Care Home: York Road (14a)

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What the care home does well All the feedback we received from the people who work at the home was extremely positive about the new manager and his leadership approach. Typical comments included - `its great the new manager has brought in some new staff so we don`t have to use relief workers so much`, `the new manager is good at getting everyone involved in running the home and at delegating things`, and `the new manager is pretty fair and seems to know his stuff`. All the staff we observed during this visit were seen interacting with the people who use the service in a very kind, respectful, and professional manner. Staff met, including the new manager, demonstrated a good understanding of the needs and preferences of the people who use the service. The atmosphere in the home remained extremely relaxed and congenial throughout the inspection. What has improved since the last inspection? The appointment of a suitably experienced and competent manager to concentrate on just running both the York Road services has been at the forefront of why 14A has improved so much in the past six months. The manager has reduced the services reliance on temporary relief and agency staff by filling most of the homes permanent staff vacancies, which includes the appointment of a new deputy manager. As a consequence, the people living at 14A York Road now receive continuity of care from support workers they are familiar with and who know their needs and preferences. The service has also developed better arrangements to enable the people who live their to express their views and make more informed choices about how their home is run. (E.g. Through the introduction of monthly one to one sessions with keyworkers, regular reviews of care plans, and by having greater access to information about the choice of meals and social activities on offer in the home). The range of opportunities the people who use the service to participate in meaningful activities, both inside their home and within the local community, has also improved in the last six months. The service looks more homely since all the walls in the communal area were painted this year, and a variety of pictures hung throughout the home. The manager told us new sofas for the lounge have also been ordered. Finally, it was positively noted that all the outstanding requirements identified in the services previous key Inspection have been met in full. Shortfalls identified in the subsequent report included: - the former manager not having enough time and support to run the service effectively because they were responsible for too many others things at Mencap in addition to managing both 14A and B York Road; care plans and risk assessments not being reviewed at regular enough intervals or being up dated accordingly to reflect changes; gaps in staffs basic training; and, failure to carry out weekly checks on the homes fire alarm system. What the care home could do better: All the positive comments outlined above notwithstanding about the improvements made by the new manager in a relatively short period of time he does acknowledge the service remains far from perfect and there is a lot more for his staff to do to make the place better for the people who live there. We have made five new requirements for the manager to address and a dozen good practise recommendations for him to consider implementing: All the people who use the service must be supplied with a copy of the homes Guide in formats they can easily understand that includes a summary of the services Statement of Purpose, complaints procedure, and their terms and conditions of occupancy. This will ensure all the people who use the service and their representatives have access to all the information they need to know about the home in order to help decide whether or not 14A York Road is the right place for them. All the people who use the service must have person centred care plans that set out in detail how the service intends to meet their needs and wishes in respect of their health and welfare, and in a format they can easily understand. This will ensure people who use the service receive person centred support that meets their unique personal, social, and health care needs and preferences. When making decisions that limit services freedom of movement, their views and those of all the relevant professionals, must be sought and a record of the best interest meeting included in care plans. This will ensure people who use the service receive person centred support that meets their unique personal, social and health care needs and preferences. The providers must ensure the faulty lighting system in the home is either repaired by the Housing Association or an alternative system installed to replace it. This will ensure the people who use the service are not continually deprived of adequate lighting. All the people who work at the home must be suitably trained to prevent and control infection. This will minimise the risk of infection spreading in the home. We also made a number of good practise recommendations for the manager to give serious consideration to implementing. These included:- developing more easy to read information about the home for the people who use the service to access; enabling people who are willing and capable of doing so the opportunity to look after their own medication; exploring new ways of minimising the impact of having a keypad device attached to the front door on peoples freedom of movement, especially those who are independent travellers; reviewing the suitability of the homes night time on call arrangements; National Vocational Qualifications in care, person centred care planning, and makaton training for all staff; and increasing the frequency of fire drills. Key inspection report Care homes for adults (18-65 years) Name: Address: York Road (14a) 14a