater number of staff working at the home need to achieved NVQ`s (National Vocational Qualifications) in care. The home needs to continue to offer training to all staff. This should include Safeguarding, Whistle Blowing and other mandatory training. This will ensure that staff take the appropriate action if there are any allegations or suspicion of abuse, and will equip staff to meet the needs of people living in the home whilst carrying out their work safely. A copy of the complaints procedure should be made available in the home at all times and should be clearly displayed throughout the service. This will help to ensure that people who use the service, staff and visitors have a clear understanding of how to make a complaint. The management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. The management needs to ensure that all documents requested for the purpose of inspection are made available on request and open to inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Willes Road 26 Willes Road Leamington Spa Warwickshire CV31 1BN     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: Julie McGarry     Date: 2 5 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 36 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 36 Information about the care home Name of care home: Address: Willes Road 26 Willes Road Leamington Spa Warwickshire CV31 1BN 01926336437 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.turning-point.co.uk Turning Point care home 6 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: 6 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 6 Date of last inspection Brief description of the care home This house is home to five young people who have significant learning difficulties, impaired communication skills and complex behaviours. All are able bodied. The service offers 24-hour staffing and high levels of intensive support and personal care. 26 Willes Road is a Georgian detached house that has been divided into two separate, self-contained dwellings. The top two floors provide three bedrooms (one with ensuite), two lounges, one dining room, kitchen, laundry, one bathroom and separate toilet and staff office, all for three people with severe learning difficulties. The basement provides accommodation for two young men with learning disabilities. There is a rear entrance, two bedrooms, one bathroom, a small lounge and a small kitchen. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 6 Brief description of the care home There is a storage space that has been converted into an office-come-laundry. Owing to the overall unsuitability of the environment, and of the difficulties of meeting the differing needs of five people with challenging behaviours all together in such an environment, the service is negotiating with the local commissioning authority towards the future of the service. The fees currently range from £1,430 to £2,501. There are additional charges for transport; a £400 allowance is made towards an annual holiday. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. 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: The quality rating for this service is a one star; this means that people using the service receive adequate outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. One inspector carried out this unannounced key inspection on one day between 07:45 and 17:00 hours. As the inspection was unannounced, the manager and staff did not know we were going. Before the inspection we looked at all the information we have about this service such as information about concerns, complaints or allegations, incidents, previous Care Homes for Adults (18-65 years) Page 6 of 36 inspections and reports. Questionnaires were sent to the service for the home to distribute to people who use the service, their relatives and staff. Three completed questionnaires from people who use the service were returned to us. Staff supported people who live at the service to complete the questionnaires. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. This form was completed by the manager and returned to us within the required timescales. At this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the lounge watching to see how residents were supported and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. There were five people in residence on the day of our inspection. Two people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. The manager was present for three hours in the afternoon of the inspection. We met with six members of staff who were working on the day of the inspection. Two relatives of one person who uses the service was spoken with during the inspection. An outside professional involved in working with the service was spoken with by phone before and following the inspection. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. During the afternoon of the visit, we discussed our preliminary findings with the manager of Willes Road. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? The people at the home are being provided with more opportunities to get out and about more in the local community. This is particularly important for supporting peoples good mental health. Care plans and risk assessment have been reviewed to provide more up to date information on the needs of the people who live there. Consideration has been made with regard to the management of finances to ensure all monies are auditable and peoples independence is promoted and protected. The two requirements made at the last inspection have been met. This should mean people are better protected through their staff recruitment processes and people are better protected from hazardous substances. Care Homes for Adults (18-65 years) Page 8 of 36 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Information is available for people wanting to live in the home to help them decide if the home could meet their needs. Evidence: The AQAA tell us We have a service user guide and statement of purpose that the service users would be given identifying their rights and expected behaviour of all who live at the service. Turning