Care Home: Wycar Leys Care Home (Bulwell)

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What the care home does well Effective needs assessments are performed prior to service users being admitted to the home to ensure needs can be identified and met. Service users can participate in a range of social activities. Service users rights and responsibilities are upheld and they can maintain contact with their family and friends as they wish. A well-balanced menu is provided which promotes service users choice and preferences. Service users receive appropriate levels of personal and health care support and medicine management promotes the service users safety. Service users feel safe in the home and systems have been recently initiated to protect service users from abuse, neglect and self harm. Service users live in a homely well maintained environment which is clean, pleasant and hygienic throughout. The home has good staff recruitment procedures, which means that people living at the home should be, as far as reasonably possible, protected from risk. The homes management structure has been recently reviewed and service users now benefit from a well run home. The health, safety and welfare of service users is promoted and protected. What has improved since the last inspection? Due to concerns regarding the quality of care at the home, Nottinghamshire County Council has formally suspended the contract with Wycar Leys, (Bulwell) on the 24th November 2000 and will make no further placements at the home until they can be assured that the home is able to provide safe and appropriate care for service users and is meeting registration and contractual requirements. The current management team are in the process of addressing the concerns highlighted by Nottinghamshire County Council and have formulated an "Improvement and Action Plan" to expedite improvements within the home, this plan will be referred to throughout the report. On the day of the inspection the inspectors were confident that the acting manager, who is in the process of registering with the Care Quality Commission, was making good progress in improving service provision at the home. It is also recorded that Nottinghamshire County Council recognise that the managers at the home are working with them to make the necessary improvements. What the care home could do better: Support plans are in place which identifies the individual needs and choices of the service users but further developments are required in this area to make them person centred. The planning and recording of social activities requires further development Not all staff have received training to effectively support service users. The provision of staff supervision requires further development. Key inspection report Care homes for adults (18-65 years) Name: Address: Wycar Leys Care Home (Bulwell) Snape Wood Road Bulwell Nottingham NG6 7GH     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: Steve Keeling     Date: 1 0 1 2 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: Wycar Leys Care Home (Bulwell) Snape Wood Road Bulwell Nottingham NG6 7GH 01159762111 01159762888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wycar Leys (Bulwell) Limited Name of registered manager (if applicable) Tracy Tucker Type of registration: Number of places registered: care home 20 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 20 The registered person may provide the following categories 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 - Code LD Date of last inspection Brief description of the care home Wycar Leys, Bulwell provides spacious accommodation for up to 16 younger adults with learning difficulties. The home is situated in a housing estate with access to local facilities. The accommodation is divided into two units. The ground floor - The Cottage - and the first floor - The Homestead - each with separate external access. All of the bedrooms are single occupancy and have en suite facilities. Each unit has a dining room, kitchen Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 20 Brief description of the care home facility and a lounge area. There is a sensory/activity room in the Cottage and a quiet lounge in the Homestead. There are large enclosed gardens which contain some appropriate activity equipment. There is a mini-bus and a people carrier available for the service users and a good sized car park is available at the front of the building. There is easy access to local transport facilities. The fees range from £1550 - £2500 per week according to the needs of the service user. The variance is dependent upon both specific needs, and the level of staff support required over the 24 hour period. 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 focus of the inspection undertaken by the Care Quality Commission (CQC) is upon outcomes for people who use the service (service users) and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. Two regulation inspectors conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting service users and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The acting manager and members of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an opinion Care Homes for Adults (18-65 years) Page 6 of 36 about the quality of care provided. A partial tour of the building was undertaken which included service users bedrooms and the communal areas they frequent to make sure that the environment is homely and safe. We have reviewed information we have received since the last key inspection was performed on the 30.10.2006 which included information provided within the homes Annual Quality Assurance Assessment which was provided on the 26.09.2009. We also used the eight responses we have received from the ten Have you Say service user surveys and the two responses we have received from the five staff surveys which were distributed in the home prior to the site visit. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Support plans are in place which identifies the individual needs and choices of the Care Homes for Adults (18-65 years) Page 8 of 36 service users but further developments are required in this area to make them person centred. The planning and recording of social activities requires further development Not all staff have received training to effectively support service users. The provision of staff supervision requires further development. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective needs assessments are performed prior to service users being admitted to the home to ensure needs can be identified and met. Evidence: Information provided within the Annual Quality Assurance Assessment states We ask for the most recent extended Community Care Assessment. At this stage we ensure that all relevant information is passed on to the Social Worker etc about the placement that we have. If we feel we may be able to meet the persons needs following receipt of the above information, we will arrange to undertake our own assessment, visiting the person in their present setting. After completion of the assessment we will evaluate the information and if we feel the individuals needs can be met, we will produce a comprehensive letter that will include the homes objectives, how we plan to meet their needs, staffing requirements and costing. Our transition process can and will be designed around the persons needs. This includes visits to the home, staff visiting the person in their current environment, visits for tea and an overnight stay if appropriate. A support plan is completed prior to admission. A copy of the Terms and Conditions are given to the service user and a copy is kept in the Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: Managers office. The Have your Say pre inspection questionnaire asked service users Did you get enough information about the home before you moved in so you decide if it was the right place for you, five respondents stated Yes and three respondents stated No The case tracking process showed that service users had received a pre admittance assessment of their needs. The assessment process was effective in providing the opportunity to identify service users holistic needs, in relation to promoting their health and wellbeing. It was also shown that the assessment process utilises information provided by other agencies, such as Adult Social Care and Health, when available. We asked staff about the pre admission assessment process, comments included Potential service users visit the home before admission to meet other service users and the staff, the pre-admission process is flexible depending on need, I dont know who assesses them before or when they are admitted but we get a file to read which includes details relating to activities, behaviour and routines, this information is always provided. Sometimes we are given instructions which do not work, in this instance we would report this to the team leader, who tells the manager and the care plans are usually altered within a few days. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Documentation is in place which identifies the individual needs and choices of the service users but further developments are required in this area. Evidence: Information provided within the Annual Quality Assurance Assessment states Each service user has an individual support plan folder which contains a copy of their assessment, risk assessments, behaviours, key worker, family details and any special requirements. It also outlines their wishes in the event of their death. We consult service users on every part of their life and their home environment. We do this via service user meetings, 1:1 meetings, discussions with Key Workers. Support staff work with service users to undertake responsible risks that have been identified. All activities are risk assessed prior to being undertaken. The home has policies and procedures in place to help maintain service users confidentiality. Following a inspection at the home by a Contracts and Monitoring Officer on the 24th September 2009 it was established that service users care plans, at that time, did not Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: allow a person reading them for the first time, such as care staff, to quickly and accurately become familiar with the needs of the service user. It was also established that service users care plans comprised of one ring binder file and five lever arch files holding disparate records, it was concluded that it would be easy for care staff to miss important information relating to the care needs of service users. In responce to the finding of the Contracts and Monitoring officer the acting manager at the home has formulated an Improvement/Action Plan to address the identified shortfalls. The plan states We are currently in the process of reviewing and developing all service user centred plans so that they are more personalised as well as providing the support staff with clear instructions on how best to support service users within our care. An expected completion for the review of the care plans was recorded as February 2010. On the day of the inspection we discussed the reviewing and developing process with the acting manager who acknowledged the current shortfalls in the care planning process and stated We are not anywhere near where we need to be with the care plans, we need a minimum of six months but twelve months would be better to do it properly. We examined the care plans of two service users on the day of the inspection. The care plans were of varying quality. One service users care plan, which had undergone the reviewing and development process, was personalised and gave good insight into the service users personality and preferences, how to manage the service users challenging behaviours and identified circumstances which could trigger challenging behaviour. One shortfall was identified in relation to the service users care plan relating to cultural and spiritual expression as it did not fully cover the cultural needs of the service user or state what support is currently being given to the service user such as hair and skin care and a culturally appropriate diet, furthermore it did not specify what had been explored in terms of providing the service user with contact with Afro-Caribbean groups. Effective risk assessments were in place and it was also noted that the service users care plans had been signed and dated by the assessor and had been