York Road Sutton Surrey SM2 6HG     The quality rating for this care home is:   two star good 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: Lee Willis     Date: 0 2 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 37 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 37 Information about the care home Name of care home: Address: York Road (14a) 14a York Road Sutton Surrey SM2 6HG 02086439612 02086431662 h4m062sohawon@mencap.org.uk www.mencap.org.uk Royal Mencap Society care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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 (CRH - 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 This service is currently registered with us to provide personal support and accommodation for up to six people with learning disabilities, which may include Autistic Spectrum Disorders and behaviours that challenge. Mencap have recently submitted an application for us to consider re-registering this care home as a Domiciliary Care Agency. Anthony Irvine has been the acting manager in day to day charge of both 14A York Road and the one next door (14B York Road) since 1st June 2009. 14A York Road is a purpose built property set back from a residential street between Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 6 0 9 0 3 2 0 0 9 Brief description of the care home Sutton and Cheam in a quiet cul de sac. The home is relatively close to a wide variety of good transport links and local community facilities and services, which includes shops, banks, restaurants, buses and trains. The service also has its own transport in the form of a people carrier. The Metropolitan Housing Association owns the building although the home is managed and staffed by Mencap. There are six single occupancy bedrooms, a lounge, dining room, and kitchen and laundry area. There is also a large well maintained garden at the rear of the property. The fees charged for services and facilities provided currently ranges between £1139.57 and 1266.45 a week per placement. Care Homes for Adults (18-65 years) Page 5 of 37 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: two star good 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 of life the people who live at 14A York Road experience has significantly improved in the past six months with the arrival of new manager. We have therefore increased the services quality rating from a one star adequate to a two star good performing care home. From all the available evidence gathered during this Key inspection it was evident that 14A York Road now has more strengths than areas of weaknesses, and we our confident the new manager will continue to recognise where further improvements are required. Fellow Regulatory Inspector James OHara and I spent 4 hours at the home as part of this key inspection. During this site visit we met two people who use the service, the new acting manager, and three support workers. We also looked at various records and documents, including the care plans, risk assessments, and health action plans for the two service users we met. The remainder of the visit was spent touring the premises. The services Annual Quality Assurance Assessment (AQAA) form was returned to us Care Homes for Adults (18-65 years) Page 6 of 37 when we asked for it. The self-assessment was completed by the new manager, and it told us very clearly what he believes the service does well, how it has been improved since the last inspection, and what they could do better in future. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: All the positive comments outlined above notwithstanding about the improvements made by the new manager in a relatively short period of time he does acknowledge the Care Homes for Adults (18-65 years) Page 8 of 37 service remains far from perfect and there is a lot more for his staff to do to make the place better for the people who live there. We have made five new requirements for the manager to address and a dozen good practise recommendations for him to consider implementing: All the people who use the service must be supplied with a copy of the homes Guide in formats they can easily understand that includes a summary of the services Statement of Purpose, complaints procedure, and their terms and conditions of occupancy. This will ensure all the people who use the service and their representatives have access to all the information they need to know about the home in order to help decide whether or not 14A York Road is the right place for them. All the people who use the service must have person centred care plans that set out in detail how the service intends to meet their needs and wishes in respect of their health and welfare, and in a format they can easily understand. This will ensure people who use the service receive person centred support that meets their unique personal, social, and health care needs and preferences. When making decisions that limit services freedom of movement, their views and those of all the relevant professionals, must be sought and a record of the best interest meeting included in care plans. This will ensure people who use the service receive person centred support that meets their unique personal, social and health care needs and preferences. The providers must ensure the faulty lighting system in the home is either repaired by the Housing Association or an alternative system installed to replace it. This will ensure the people who use the service are not continually deprived of adequate lighting. All the people who work at the home must be suitably trained to prevent and control infection. This will minimise the risk of infection spreading in the home. We also made a number of good practise recommendations for the manager to give serious consideration to implementing. These included:- developing more easy to read information about the home for the people who use the service to access; enabling people who are willing and capable of doing so the opportunity to look after their own medication; exploring new ways of minimising the impact of having a keypad device attached to the front door on peoples freedom of movement, especially those who are independent travellers; reviewing the suitability of the homes night time on call arrangements; National Vocational Qualifications in care, person centred care planning, and makaton training for all staff; and increasing the frequency of fire drills. 