Point has a referral assessment policy in place with comprehensive risk assessments. To find out whether this was the case, we looked at the homes statement of purpose and service user guide and the referral process for any prospective residents. Information is available to the relatives/advocates of people who are considering moving to the home. This information is provided in the statement of purpose and the service users guide. We saw that these documents provided a range of information Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: about what a person can expect from the service. Both the service user guide and statement of propose need to be updated to reflect current fees and correct details about the Care Quality Commission. All Information about the service is provided in a format suitable for the people for whom the home is intended. One relative spoken to during the inspection told us that they do not recall having received information about the service prior to their relative moving in. No new residents have moved to live at this service since the last inspection. The home has one vacancy. The referral process was discussed with the deputy manager, if fully followed this should provide staff with the information they need to determine if the home can meet peoples needs before any offer of placement is made. Contracts for people who use the service were not available for inspection. The manager was not sure if people have contracts or where the contracts are kept. It is necessary to issue contracts so that the people at the home and their representatives are clear about the service they can expect to receive for their money. The relative of one of the people who use the service talked about how happy this person has been since they had moved to the home, and concluded that it was a better place than previous homes X has lived in. Intermediate care is not provided at this home. Care Homes for Adults (18-65 years) Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from choices to enable them to exercise day to day control over their lives and from having their personal care needs met in the way they preferred and with respect for their privacy and dignity. Evidence: In the AQAA, the manager stated that We support the service users to lead their own lives through making their own choices, creating opportunities to experience wishes, and dreams as well as new opportunities. We gain feedback in the form of service users meetings, surveys, and family forums, and change the individuals support plan and service accordingly. We have compiled personal portfolios for each resident and have introduced person centred risk assessments. To find out whether this was the case, we looked at two peoples care files, talked to staff and the relative of one person. Each person living at the home has a care file. Care files include important background Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: information about each person and the plans identify their care needs with any support needed to meet them. The homes approach to care planning is appropriately person centered (PC) in that the plans focus on the preferences skills and goals of each person. The manager informs us that all care files are currently being reviewed and a deadline for review completion is the 31st August 2009. Two peoples care plans were looked at. Good levels of information about each persons personal routines and likes and dislikes are recorded so that staff are able to support people in the way they like. This is particularly helpful for people who cannot easily say what they want so that their known choices can be respected. The care plans covered all the main areas of care including medical history, personal care, nutrition, continence and communication. We saw that care plans were written from the point of view of the person using the service. Information contained in the plans remind staff about the way the person would wish to be treated and the way they may be feeling. Examples of statements recorded in a care plan include, when I say thank you for something I will touch my chin with my fingers and, I can make my own tea but need prompting what to do. People who use this service have high communication needs, their plans contain good advice telling staff how to communicate with each person concerned, for example, Anywhere any time, X pulls your arm, X is trying to show you something, go with X to see what they want. And, X appears out of sorts, X maybe in pain or feeling unwell, check for other signs and contact necessary people. We saw clear evidence of a strong focus on staff obtaining the views of people who had limited verbal communication, by observing their body language and facial expressions. Discussion with staff demonstrated that they have a good appreciation of each persons individual means of communicating with people. Staff are supporting one person in using their light writer to help aid communication. People who use this service were unable to tell us about their views of the service due to their communication needs. Risk assessments are in place addressing hazards associated with everyday living and peoples specific needs for example, support with continence, behaviour, and nutrition. Behavioural plans include advice on what action to take in various situations and what staff need to do in attempt to diffuse the behaviours to avoid them escalating. One individual plan seen has been developed with a professional from the local Primary Care Trust. This plan tells staff what actions they need to take in the event this event Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: displays a particular behaviour in public or at the home. The guidelines are clear and staff spoken to were clear about what actions they should take. The assessments would benefit from further development to ensure staff have information on the actions they need to take in the event that the behavioural management strategies in place fail to work, and to what point physical intervention may be required. From discussions with staff and looking at individual