reviewed effectively to ensure any changing needs could be identified and met. As stated earlier in the report the second service user care plan, which had not been fully reviewed, was not of the same quality. The care plans had not been dated or signed by the assessor. Elements identified within the pre admission assessment such as food allergies were not addressed in the Dietary Intake care plan. The service users pre admittance assessment documented that the service user had a history of Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: epileptic seizures, this was documented in the physical health care plan but the care plan did not provide any details to inform staff of the actions to be taken should the service user experience a seizure. The service users daily records also showed that the service user experienced episodes of incontinence but no care plan was in place to effectively manage this issue. It was evident that the wording used in some sections within the service users care plans were similar in content, for instance I am aware that the water temperature is regulated with an automatic mixer valve thermostat, but I prefer a second hand water temperature test and As a last resort physical intervention may be used, at a level which is required for the behaviour displayed. As behaviours reduce so must the level of physical intervention, following training, provided by Wycar Leys. The sections where these examples were found were written in the first person so should be individual rather than generic in terms and content, furthermore it is questionable that the service users have the a level of understanding to make such complex statements. 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. Service users can participate in a range of social activities but the planning and provision of these activities requires further development . Service users rights and responsibilities are upheld and they can maintain contact with their family and friends as they wish. A well-balanced menu is provided which promotes service users choice and preferences. Evidence: Information provided within the Annual Quality Assurance Assessment states The service users have the opportunities to access college placements as well as external tutors coming to the home, taking into consideration service users likes, abilities and risk assessments. The home offers a variety of different age, peer and culturally appropriate activities that take into account service users abilities. We offer both internal and external community based activities to ensure service user involvement in their local community. We offer a wide range of leisure activities in the community as Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: well as providing an annual holiday for the service users. Service users are supported to maintain appropriate personal relationships with their friends and family. The service users are afforded dignity and respect and are involved in the day to day running of the home. The Have Your Say pre inspection questionnaire asked service users Can you do what you want during the day, evenings and weekends, six respondents stated Yes and two respondents stated No. The care plans examined on the day of the inspection showed a weekly activity planner was present which detailed the service users plan of activities. On examination of the activities diary it was shown that few of the planned activities were being followed on the specified days, however records did show that service users do undertake activities such as swimming, trips out shopping, walks into Bulwells town centre, craft activities and trips to the fair. We asked a member of staff about the provision of social activities who commented We have planned activities but they [service users] do the same thing each week, the activities could be more varied. Another member of staff said There are activities every day, usually a group activity such as horse riding, going to the pub, going on the bouncy castle, shopping in Bulwell, swimming and hand and nail treatments. At the weekends service users can choose what they want to do, they usually do something as a group, I think it is always best for them to do something as a group and we [staff] like that. The member of staff stated that she is the key worker for a service user, and stated My client and I do personalised shopping together so we can try clothes for her, I take her to the local shopping centre and cook her AfroCaribbean food for her when I am on duty. The acting manager and staff confirmed that the activities were generally those made available to all service users and stated that further developments are required in relation to the provision of activities both within the home and within the community. The acting manager stated At present the level of routine and structure is dependant on the mood of the service users and also the availability of our drivers, and agreed that the provision of social activities needs to be more structured in its delivery. It was difficult to determine service users satisfaction with the social activities provided at the home due to the inspector having difficulty communicating with the service users, but one service user commented I like it when I go out on Tuesdays, I have fried fish which I like and I like it here, its the best place I have lived in. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Information provided within the Annual Quality Assurance Assessment states The Service Users are involved in producing and cooking a healthy menu which takes into account dietary needs, cultural needs, as well as likes and dislikes. On the day of the inspection a service users was asked if he like the meals provided at the home, his response was Yes, they are nice. The acting manager stated that the kitchen in the administration block is no longer in use as it was felt that it would be beneficial to utilise the kitchens in the Homestead and Cottage. On the day of the inspection it was observed that service users were assisting with food and drink preparation within the kitchen areas and that staff were directing service users in this area so as to promote the service users independent living skills. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive appropriate levels of personal and health care support and medicine management promotes the service users safety. Evidence: Information provided within the Annual Quality Assurance Assessment states All personal care is recorded daily, including which care team member has supported the individual. The care team respect the needs of each service user and offer support which respects their privacy and dignity at all times. The service users are all registered with the local G.P and attend appointments as and when required. Service users have a Health Action Plan document in place. They have annual health checks at their G.P and also have routine dental, chiropodist and optician appointments. Service users are supported to attend any health appointments, including any hospital visits, by care team members. Service users whom have the ability to sign give their permission for staff to administer medication to them. There is a staff signature sheet for all staff to sign who have been trained and have completed the Safe Handling of Medication Course. Each Service User has completed documentation which expresses their wishes should they become ill and die. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: The Annual Quality Assurance Assessment asked What could you do better, the response was Support plans need to be more person centred and in a format that is user friendly. We need to develop flash cards/pictures that show routine doctors checks, opticians, chiropodist and dentist procedures which can be used to explain to service users what they can expect to happen so that they are less anxious. Further medication training is to be undertaken with Nottingham NHS in October, including the use of controlled medication. Good working relationships need to be built with the local G.P. practices so they have a better understanding of our service users needs. Care plans showed and a service user confirmed that he has access to health care services from members of the multi-disciplinary health team, both within the home and the local community and expressed no concerns in this area. We spoke to a member of staff who stated Medication is only given out by staff who have had training, I give out medication (it was noted that the staff training matrix did not show the training had been provided). I always wash my hands, two staff give out the medication, one person checks the Medication Administration Records (MAR) the other person checks the name of the service user, checks the photograph on the MAR charts charts and if the service user has any allergies. We read what is on the blister pack and confirm it with the MAR chart, once the medication is taken we initial the MAR chart if I notice any gaps in the MAR chart I would inform the team leader and check that the medication had been given. A service user spoken with confirmed that he receives his medication and records relating to the administration of medications were filled in appropriately and well maintained. Medication was stored in a safe environment. Care Homes for Adults (18-65 years) Page 20 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. Service users feel safe in the home and systems have been recently initiated to protect service users from abuse, neglect and self harm. Evidence: Information provided within the Annual Quality Assurance Assessment states Service users all have a Service User Guide within their bedrooms, which gives the service user the information of who to make a complaint to and the telephone numbers to do this. There is also copies of the Complaints Procedure within all homes and in main reception. service users are supported to make a complaint if they wish to do so. The Manager of the home is responsible for ensuring complaints are dealt with promptly, unless the complaint is against them. In this case, it would go to the General Manager. We have a Whistle Blowing policy in place and policies and procedures which clearly identify what actions need to be taken in the event of any allegations and incidents of abuse occurring. Staff are trained in the protection of vulnerable adults We asked a service user if he felt safe in the home, his response was Its the best place I have lived in, They [staff] are kind to me here, I feel safe. We have been made aware that serious incidents involving service users within the home had, historically, not been reported through Safeguarding Adults Protocols, which had left service users at risk. As a result of an investigation by Nottinghamshire County Council it has been established that there had been 72 unreported incidents at Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: Wycar Leys (Bulwell) 11 of which were potential safeguarding issues, which were not reported to the appropriate authorities. In addressing the shortfalls in the reporting of significant events the acting manager in the Improvement and Action plan states We are ensuring that the completion of Regulation 37 documentation (a document designed to report significant events to the Care Quality Commission) is completed in line with the Care Quality Commissions legislation as detailed in the Care Home Regulations. After any incident which has occurred which may effect the health, safety and wellbeing of the service users we will telephone the service users social worker and inform them of the incident and what actions we have taken. We will provide a daily report seven days a week for the Contract Monitoring Officer at Nottinghamshire County Council which contains any incident or near miss that has occurred in the home. A general manager/senior manager is attending the home each day and at the weekends to ask staff if there have been any incidents and offer advice and support. Since the revised process has been in place the Care Quality Commission has received numerous Regulation 37 reports and our records show that the acting manager at the home responds appropriately to these incidents, thus promoting the health and well being of the service users. We have been also been provided with information in relation to the 11 un-reported safeguarding incidents from Nottingham County Council safeguarding investigations team who