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 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and others enquiring about it do not have access to all the information they need to know about the home in formats they can understand. Easy read versions of the Guide must be developed to help the people who use the service and their representatives decide whether or not the service is right for them. The aforementioned judgement notwithstanding, prospective users of the service can be confident that they and their representatives will have the opportunity to find out about the home through planned visits and a thorough assessment of their needs and wishes before any decisions about moving in on a trial basis are taken. Evidence: The manager was able to produce a Statement of Purpose, which as required in the services last inspection report had been up dated to include information about the homes philosophy of care, and staff numbers, experience and qualifications. This document contains a lot of the information the people who use the service and their representatives need to know about the home, but we agree with the managers comments that its contents are not particularly easy to read or accessible stored away in the office. The service must produce a separate Guide to the home and copies given Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: to all the people who use the service in formats they can understand. The Guide should contain a summary of the homes Statement of Purpose, complains procedures, and peoples terms and conditions, including the amount and method of fees charged for service and facilities provided. The new manager told us no placements had broken down or any new referrals accepted in the six months he had been in charge of the service. It was evident from the examples he gave us about declining a number of referrals the service had recently received that he understood what responsibilities were regarding new admissions and what constituted best practise in this area. The manager was very clear that under no circumstances would he admit anyone who was not compatible with the others already living in the home or whose needs they could not meet, and he also told us he had been unwilling to accept any new referrals in the first 6 months of his reign because the service lacked a settled staff team at that time. Care Homes for Adults (18-65 years) Page 12 of 37 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. Care plans reflect what needs a person who uses the service has, but there is significant room to improve these documents by including more detailed information about what is important to the individual, what their strengths are, and what support they need to achieve their personal goals. This will ensure the people who use the service receive person centred support that meets their unique personal, social and health care needs. The people who use the service are protected by the homes arrangements for identifying, assessing and managing risk. However, the service could do more to actively support and encourage those individuals who are willing and capable of taking more responsible risks to help them maintain and develop their independent living skills. Significant progress has been made by the new manager to improve the way the staff consults and encourages the people who use the service to participate in the day to day running of their home and make informed decisions about all aspects of their life there. However, not enough of the information the people who use the service need to Care Homes for Adults (18-65 years) Page 13 of 37 Judgement: make decisions about how their home is run is available to them in accessible and easy to understand formats. Evidence: The two care plans we looked at in depth contained lots of information about the assessed needs of the people for whom they service was intended, but lacked detailed regarding the support they required to have these needs met and what their personal goals were. We agree with the statement made in the homes AQAA by the manager that care plans were rather static documents. The manager and a member of staff we spoke with at length about care plans agreed the current format was not a very good working document as it was are not particularly easy to read. The manager must ensure all the people who use the service are supported by their keyworkers to develop far more person centred and easy to understand care plans. Documentary evidence was produced on request that showed us as required in the services last inspection report care plans and risk management strategies are now being reviewed at regular intervals with all the relevant parties, and up dated accordingly to reflect any changes in peoples need and/or circumstances. The manager told us in the AQAA that keyworking has improved, which has led to better risk assessments and allowed the voice of each individual service user to be heard better. We noted that as required in the homes last report all the risk assessments that were previously in place had been reviewed in the past six months and up dated accordingly. All the risk assessments sampled at random contained lots of details about the action to be taken in order to minimise these identified risks and hazards. It was evident from the aforementioned risk assessments and feedback we received from the manager that he believes in actively supporting and encouraging