care plans, it was evident that people are encouraged to maintain and develop their independence. On the day of the inspection each person was supported to participate in individual activities of their preference, for example, one person went to the local leisure centre for lunch. Information contained in the homes records and that provided by staff tells us that this person has historically had difficulties in being in public places. Staff intervention with the support from professionals has helped to enable this individual to address their behavioural needs and spend more time in public areas. Staff meet with the people who live there every week to make decisions about menu choices and activities preferences. Care plans and daily records also detail information on promoting peoples independent living skills through such activities tidying bedroom and hovering, house shopping and cooking - baking cakes. On the advice of a health professional, staff have made arrangements to enable one individual to have their own car via the Motability Scheme. The home hopes that a second resident will also be able to avail of this benefit. Comments by staff demonstrated a good understanding of peoples needs and of the support they are expected to provide. One persons record states that they wish to have regular communication with their family and go on a holiday once a year. From records kept we found that this persons wish is being achieved. Two others go to a local Church Centre every week to maintain links with their local community. Care Homes for Adults (18-65 years) Page 15 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. People living at the home are enabled to take part in activities they enjoy and go out in the wider community if they wish. Their daily choices and individual rights are respected and contact with their families is supported. Staff ensure that residents are offered a variety of healthy and suitable meals they like. Evidence: The AQAA tells us We have a person centred approach to all aspects of service users life. Activities are planned with the service user ensuring their own choice. This choice is an informed choice and the key worker directs the choice of activity to be age peer and culturally appropriate. To find out whether this was the case, we looked at two peoples care files. Activity planners were seen in individual care plans and showed that people do different things each day either in small groups or on a one to one basis with staff. From looking at Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: the information in the care plans of the two people case tracked, it was evident that the activity planners reflect individual preferences. We saw records which are used to monitor when people take part in a variety of activities based on their individual needs and capabilities, for example, visits to the library, the safari park and Warwick Castle. We saw evidence to demonstrate that a number of outings had taken place in 2009 includes trips to Minehead and Somerset. One individual was supported by staff to go on holiday to Spain with their parents. Two residents are planning to resume college courses, helping to widen their skills and social contacts. Two residents have also started a paper round which they carry out with the support from staff. People who live in the home do not access local community day service provisions. Support is provided by the staff team on a 24 hour a day basis to enable them to participate in whatever activities they choose to undertake. Weekly key worker meetings between staff and people who live at the home ensure they are part of any planning of activities within or outside of the home. We also observed staff offering choices during the inspection in less formal ways. Due to the learning needs of the people who live there they require staff support to make any meals / snacks. It was seen that staff understood when residents were indicating that they wanted something and staff responded in a timely and respectful way. Staff were observed offering choices to the people who live there. The home does not employ catering staff, the care staff team prepare all meals and snacks. Records show that three of seventeen staff have completed training in food hygiene. Menus and records of food consumed by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples needs and preferences. A range of food had been offered including chicken curry, fish dishes, and vegetable stir fry. In relation to household tasks there are limitations to the extent that residents are able to be involved. However staff encourage them to do so as much as possible even if this is just being with them and observing. The cultural and religious needs of people living at the home are respected and suitable arrangements have been made to meet these. The manager told us that the staff support people to maintain contact with families and friends. We saw examples of Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: visits made by peoples families and some are involved in and consulted about most aspects of the care. Relatives spoken to confirmed that they are able to visit and are made welcome at the home. Care Homes for Adults (18-65 years) Page 18 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. Not all people benefit from up to date care files with information about their needs. Management of medicines need to be improved to ensure medication is appropriately administered at all times. Evidence: The AQAA tell us Support plans identify personal care support needs. All service users have an identified GP, consultant psychiatrist, community learning disability nurse, and social worker when necessary. The medication policy is in place at the service. Risk assessments have identified the needs for the staff to administer medication and store it safely. Only staff that have been trained and assessed as competent are allowed to administer medication. To check if this was the case we looked at two peoples care files, audited the medication records of two people, spoke to staff about peoples needs and observed staff