concluded that all 11 incidents could not be substantiated. We spoke to a members of staff to determine their level of understanding in relation to their roles and responsibilities in the reporting of significant events. A member of staff stated Our Safeguarding Adults training covered the protection of the Vulnerable Adult and the Whistle Blowing policy and it covered procedures to follow if abuse is identified. The member of staff stated that if she suspected abuse at the home she would make sure the others [service user] were safe, report the incident, record the incident to include what had been seen or the information she had been told. The member of staff also stated that in the past she was aware of serious incidents and said I know the incidents were documented, I did them myself, but I am not sure whether it was just swept under the carpet. Another member of staff when asked about her roles and responsibilities in safeguarding the service users stated I have had Safeguarding Adults training this year (this was not recorded in the staff training matrix) but I cant remember what it covered, I cant remember what the training said but I have done protection of the vulnerable adult training about the types of abuse. It taught me that if I see abuse I Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: must report it to the team leader, If I saw a member of staff being abusive I would tell them they are wrong, if they didnt listen I would report it. I would tell the team leader what had happened, I dont know if I have the responsibility for recording it. On examination of the staff training matrix it was evident that a significant percentage of staff have not received training in the protection of the vulnerable adult. Furthermore the homes training matrix showed that refresher training in this area had not been undertaken on an annual basis. In addressing the shortfalls in Safeguarding Adults training a training booklet has been supplied to all staff in October 2009. In addition a tracking system has been introduced that will demonstrate full completion of the training programme by all staff by 6th January 2009. In addition to the training previously mentioned there is a E learning system to being implemented which is expected to be operational by Friday 17th December. The acting manager confirmed that his first priority will be a Safeguarding Adults training programme which will be undertaken by all staff. The acting manager stated that the training requires eight hours of self directed study by each staff member. The progress of staff will be remotely monitored by the Administrator / Acting Manager and any members of staff not demonstrating completion of its components will be provided with additional support. It is expected that all staff will have completed this, or an alternative external course by 28th February 2010 Secure facilities are available for service users to store their spending money. We examined the records relating to service users monetary transactions and they were found to be well maintained, accurate and showed receipts are retained. All transactions are recorded. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a homely well maintained environment which is clean, pleasant and hygienic throughout. Evidence: The Have Your Say pre inspection questionnaire asked service users Is the home clean and fresh, two respondents stated Always four respondents stated Usually. Information provided within the Annual Quality Assurance Assessment states The home is clean, very spacious and meets all of the required standards. The home has good quality furnishings and fittings. There is ample living space within the home. All Service users bedrooms have en-suite facilities with a minimum of a toilet and wash hand basin. They are decorated to the service users choice. Each individual chooses their colour scheme within the bedroom and are encouraged to personalise their rooms. There are adequate toilets/showers and baths within the home for the service users to undertake their personal care needs. All rooms have privacy locks to maintain the service users privacy. There is ample seating and space for the service users within the communal areas. Adaptations are made to the home if required to support any specific service users needs. The home has three full time Housekeepers to ensure the home is clean and tidy and free from offencive odours. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: All areas observed on the day of the visit were well maintained, clean and fresh, bedrooms were homely safe and personalised. There is also an enclosed, well maintained, secure garden. A service user spoken with on the day of the inspection stated that his bedroom is cleaned daily and that sometimes he helps with the vacuuming, he stated that he was satisfied with the standard of cleanliness in the home. Care Homes for Adults (18-65 years) Page 25 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. The home has good staff recruitment procedures, which means that people living at the home should be, as far as reasonably possible, protected from risk. Not all staff have received training to effectively support service users but this shortfall is being addressed. Evidence: The Have Your Say pre inspection questionnaire asked Do staff treat you well, Six respondents stated Always and two respondents stated Sometimes. Information provided within the Annual Quality Assurance Assessment states All staff upon commencement of employment have eight supernumerary shifts to work alongside experienced care team members to ensure that they receive the appropriate level of support and have time to read support plans and policies and procedures. As part of the recruitment process we endeavour to ensure that prospective employees have the right attitude and will respect the service users and are able to effectively listen and respond appropriately to their needs. The management approach is open and honest and aims to provide effective leadership and support. The home has an extensive recruitment policy. Adequate training is provided to enable the care team to carry out their job description. Staff receive supervision from their line manager a minimum of six times per year and should receive an annual appraisal. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: The management team were asked in the AQAA What is the number of permanent care workers who have completed the induction training expected by the National Minimum Standards. The recorded figure was 50 but we could not evidence this as the staff training matrix showed the majority of staff had not received an induction programme. We discussed the induction process with the member of staff who stated I have received an induction programme, which was practical and written and lasted about a month or two. This information was not recorded in the staff training matrix. In addressing the shortfalls in the induction process the acting manager at the home states within the Improvement and Action plan that In addition to changing the process that employees undertake, new support staff will now spend the first six days within the office area working through an induction booklet as well as reading policies and procedures and individual service users plans. Time with the manager will also be provided to ensure that new employees have the competencies to start their roles in the home. The final two days of the induction period consists of spending one day in each of the areas within the home. We have also introduced a new managers induction pack for all new managers to follow which clearly identifies their roles and responsibilities. As part of the induction process we aim to have provided all mandatory training for all new staff within a twelve week period. The records of another member of staff, who had been in employment for over a year, showed that she had only received Breakaway Training from an non accredited training agency on the 08.12.2009. We discussed training provision with the member of staff who stated that she had received training at Wycar Leys in relation to Infection Control and Health and Safety, once again these training events were not recorded in the staff training matrix. The member of staff also said that she had received training pertinent to the needs of service uses such as Moving and Handling techniques from a previous employer and said that she had provided copies of her training certificates to the previous manager, once again we could not find the training certificates to support this. The records of another member of staff, who has been in employment of the home since August 2002 showed that mandatory refresher training was out of date in some instances. In addressing the shortfalls in staff training the acting manager at the home states within the Improvement and Action Plan that As part of the induction process we aim Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: to have provided all mandatory training for all new staff within a twelve week period. We were provided with documentary evidence to show that training has commenced in relation to The Deprivation of Liberties Act and the Mental Capacity Act. External providers will also be providing training at the home in relation to Safeguarding Adults and the role of the alerter. In the interim, as stated earlier in the report, staff have been issued with information pertaining to Safeguarding Adults and have been given timescales to complete the training. The home has recently facilitated a training scheme run by an accredited training provider to address the mandatory training needs of staff via E-Learning which is expected to be implemented by the end of December 2009. The company has recently recruited a personnel officer who will coordinate the staff training matrix to ensure it is up to date and provide documentary evidence that all staff have received appropriate training to meet the needs of service users. Through discussions with the acting manager and members of staff it was determined that the provision of staff supervision has, in the past been sporadic. We discussed this issue with staff on the day of the inspection and comments included I have supervision but I cannot say when it was last performed , they are supposed to be every two months, the team leader does my supervision but she is off sick so it is not being done. In addressing the shortfall the acting manager, states in the Improvement and Action Plan that We have redeveloped the format for staff supervision, the new documentation ensures that more relevant information can be passed on as well as encouraging a two way communication between the supervisor and the supervised. All support staff will now receive supervision in the new format. The Contract and Monitoring Officer, following his visit to the home on the 24th September 2009 found shortfalls in the homes staffing ratio and concluded The diary of staff on duty shows their are days when the ratio of staff is not sufficient to meet the needs of service users. Through discussions with the acting manager and an examination of the staff rota it was established that this issue has been addressed. We examined a sample of staff recruitment records which showed recruitment practises had been followed, the records were well maintained, stored securely and showed that Criminal Record Bureau checks have been obtained, together with two satisfactory references and proof of identity. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management structure has been recently reviewed and service users now benefit from a well run home. The health, safety and welfare of service users is promoted and protected. Evidence: Information provided within the Annual Quality Assurance Assessment states The home currently has two General Managers undertaking the day to day running of the home in the absence of a Registered Manager who resigned due to safeguarding issues which had not been reported. The General Manager, who is also the Responsible Individual, has over 28 years experience in the care sector, is a qualified nurse in learning disabilities, has her RMA and Management certificates, and was previously a Registered Manager. The General Manager has an open door policy and is very approachable. She runs the home in a manner that is positive and creates a happy atmosphere. She ensures that all service users are treated with the privacy and respect that they deserve. If