people who use the service to take responsible risks and in doing so help them maintain and develop their independent living skills. For example, we observed an individual who uses the service helping themselves to a piece of fruit from the kitchen and another cleaning their bedroom. The manager also told us that those service users assessed as willing and capable of accessing the wider community without staff support and looking after their own front and bedroom door keys are actively encouraged to do so. However, the manager acknowledges that none of the people who use the service have been encouraged to look after their own medication. Peoples willingness and capacity to take on at least a degree of responsibility for handling their own Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: medication must be properly risk assessed. As required in the services last inspection report the new manager has taken some steps to improve the way it enables the people who use the service to be consulted on and participate in making informed decisions about how their home is run. For example, the manager confirmed that all the service users now had designated keyworkers and that as recommended in its last report they now met with the individual they keyworked on a monthly basis to ascertain their views about how their home was run. The manager told us these one to one sessions had proved to be more successful than service user group meetings. Also, a number of the people who use the service who do not have any involvement with their families have independent representatives in the form of a Mencap befriender or an IMCA (Independent Mental Capacity Act) advocate. Finally, the manager has started the process of developing pictorial and photographic aids to enable the people who use the service to make informed choices about the meals they eat each day and to let them know which staff will be on duty each shift. The manager concedes this is a work in progress and is fully aware that the services Guide, care plans, complaints procedures, menus, and activity schedules all need to be available in easy to read formats the people who use the service can have access too and understand. Care Homes for Adults (18-65 years) Page 15 of 37 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. The range of opportunities the people using the service have the chance to participate in meaningful activities, both inside their home and within the local community, has improved in since the last inspection. People have regular contact with their families and advocates where appropriate. How risk assessments are used in the home should be reviewed as the freedom of movement and power to make informed choices of some of the people who use the service are being limited unnecessarily. The people using the service are also offered an appropriate and varied diet, and alternatives are provided when the meal provided is not wanted. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: Both the care plans we looked at in depth contained information about the social and leisure interests of the individual for whom the plans were written. The manager told us the range of social activities all the people who use the service had the chance to participate in on a regular basis had improved in the past twelve months, which included a number of new leisure pursuits for individuals whose day centres had recently closed. On the day of inspection, two of the service users were out attending courses at a local community centre and a Further Education college. Daily diaries we sampled at random confirmed the service users were regularly participating in a range of interesting activities. The care plans viewed indicate that none of the service users who currently reside at the home actively pursue religious worship, though the manager confirmed this would be supported if it became an identified need. The manager told us service users are actively encouraged and supported to maintain close links with their families. As previously mentioned in this report for those without any family input alternative representatives in the form of a Mencap befriender or independent advocate are sought. When we asked the manager about the keypad lock fitted to the front door he told us he believed that for the vast majority of the people who currently used the service this restriction placed on their freedom of movement was the only practicable means of securing their welfare. The manager also told us that one individual who uses the service is capable of accessing the wider community safely without the need for staff support, has front door key to let themselves back in when they like, but cannot use the keypad device to let themselves out. We therefore recommend the views of this individual, their representatives and all the relevant social and health care professionals should be sought about eliminating, or at least minimising, the impact the keypad on this persons freedom of movement and right to go without seeking permission from staff to do so first. Furthermore, none of the care plans viewed contained a record of this limitation regarding service users freedom of movement, which they and/or their representatives should have agreed too as being in their best interests. During a tour of the kitchen we noted a wide variety of fresh fruit and vegetables available in the fridge and easily accessible bowls. A menu of the weeks meal choices was conspicuously displayed on a notice board in the kitchen, which a member of staff we spoke with at length told us the service users help staff plan every Sunday. The published menus are not available in a format that can be easily understood and read by all the people who currently live at the home. As previously mentioned in this report the service needs to improve the way it makes information that would be of interest to the people who use the service more accessible (See good practise Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: recommendation No.1). Identified in one care plan we looked at in depth was an individuals favourite food, which we noted staff we preparing on a regular basis. The manager told us the people who use the service like traditionally British cuisine, which was reflected in the meal choices on the menus sampled at random. Care Homes for Adults (18-65 years) Page 18 of 37 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique health care needs and preferences are continually recognised and met. Overall, the medication handling practises the service has in place have improved and are sufficient to keep the people who live there safe. Evidence: All the people we met who use the service were suitably dressed in well maintained clothes that were appropriate for the season. The manager was able to produce individualised health care actions for the two people whose care we were case tracking. These records set out in detail the dates and outcomes of all the appointments these individuals had attended with various health care professionals in the past year. It was evident from the information continued in these plans that the service users are actively encouraged and supported by staff to attend appointments with various health care professionals, including GPs, community based nurses, dentists, and a speech therapist. The manager confirmed that none of Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: the people who use the service had been involved in a serious accident or been admitted to casualty in an emergency since the homes last inspection. Following the services last site visit we made the requirement that the former manager develops guidelines for staff to follow in relation to a service users asthmatic condition based on advice sought from the individuals GP and or a community based nurse. The new manager produced these guidelines on request which he told us a district nurse had approved. The new guidelines described in detail how staff should support the individual to administer their inhaler, but were not very clear under which circumstances and at what point staff should take further action if their health significantly deteriorated. We recommended the new manager reviews the guidance on asthma indicating at what point medical help should be sought and what these actions would be. No recording errors were noted on any of the medication administration records MAR sheets we looked at. These records accurately reflected stocks of medication held by the home on behalf of the people who currently live there. The service notified us and all the other relevant agencies, including the local safeguarding vulnerable adults team, about the occurrence of a recent medication handling error at the home. This matter is currently being investigated in accordance with locally agreed safeguarding protocols, but whatever the outcome of the enquiry this incident represents a number of medication failures that have occurred within Mencap services in Sutton and Croydon in the last couple of years. In response to on going problems in this area the providers have started implementing an action plan to improve its medication handling practises. The manager showed us documentary evidence that indicated two suitably trained staff are now required to always counter sign MAR sheets when they administer medication; all staff authorised to handle medication in the home have up dated their training in this area; staffs medication administration practises are now spot checked at regular intervals; and all the homes medication records are checked on a daily basis. The home uses a monitored dosage system that the local pharmacist who supplies all the service users prescribed medication operates. Medication held on behalf of the people who use the service is securely stored in a locked cabinet in the office. The manager showed us two holders that contained all the blister packs that were currently in use at the home. We noted that some of the dispensing pharmacists labels on these blister packs were not always very clear regarding what times each dosage needed to be administered. The relatively new manager agreed that in light of all the medication errors that had occurred in the past couple of years the system could be made clearer, especially for new staff or relief bank staff who were unfamiliar with the Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: system. We recommend the manager labels the medication holders morning medication and evening medication in order to minimise the likelihood of medication errors happening. Care Homes for Adults (18-65 years) Page 21 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. Arrangements that are in place to ensure the people who use the service are protected and kept safe are also sufficiently robust. Evidence: The manager confirmed that as stated in the AQAA the service had not received any formal complaints about its operation since its last inspection. A copy of the providers complaints procedures were produced on request, but this information was not conspicuously displayed in the home or available in a format the people who used the service could easily understand. We recommend the service develop easy read versions of its complaints procedures and supplies all the people who live at the home and their representatives with copies (See recommendation No.1). We also recommend the manager establishes a book to record any suggestions and/or informal concerns made by the people who use the service, their relatives or representatives about the operation of the home, and any action taken in response. Staff spoken with about safeguarding demonstrated a good understanding of what constituted abuse and the manager was very clear about his responsibilities regarding the reporting of allegations of abuse and/or neglect to the host Local Authorities