interactions with people living at the home. The people at the home were seen to rise at their own pace and receive unhurried support to prepare and eat their breakfast. Everyone was well groomed and dressed in Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: age appropriate good quality clothing indicating they are supported to maintain a good self image. It is evident that the manager and deputy managers have made efforts to improve the quality of the care plans. The manager said that consultation with staff regarding the care plans had taken place and feedback from staff has guided management in the development of the care plans which have strong emphasis on person centred care. The records in peoples care plans are dated to show when they were last reviewed or amended. The dates on the records seen indicate that most documents including information about personal care and risk assessments are being reviewed periodically or as needs change to keep the information up to date. During the inspection staff were seen to be responsive to requests for help and to enjoy a good rapport with the people living at the home. All personal care support was carried out behind closed doors indicating a regard for peoples dignity. We saw and heard staff seeking permission to enter residents bedrooms before entering talking to individuals in a friendly and respectful manner and offering assistance with personal care discreetly. Staff spoken to and daily records seen described the improvements to one persons wellbeing since the last inspection, stating that this individual is calmer, smiling a lot more, laughing, and doesnt appear anxious. These positive changes have been noted since a change in the location of this persons bedroom to a quieter part of the home and ongoing input from staff with the support from a psychologist. A letter received at the home from the psychologist notes the change in bedroom and acknowledges that this change has had a positive impact upon this person, they states that they are heartened that a move from the main house to the basement has been successful, and X seems very settled. Having free access to the garden is a bonus for X. The letter further states that this individual would benefit from access to a car and more variety in stimulating activities as boredom can be a trigger and it would be a shame if behaviour regressed this infers that that improvements have been made in relation to this persons quality of life through better behavioural management. As previously mentioned, staff with the support of professionals have also enabled one individual with behavioural needs to have more access to the local community. There was information absent from both care files. For example there is no care plan or risk assessment plan in place for one person who has epilepsy. Discussions with staff show that there is some understanding about how support needs to be provided Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: should this person have a seizure, however there is no documentation that records the type of epilepsy or actions staff need to take should this individual require support. We spoke with this persons social worker following the inspection and we were told that it has been many years since this individual has had a seizure. This individual is however still prescribed anti epileptic medication and the lack of this information could result in inconsistent or incorrect actions taken by staff should this individual have a seizure. Records show that the another individual requires the use of a specialised belt and has their medication disguised in yogurt (covert medication). Records in 2008 show that a GP has agreed to the practice of covert medication however, there have been no reviews of this approach from a multi disciplinary perspective to ensure this is the most appropriate way of administering this persons medication. This individual also requires the use of a specialist belt to support their behavioural needs. To ensure appropriate use of the belt the homes core policy on restraint states that a multi disciplinary approach to restraint is required. There are no records to demonstrate the home is following a multidisciplinary approach to supporting this particular need. Staff have a walkie talkie in place to monitor an individual during the night. There is no risk assessment plan in place to support the use of a device that could impact upon this individuals privacy. Staff spoken were able to discuss the need for the walkie talkie explaining the benefit of this individuals safety. Entries in peoples health records show that they are being supported to attend health care appointments to monitor and treat diagnosed health needs. Peoples records show that they are being supported to attend routine health appointments such as annual health checks, dental check ups, psychologist appointments, and eye tests. An external health professional with connections with the service was spoken with, and felt that staff are continuing to work well with professionals to improve the wellbeing and futures of individual residents. The deputy manager explained that due to peoples high support needs no one currently manages their own medication. A sample of medication Administration Record sheets (MARs) were checked and indicate that staff are recording medication correctly. A member of staff was able to demonstrate a good understanding of safe medication procedures. The home currently carries no controlled drugs that would necessitate any special storage and recording arrangements. Staff in both parts of the home confirmed that only staff that have received medication training and have been properly observed and assessed by managers are Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: allowed to give out medication. A sample of medication records were examined these were satisfactory. Medications recorded as dispensed tallied with those remaining. The majority of medicines are dispensed from pre-packed blister folders. These were seen to be accurate. Entries on the medication sheets show that the amount of medication received for people is being recorded so that it can be accounted for properly. The deputy manager in confirmed that all unused medication in blister packs is returned to the chemist and not carried over until the next month. Staff confirmed that medication is checked daily to make sure that it has been given out and signed for properly so that any errors can be promptly picked up and addressed. We did however find a small number gaps in the MAR sheets for one individual and there was no record of any action taken by staff in response to this. The manager informs that medication protocols are in place explaining the circumstances under which people should be given PRN (as required) medication or covert medication. The protocols were not seen by us as the manager could not locate these documents. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from all staff receiving training in the protection of vulnerable adults. This would help to ensure all staff recognise and respond to potential concerns in an appropriate and consistent manner. Evidence: The AQAA states We have a concerns, complaints, compliments folder, service user monthly meetings, family forums, satisfaction surveys, and key worker sessions with the service users. Protection of Vulnerable Adults (PoVA) training is part of the induction process for all new employees. Enhanced Criminal Record Bureau and POVA checks are in place prior to starting employment. To find out if this is the case, we requested the concerns, complaints and compliments folder, looked at staff records and talked to staff about complaints and safeguarding the people who live there. The home has a complaints policy, however this is not displayed in the home for the benefit of the people who use the service or visitors. One relative spoken to was not clear about the homes complaints policy however felt that they would be able to speak to a member of staff should they have any concerns. Documented concerns raised by relatives centred around uncertainty over the future of the service. This was evident in records of family forums. A manager from Turning Point visits the home to carry out regulation twenty six visits. Registered providers are required to carry out Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: such visits at least once a month. Visits carried out by a manager at turning point show that the most recent family forum was in December 2008. The manager tells us that these meetings stopped at the request of families who preferred to have quarterly news letter. The manager told us that no copies of the newsletters are kept. Staff were seen to be attentive to the needs of the individuals, using knowledge gained from other professionals, the homes care plans, and their own experience of working with each person. We observed staff taking time to listen and observe signs and cues to ensure they understood peoples views. Individuals who live at the home appeared relaxed with staff which may indicate that they feel safe. The manager said that there have been no complaints made to the home since the last inspection, one year ago. We were unable to verify this as the complaints folder was not available for inspection. An accessible complaints procedure is available in the home and in the homes service user guide. The training matrix shows that no staff have completed their training in the protection of vulnerable adults. Some staff spoken to told us that they have completed this training however their records do not show a record of this or any training certificates. Staff development records showed that the majority of staff had completed Learning Disability Award Framework (LDAF) training, which includes sessions in safeguarding vulnerable adults. The home has a safeguarding policy in place which includes the multi agency approach to safeguarding. Four staff spoken with demonstrated a satisfactory understanding of the types of abuse they might encounter and to whom they should report any concerns. There have been three safeguarding incidents at the home reported to Social Services. These incidents have been investigated with the involvement of Social Services and the home manager. As previously noted, to ensure people are protected from inappropriate use of restraint, any actions by staff or devices used that could restrain an individual should be clearly documented with information that demonstrates a multi disciplinary approach. Peoples money is held in safekeeping by the home. Two peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Receipts are being kept as further evidence of money spent. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work at the home is required to ensure people live in a well maintained environment. People benefit from personalised bedrooms, but do not benefit from all parts of the home being maintained to a good standard. Evidence: Willes Road is a Georgian detached house that has been divided into two separate, self-contained dwellings. The top two floors provide two bedrooms (one with en-suite) and two staff offices. The ground floor has two lounges including a dining room, kitchen, laundry, one bathroom and separate toilet. The basement has a rear entrance, two bedrooms, one bathroom, a small lounge and a small kitchen. There is a storage space that has been converted into a laundry room. In the basement, one door, from the lounge allows access to the back garden, and was open. There is an emergency key next to it, for exit in the event of a fire or similar emergency. In the basement, one door from the lounge allows access to the back garden, and was open. There is an emergency key next to it, for exit in the event of a fire or similar emergency. We looked at the environment in which people live, this included peoples personal rooms and communal areas. We sampled relevant health and safety records. One requirement was made at the inspection regarding the safe management of hazardous Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: substances. Continued improvements have been made at the home since the last inspection, notably peoples bedrooms have been redecorated