shortfalls are found within the running of the home she will endeavour to rectify these issues as a priority. The home has extensive policies and procedures in place that have been developed around current legislations and Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: guidelines with the service users best interests at heart. Service users records are kept within the Team Leaders office which is locked when not occupied. The home employs its own team of maintenance workers to ensure that the home is safe and as risk free as possible. The General Manager is undertaking spot checks to ensure safe working practices are maintained and developed. The home is currently being run following regulations and guidelines. The General Manager is competent in her job role and has support from the Senior Management Team, including Directors. The Have Your Say pre inspection questionnaire asked service users What does the home do well comments included Taking care of my needs on a day to day basis and We have a lot of activities to do. Due to concerns regarding the quality of care at the home, Nottinghamshire County Council has formally suspended the contract with Wycar Leys, (Bulwell) on the 24th November 2009 and will make no further placements at the home until they can be assured that the home is able to provide safe and appropriate care for service users and is meeting registration and contractual requirements. It is also recorded that Nottinghamshire County Council recognise that the managers at the home are working with them to make the necessary improvements. As highlighted throughout the report the current management team are in the process of addressing the concerns and have formulated an Improvement and Action Plan to expedite improvements within the home. The Improvement and Action Plan states We have employed an experienced home manager who commenced employment on the 19th October 2009. In addition to the homes manager we have two general managers who are predominantly based at the home to ensure that the home is making every attempt to achieve the elements within the action plan. This has also helped to improve communication between the management team. We spoke to the acting manager and it was evident that although he had only been in post for a relatively short period of time he had made significant developments in improving the management performance and service provission within the home. We asked staff about the quality of the management at the home and if they felt supported, comments included, Management listen a little more to our team leaders, no one has listened in the past 8 months but I know think that the home is doing everything in its power to put right the things that have gone wrong. We asked staff what they think the home does well comments included I think we always listen to what people want, we dont force people, we act on their wishes and I Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: feel that we uphold peoples rights particularly in relation to personal dignity. A member of staff indicated that the service provision has improved since the newly appointed acting manager has been in post and stated At first it used to be very relaxed, but know staff are on their toes and working properly as they always should have done, I would say the managers are now very strict on recording. I think the staff are good now, we work well as a team and we help each other out, I feel the people living here are now safe and protected from harm. 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 6 15 The registered person must ensure that the planned reviewing and development of all service user centred plans is undertaken. So that they are more personalised as well as providing the support staff with clear instructions on how best to support service users. 28/02/2010 2 9 15 The registered person must ensure that risks identified on assessment documentation are addressed in the service users care plans. To ensure the health and well being of the service users is promoted at the home. 28/02/2010 3 20 19 The registered must must 28/02/2010 ensure that the staff training matrix is updated to show that training has been Page 33 of 36 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 provided to care staff who are responsible for the receipt, administration and disposal of medicines. To promote the health and wellbeing of service users at the home. 4 23 18 The registered person must ensure that all staff receive the planned Safeguarding Adults programme and the Safeguarding Adults refresher training. To ensure all staff at the home are fully aware of their roles and responsibilities in relation to the protection of the vulnerable adult. 5 32 18 The registered person must 30/04/2010 ensure that 50 of the care staff hold or are working towards an NVQ qualification in care. To equip staff with the skills and knowledge to fulfil the aims of the home and the meet the changing needs of service users. 6 35 18 The registered person must ensure that all staff receive the planned mandatory training. To equip staff with the skills 26/02/2010 28/02/2010 Care Homes for Adults (18-65 years) Page 34 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 and knowledge to fulfil the aims of the home and the meet the changing needs of service users. 7 36 18 The registered person must 29/01/2010 ensure that all staff receive the revised staff induction process on commencement of employment at the home. To equip staff with the basic skills and knowledge to fulfil the aims of the home and the meet the needs of service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 14 The registered provider should ensure that the planned developments in relation to the provision of activities both within the home and within the community are instigated and all activities are recorded effectively. The registered provider should ensure that social activities are provided on an individual basis when a need has been identified. The registered person should ensure that all staff receive the support and supervision they need to carry out their jobs. 2 14 3 36 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). 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