safeguarding team, the CQC, and the police (where appropriate). The AQAA states Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: there has been one allegation of abuse made within the service since its last inspection which the manager told us was dealt with in line with locally agreed safeguarding protocols and fully investigated. Our databases reveal the service continues to notify us without delay about the occurrence of significant incidents and events involving the people who use the service and deals with them in a prompt, transparent and professional manner. The manager and other staff we spoke with confirmed that as required in the homes last report all members of staff had received managing challenging behaviour training. In addition to this the manager told all his current staff had either recently up dated their safeguarding training or were scheduled to attend an appropriate course. The manager told us one service user who is willing and capable of taking a degree of responsibility for looking after their own finances is encouraged to do this. Staff look after the majority of the service users monies and keep up to date records of all these financial transactions they take on their behalf as well as the receipts for goods and services purchased. This money is individually stored in a secure place within the home and the balance sheets sampled at random matched the monies held. The manager told us the providers carry out routine financial audits. Care Homes for Adults (18-65 years) Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior decor of the home, and fixtures and fittings in communal areas have been improved since its last key inspection, although there remains room to make 14A York Road an even more comfortable and homely place to live. Lighting in the home is not suitable for the people who use the service and those that work there. The homes cleaning and infection control arrangements are sufficiently robust to keep the environment fresh and tidy and the people who live their safe. Evidence: During a tour of the premises we noted that as stated in the AQAA all the communal areas, including the living room and hallway, had been painted in the past six months and a variety of pictures hung throughout the home. This has improved the look of the home, although we also agree with other comments made by the manager and staff we met that there remains considerable room to make the home an even more comfortable and homely place for people to live. The manager told us arrangements had already been made for the rather worn and untidy furniture in the lounge to be replaced and that his staff team were looking into Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: creative ways of ensuring curtains remained hung. Progress made by the service to achieve these mains will be assessed at its next inspection. As required in the services last report the back door leading to the garden had been repaired and the manager told us he was in the process of replacing the damaged toilet seat on the first floor. Requirements have been set in previous inspections about the lack of light in the home. This is caused by the short lifespan of bulbs used in the services light fittings, which cover the ceilings in every part of the home. It was therefore disappointing to note that a high proportion of these ceiling lights were not working at the time of this inspection and nor were the ones that did work particularly bright. This makes the entire home look rather dark and gloomy. The manager told us the Housing Association who are responsible for maintaining the lights in the home had looked into the problem on several occasions, but had clearly been unable to resolve it. The manager is required to revisit the matter with Mencap and the Housing Association and either fix the existing lighting system or consider some alternatives. This on going issue must be resolved once and for as its depriving the people who use the service as well as those that work there of much needed light. There are appropriate laundry facilities separate from the kitchen and the preparation of food. The washing machine is capable of washing clothes at high temperatures, which helps with the control of infections. The laundry has suitable flooring. There is a locked cupboard for the Control of Substances Hazardous to Health products. Care Homes for Adults (18-65 years) Page 25 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager has now recruited enough permanent support workers to ensure the people who use the receive continuity of care from people who are familiar with their needs and wishes. Overall, the new staff team is relatively experienced and well supported by the new manager, although insufficient numbers are suitably qualified to meet all the needs of the people who use the service and should receive NVQ, infection control, person centred care planning and Makaton training. The providers staff recruitment arrangements are sufficiently robust to protect the people who use the service from being supported by people who are unfit to work with vulnerable adults. Evidence: We agree with the statement made by the manager in the AQAA that recruitment has been more successful, allowing for better continuity and stability. It was evident from the comments made by staff we met and the staff duty rosters we sampled at random that the service was no longer so heavily reliant on temporary relief and bank staff to cover staff shortages. The manager told us in the past six months he had recruited four new support workers and a new deputy manager. As a direct consequence of Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: having very few staff vacancies the people who use the service now receive continuity of care from people who are familiar with their needs and preferences. All the staff on duty during this inspection were observed interacting with all the people who