to reflect their own personal taste and contained personal effects, including an exercise bicycle in one persons room. Further improvements are planned for these include a new kitchen, new flooring and new chairs for the dining room. The home was tidy and clean with no unpleasant odours. The kitchen was clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. To help maintain good infection control procedures, staff are supplied with paper towels and soap dispenser in the bathroom and kitchen areas. Records show the home has achieved a silver award in food hygiene from the District Council. Laundry facilities are domestic in nature but are suitable to the needs of the people who live there, staff support people in undertaking some laundry and cleaning duties. From talking to staff and observations, cupboards containing potentially hazardous materials is being kept locked at all times when not in use. This meets the requirement set out at the last inspection. There has been one incident at the home since the last inspection that could have adversely impacted upon one persons wellbeing. The home therefore needs to ensure that when hazardous products are brought into the home from outside contractors they are appropriately stored and locked away to ensure the safety of people who live here. 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. People would benefit from a better trained staff team who have the knowledge and skills needed to carry out their job. People who use this service are protected by robust recruitment procedures that have been consistently followed to ensure staff are suitable to work with vulnerable adults. Evidence: The AQAA states A vigorous recruitment campaign in the last year has led to a large increase in the number of permanently employed staff. At the time of writing there are only three vacancies remaining which we expect to fill soon. This has led to a reduction in the use of agency staff and a more consistent service for the residents. To check that this is the case, we looked at three staff files, spoke with staff and the manager. Comments by staff on duty confirmed that there are typically four staff on duty to support the five people at the home in addition to the manager team leader. This was verified by the manager and in a sample of recent rotas. There are two waking staff at the home at night in case they are needed to provide care and support. This will provide the support needed to those who are routinely in need of care and support during the night. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: The home continues to use agency staff who have worked at the home over the past year. Agency staff spoken told us that they are currently applying for the vacant permanent posts at the home. Agency staff were able to demonstrate a good knowledge and understanding of peoples needs and individual preferences. Two staff confirmed that they are provided with regular planned supervision. The manager was unable to verify this from staff supervision records as none were available for inspection. Records showing appraisals of staff performance were also not available. Staff who joined the service since the last inspection told us that they did have a general induction to the service when they started, this was verified in staff folders. Other training records do not appear to be up to date as some staff names and details are not recorded. On discussion with the manager were are told that this was the old training matrix and an up to date matrix would be sent to us after the inspection. This up to date matrix was received and also shows that not all staff have received mandatory training. The matrix shows that only three staff have received training in food hygiene, the home does not have any catering staff as the care staff make all meals for the residents. Staff should be trained in food hygiene before preparing meals for residents to ensure safe food preparation practices. The matrix does show that the majority of staff have been trained in positive behaviour this year. Two staff files were looked at to check the homes recruitment procedures. Both files contained evidence to show that staff are interviewed and issued with contracts of employment. Both files contained evidence of proper vetting procedures including two references and Criminal Record Bureau checks. This is necessary to ensure that suitable staff are employed at the home. Information supplied by the manager in the AQAA states that three members of the 15 permanent care staff are qualified to National Vocational Qualification in Care Level 2 NVQ level 2. This is below the national Minimum Standard for 50 per cent of staff to be qualified. Care Homes for Adults (18-65 years) Page 28 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. The home is being managed in a way that listens to and acts upon the views of the people who live there. The management of some areas of health and safety practice needs to be improved to ensure people are protected from potential risk of harm. Improved record management is required. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the service manager was completed to a good standard. It states The health and safety and well being of the service users are promoted and protected by the approach she takes to ensure all staff are aware for their responsibilities she monitor performance and audits practice regularly. The Regional Manager monitors the performance of the manager and staff team by supervision appraisal and Reg 26 visits. The current manager of the home has been in post for approximately eighteen months. She is the registered manager of another Turning Point service. As she Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: manages two services, her time is split between the two homes. Although registered to manage another service in the organisation, the manger is required to be registered with us for any additional services that she may manage. From a discussion with the manager and a regional manager in the organisation following the inspection, we have been told that arrangements are now in place for the manager for Willes Road to be register with us for this service. The manager was available for a limited amount of time during the inspection as she had other commitments at another service. When the manager was available she showed an open, inclusive approach to management. As stated in the AQAA, a manager from Turning Point visits the home to report on the standard of care provided. From the most recent reports we are told that minutes of staff meetings and discussion have taken place and it is evident that the views of people who live in the home are being actively sought with regard to the way in which the service is being run. We were told that there are regular house meetings so that people have an opportunity to discuss issues that are important to them such as planning activities and menus. Information provided by the manager in the pre-inspection questionnaire indicates that relevant Health and Safety checks and maintenance are being carried out at the home. There are comprehensive policies and procedures in place, however the manager and deputy manager could not provide us with protocols to demonstrate appropriate management in the use of restraint devices, and the use covert medication practices. Risk assessments are carried out in relation to the environment including for hazardous substances COSHH. The AQAA confirms all necessary checks and servicing are being carried out by staff and or approved contractors including the fire safety system and equipment electrical appliances heating hoists and other equipment. Accident and incident records are kept and notified appropriately to the Commission and relevant other agencies. A number of checks are made by staff to make sure that peoples health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. Records show that not staff have participated in fire drills in the past year. As previously mentioned, the personal monies of the three people were audited. The home was able to demonstrate good and safe practices in the management of peoples Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: monies. A manager from turning point visits the home to carry out regulation 26 visits. Registered providers are required to carry out such visits at least once a month. The most recent record available at the home of these visits was dated May 2009. Regulation twenty six visits must be carried out monthly and records of the visit report made available for inspection. The manager has demonstrated through discussions and within the completed AQAA that she is determined to make further improvements to the home so that people living there have good quality outcomes. 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 18 13 The manager must ensure that all medication is administered safely and ethically, this specifically relates to the administering of covert medicines. This will ensure all medicines are administered in lines with guidance from the Royal Pharmaceutical Society. 30/10/2009 2 39 26 Regulation 26 visits must be carried out at least once a month by a registered provider. This is to comply with the Care Homes Regulations 2001. 30/10/2009 3 41 17 Documents requested for the purpose of inspection must be made available on request and open to inspection. This is so the home can 16/10/2009 Care Homes for Adults (18-65 years) Page 33 of 36 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 evidence what actions have been taken by the home to comply with the Care Home Regulations 2001. 4 42 18 The service must ensure that staff are trained in safe working practices, this specifically relates to Food and Hygiene. This is to ensure to health, safety and welfare of people who use this service and staff are protected. 5 42 13 All areas of risk are identified, and appropriate plans in place to minimise any risks. This relates specifically to use of restraint. This will ensure the appropriate actions in the use of restraint are in place. 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 27/11/2009 30/09/2009 1 1 The home needs to ensure that the information provided to prospective residents details up to date information and includes the weekly fees and any other costs. People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have 2 5 Care Homes for Adults (18-65 years) Page 34 of 36 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 to pay for and so that their rights may be upheld. 3 9 Risk assessment plans to be reviewed and updated to include action plans that will guide staff should peoples behavioural management strategies fail to work. Staff drug audits undertaken should include checks on peoples Medication Administration Record Sheets. Appropriate action must be taken when discrepancies are found. A copy of the complaints procedure should be made available in the home at all times and should be clearly displayed throughout the service. This will help to ensure that people who use the service, staff and visitors have a clear understanding of how to make a complaint. The home should continue to review the accommodation for residents. This is to make sure residents are provided with a pleasant environment to live in and enjoy. 50 of staff should be qualiofied to NVQ level two to ensure peopel are supported by staff who have the competencies and qualities required to meet their needs. Staff should receive regular refresher training in all the mandatory health and safety topics and in respect of procedures such as Safeguarding. This is to ensure that they are all clear about the procedures they should follow and know and understand the currently accepted practice guidelines in areas that promote the safety and protection of people living at the home. All staff should have annual appraisals to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. Staff should be involved in regular fire drills. This is to ensure all staff respond appropriately should there be a fire 4 18 5 22 6 24 7 32 8 35 9 36 10 42 Care Homes for Adults (18-65 years) Page 35 of 36 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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