use the service in a very caring, respectful, and professional manner. The manager told us during the day there are always at least two staff on duty, which is sufficient to meet the current service users needs. At night one member of staff sleeps in and a second person is designated on call off site. The manager conceded that all the people designated on call at night would not be able to reach the home within 20 to 30 minutes to deal with an emergency. The providers should review their on call and night time staffing arrangements. It was evident from the comments made by the relatively new manager that he strongly believes the recruitment of quality carers was the cornerstone of delivering good outcomes for the people who use the service. The manager told us his new staff team were committed to improving the home and had all successfully passed their induction and probationary periods of employment. One new member of staff we met told us Mencap had carried out satisfactory pre-employment checks on them before they were allowed to start working at the home, which had included a Criminal Records Bureau check and two written references from their previous employers. We also looked at the files for two other new members of staff which contained all the necessary pre-employment checks a care home is required to carry out. As required in the homes last report documentary evidence was produced on request that revealed sufficient numbers of the current staff team had received basic food hygiene, autism, and managing challenging behaviour training. However, none of the services staff have achieved a National Vocational Qualification in care - level 2 or above, infection control, person centred care planning, or Makaton. Staff we met told us they received at least one formal supervision session with their manager every two months and that there had been four staff meetings in the past six months. The minutes of the homes last two staff meetings revealed they were well attended and covered a wide variety of relevant topics. Care Homes for Adults (18-65 years) Page 27 of 37 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 people who use the service benefit from living in a home that is now being extremely well run by an experienced and competent new manager. The quality assurance systems CMG have in place enables the people who use the service to feel confident their views are listened to and taken into account when raising standards at the home. Health and safety arrangements, including fire, are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: The manager told us Mencap are still planning to deregister this service sometime in the New year and make it a Supported Living project. The manager believes this will benefit the people who use the service has it will enable them to develop their independent living skills. As mentioned throughout this report it was evident from all the feedback we received from staff who work at 14A York Road that the appointment of a new manager has Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: had an extremely positive impact on the service in the past six months and is the single biggest factor in turning the place around from a one star adequate to a two star good home. The new manager has two years or more experience of running a residential care home for vulnerable adults and unlike the previous manager has more time to manage both York Road A and B because he is not responsible for running any other Mencap establishments other than the one next door, which is similar in size and nature to 14A. Staff we met told us the new manager was good at delegating responsibility to them which ensures the home continues to be effectively run even in his absence. We are also aware that the long standing deputy managers position has now been filled. The manager is aware that he needs to have completed her Registered Managers Award to be suitably qualified to run a residential care service, and will also have to successfully pass a fit person interview with us to be the homes registered manager. The manager completed and returned our Annual Quality Assurance Assessment when we asked for it, which tells what the service does well, has improved recently, and plans to do better. This self assessment showed us the new manager is committed to making further improvements to the home. Documentary evidence was produced on request in the form of Regulation 26 reports, which showed us unannounced monthly inspections of the home were being carried out by senior representatives of Mencap as part of the providers improved quality assurance arrangements. The manager told us he gets a lot of support from his line manager. As required in the services last inspection report its fire records revealed the fire alarm system is now being tested on a weekly basis in line with good fire safety guidance. Furthermore, records showed the last fire drill was carried out within the last six months, although the manager conceded that with so many new staff starting in this period not everyone would have participated in a recent fire evacuation of the building. We recommend the new manager carries out fire drills on a quarterly basis. The manager was able to produce a fire risk assessment for the building on request. It was positively noted that a visual warning aid had also been installed in one service users bedroom to ensure they knew when the homes fire alarm was activated. Certificates of worthiness were made available on request that showed us the homes gas installations, portable electrical appliances, fire detection and fire fighting equipment, and heating system had all been tested by the manufacturer or regulatory body in the past year. We tested the temperature of hot water emanating from a first floor bath at 11am, which we found to be a safe 42 degrees Celsius. Food taken out of its original Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: packaging which was being stored in the kitchen was always labelled and dated in accordance with environmental health standards. Care Homes for Adults (18-65 years) Page 30 of 37 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 31 of 37 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 1 5 All the people who use the 01/03/2010 service must be supplied with a copy of the homes Guide in formats they can easily understand that includes a summary of the services Statement of Purpose, complaints procedure, their terms and conditions of occupancy, and fees charged for facilities used. This will ensure all the people who use the service and their representatives have access to all the information they need to know about the home in order to help decide whether or not 14A York Road is the right place for them. All the people who use the 01/06/2010 service must have person centred care plans that set out clearly as to how the service intends to meet their Page 32 of 37 2 6 15 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 needs in respect of their health and welfare, and in a format that can be easily understood by service users and staff. This will ensure people who use the service receive person centred support that meets their unique personal, social and health care needs and preferences. 3 16 17 When making decisions that 01/02/2010 limit services freedom of movement, their views and those of all the relevant professionals, must be sought and a record of the agreed risk management strategy included in care plans. This will ensure any limitations placed on service users freedom of movement and choice are made in their best interests with all the relevant parties involved in the decision. The providers must ensure the faulty lighting system in the home is either repaired by the Housing Association or an alternative system installed to replace it. 01/03/2010 4 24 23 Care Homes for Adults (18-65 years) Page 33 of 37 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 This will ensure the people who use the service are not continually deprived of adequate lighting. 5 35 18 All the people who work at the home must be suitably trained to prevent and control infection. This will minimise the risk of infection spreading in the home. 01/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 All the people who use the service should have access to easy to read and understand versions of the homes Guide, complaints procedure, menus, activity schedules, staff rosters, and their care plans. This will ensure the people who use the service have all the information they need to make informed choices about their lifes and how their home is run. All the people who use the service should been given the opportunity to manage their own medication if they willing and capable of doing so within an appropriately agreed framework of risk. This will ensure the people who use the service are able to live their lifes as independently as possible. The views of this individual, their representatives and all the relevant social and health care professionals should be sought about eliminating, or at least minimising, the impact the homes keypad lock is having on their right to go out when they like without asking staffs permission to do so. This will ensure service users freedom of movement and Page 34 of 37 2 9 3 16 Care Homes for Adults (18-65 years) 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 rights to make informed decisions about their lives are not restricted unnecessarily, contrary to their best interests. 4 19 We recommend the manager labels the medication holders in order to minimise the likelihood of medication handling errors occurring. We recommended the new manager reviews the guidance on asthma indicating at what point medical help should be sought and what these actions would be. This will ensure all the people who use the service have their health care needs met and are kept safe. The manager should establish a book to record any suggestions and/or informal concerns made by the people who use the service, their relatives or representatives about the operation of the home, and any action taken in response. This will allow us to determine whether or not the service takes the views of people who live there seriously and acts upon what they say. The service should explore new and creative ways of ensuring curtains in communal areas remain hung. This will make the place look more homely. The homes night time staffing arrangements should be reviewed as a matter of urgency as it is unclear whether or not all the people designated on call at night can reach the home in 20 to 30 minutes in an emergency. The providers should establish a time specific plan setting out how they intend to ensure all the people who work at the home achieve a National Vocational Qualification (NVQ) in care - level 2 or above. Sufficient numbers of the homes staff should receive training in person centred care planning and Makaton. This will ensure they have the necessary knowledge and skills to communicate effectively with all the people who use the service and meet their needs and wishes in a person centred way. The person in day to day charge of the service should be registered, subject to a fit person interview with us, and complete his Registered Managers Award (NVQ4 equivalent). This will ensure the service is run by a suitably fit and qualified manager. 5 19 6 22 7 24 8 32 9 33 10 33 11 37 Care Homes for Adults (18-65 years) Page 35 of 37 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 12 42 Fire drills should be carried out on a quarterly basis. This will ensure all the people who work at the home, including new staff, have the opportunity to participate in at least one every six months. Care Homes for Adults (18-65 years) Page 36 of 37 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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