Inspection on 27/05/10 for 153 St Marks Road

This is the latest available inspection report for this service, carried out on 27th May 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Polesworth Group Pooley Heights

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 153 St Marks Road 153 St Marks Road Chapel Ash Wolverhampton West Midlands WV3 0QN 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: Jonathan Potts Date: 2 7 0 5 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: 153 St Marks Road 153 St Marks Road Chapel Ash Wolverhampton West Midlands WV3 0QN 01902 427141 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 153stmarks@btconnect.com Select Lifestyles Limited Name of registered manager (if applicable) Miss Emma Cherice Franks Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: Date of last inspection 0 1 0 6 2 0 0 9 A bit about the care home 153 St Marks Road is a modern three story detached building along a quiet residential road Care Homes for Adults (18-65 years) Page 4 of 36 close to Wolverhampton City Centre. It is close to local amenities and local transport links for Birmingham, Dudley and Walsall. There are five bedrooms, two of which are on the ground floor, each with ensuite facilities. In additional there is a communal bathroom on the first floor. On the ground floor there is a kitchen, lounge and conservatory. There is a large rear grassed garden. 5 People Live at House St Marks provides care and accommodation to five young people whose primary needs on admission is learning disabilities. These people have moved from residential schools as part of their transition from children to adult services. Care Homes for Adults (18-65 years) Page 5 of 36 Weekly fees are now available in the homes information. These range between 1500 pounds a week to 1800 pounds a week. There are additional charges for such as newspapers, some activities, meals outside of the ones the home would normally provide and any items of a luxury nature. The home is managed by a new company Select Lifestyles Limited. Care Homes for Adults (18-65 years) Page 6 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: 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 Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: CQC This is what the inspector did when they were at the care home Our surprise visit to 153 St Marks Road was carried out by one inspector on the 27th May 2010. We arrived at 9.25am and left at 5.45pm. Prior to our visit we looked at all the information we have received about the service over the 12 months since the last main inspection. This included information sent to us every year by the care provider and information from different organizations. 27/05/2010 9.25 am to 5.45pm We have checked the homes performance against key standards and looked at outcomes for people living at the home. This was carried out by us meeting people living at the home, and asking staff about these peoples needs and wishes. We also looked at care plans, medical records and daily notes for two people living at the home. This is called case tracking. Care Homes for Adults (18-65 years) Page 8 of 36 CQC People We also looked around the house, looked at a number of management records and talked to management and staff. We received two completed questionnaires from people living at the home and four from people who work at the home. What the care home does well St Marks Road is of a size that helps it to be homely and part of the local neighbourhood. Everyone living at the home has their own bedroom and ensuite. People who live at St Marks Road are happy and enjoy living at the house. Relationships between the people living at the home and the people that work there are relaxed and warm. People smile alot. Care Homes for Adults (18-65 years) Page 9 of 36 People who use the service are supported by staff that have a good understanding of their needs and want to improve the quality of the service. Checks are carried out with people to ensure staff know how they want to be supported, with detailed care plans summarising this information. Staff have developed good working relationships with the people they support, their relatives and other agencies. They identify and respond to changes in peoples health care needs well and seek help from others where necessary (such as community nurses, doctors and such like). There is a real commitment to promoting activities for people living at the home, this in the community and at the house. People living at the home enjoy busy and fulfilling lives. Care Homes for Adults (18-65 years) Page 10 of 36 What has got better from the last inspection The home has improved in a number of areas since our last main inspection, some of these listed below. The checks staff make to ensure they know what people living at the home want and need are more detailed. This helps peoples individual care plans better reflect what support they need. People living at the home are involved in putting together their individual plans. Checks on what risks are present to people living at the home have improved. An example of this is behaviour plans that now clearly state what upsets individuals and how staff should support them when they are upset. The way the home stores, records and gives people their medication is now safer. Care Homes for Adults (18-65 years) Page 11 of 36 Staff training has continued so that they have improved their knowledge and skills and as a result better support people living at the home. The way the home checks new staff before they come to work is more robust CHECKS The home now has a person that is identified as the homes manager and she is now registered with us. She has improved the homes administration in a number of areas so the home is better managed. What the care home could do better Care Homes for Adults (18-65 years) Page 12 of 36 Staff need to make sure that when they book peoples money out of safekeeping there are two signatures to verify the amounts of money put in or taken out. It would be preferable that the witness that signs is the person whose money it is. There are some areas where risk checks could be better, such as in the way staff protect peoples money and whether people are safe holding keys as examples. Checks of how the home can promote the control of infection can also be improved. IN – OUT The homes rules about medication handling should say how medication is booked out of the home, and then booked back in when people go to stay somewhere else for a few days. The homes rules should state how peoples bank and store loyalty cards (if they have them) are to be handled so as to protect people living at the home and the staff. Care Homes for Adults (18-65 years) Page 13 of 36 HOT? WARM? COOL? People living at the home should have more control of the temperature in their bedrooms through access to temperature controls. If you want to read the full report of our inspection please ask the person in charge of the care home Miss Emma Franks If you want to speak to the inspector please contact Jon Potts 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 03000 616161 Jon - CQC If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 Care Homes for Adults (18-65 years) Page 14 of 36 line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 15 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 16 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. People looking to move into St Marks are supported by staff so they know what the service can offer them, this through documented information and stays at the home. The checks the homes carries out confirm what a persons needs and wishes are prior to their move into the home. Evidence: We looked at the homes information books (statement of purpose and service users guide) and found these to contain a range of information about the service that is available to people living at the home. One of the information books we saw is written in easy to understand language and supplemented with pictures. Peoples rights and what they can expect from the service is very clear. We saw that people are shown these documents, with people signing to say they have seen a copy of the information. The fees for the service and any additional charges that may be applicable are detailed in the homes information book. We looked the information for a person that had moved into the home since the last main inspection and we saw that the checks the home carries out have improved. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Information as to what the individual needed and wanted we saw to be clearly recorded. This information was also supplemented by copies of checks carried out by the people paying for the persons care, in this instance the local social services department. We saw recording that showed the person was involved with their decision to move into the home, this through the admission. We saw that the transition for the individuals move into the home was planned, with numerous short visits leading up to overnight stays. We saw that staff had also spent time with the person outside of the home in such as youth clubs so as to get to know them better. We saw that the homes own checks with the individual centered on their thoughts about what was happening and this was available in a pictorial format to assist their understanding. The information in the homes checks reflected what we saw other agencies had written in their checks. Care Homes for Adults (18-65 years) Page 18 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at 153 St Marks Road are involved in decisions about their lives, and are supported to take an active part in these as an individual, and as part of a group. Evidence: We looked at the individual plans for two people living at the home. We saw that these have improved since the last main inspection we carried out. The plans that we saw are clear as to what the individual requires in terms of support and personal care. They are also easy to read and are supported by pictorial cues to assist the individual to understand the plan. The clarity of the plan also supports staff understanding as we found by talking to staff, who are very clear about individuals support needs. Where able individuals have signed their plan, although we also saw that the plans reflected meetings where people are involved in saying what they want. We also saw that staff are observant and record what peoples likes and dislikes are in their records. Another example of people making choices is the staff asking people their views about having their photograph taken, this with use of appropriate communication methods as detailed in peoples individual plans and needs checks. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: We saw that peoples individual plans are supported by risk checks that show how staff should respond to any potential dangers to people without limiting choice. These risk checks have also improved since our last main inspection and provide better support for staff and the individual. Specific areas where they have developed in is respect of behaviour management where triggers to someone becoming upset are clear, as are the way staff should respond to these. There are some areas of risk that the manager told us risk checks could be better, such as in the way people handle their money, and ways in which their finances can be protected. The registered manager is looking to develop these with the support of her manager. Consideration of whether people hold keys for bedrooms and the front door should also be explored within a risk framework. From observation of interaction and support offered, looking at records and talking to staff we can see that people living at the home are offered choices as part of their day to day routines. There are regular residents meetings where people living at the home are asked what they think about activities, menus and the house, as well as any other matters they think are important. We could see that what people say in these meetings is followed up, with action plans. People living at the home have made decisions recently about such as planning the layout of the garden and changing the menu. Care Homes for Adults (18-65 years) Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are presented with daily opportunities to develop their social, emotional and independent living skills at the house and in the wider community. The home offers foods that meet with peoples preferences and dietary needs, in a way that reflects peoples communication needs. Evidence: The house is a very busy place, that we saw to be full of activity and energy generated from a motivated and young minded staff group that are supporting people that have not long become adults. Two people living at the home told us via surveys that they can always decide what they wish to do at any time of day. One also said that the home does activities and outings’ well. The number of young people at the home varied throughout the day, with a number of comings and goings as people came and went in line with their planned activities, such as Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: school. People have a range of planned activity that is set out in individual activity plans, although we have been told there is flexibility that allows change based on peoples choices. There is also scope for more sedentary activity such as watching TV and relaxing in bedrooms, the latter we saw was the case with one person relaxing on their bed with a range of sensory equipment. People are also encouraged and supported to have involvement with domestic routines such as laundry, cooking and cleaning, this fitting in with the objective to develop skills and look at people moving toward independence. When we looked at records we could see that activities and stimulation are prioritized. We saw a DVD of the activities people have had involvement in over the first year of the home life and saw a wide variety of opportunities. This included trips and visits to a number of parks, outdoor adventure centre, sea life and holidays as examples. The DVD also showed a range of house based activity such as cooking, trampolining and gardening to name a few. Of note was the fact that people in the DVD looked happy and content, this reflecting how the people living at the home seemed at the time we visited and met them. We also saw that records showed that staff are mindful of peoples religion and support people to attend churches of their choice. We saw that arrangements for assisting people to retain contact with friends and relatives is well recorded and reflects what staff need to know, this in respect of peoples wishes and the need to protect them. Staff involve people in shopping for the home and menus are discussed in meetings. We saw from records that peoples diets reflect their health needs but also allow for their individual likes/dislikes. The menu, which we saw displayed in the kitchen in a pictorial (PECS) format, is flexible. Room is allowed within this flexibility for people to have a range of commonly enjoyed foods that reflect their age range, but also heed health needs such as diabetes. We saw from pictorial evidence that people living at the home are very involved in food preparation. Care Homes for Adults (18-65 years) Page 22 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. People receive personal support and health care that reflects their agreed and individual plans. Staff are aware of and promote the need to treat people with respect. Management of medication has improved and people are safer as a result. Evidence: We saw people living at the home to be well groomed and dressed appropriate to their age. Records confirmed that people are encouraged to maintain their own personal hygiene with support, and as detailed in their individual plans. We saw that the interaction between staff and people living at the home was positive and respectful. Two people living at the home that responded to our surveys stated that staff treat them well. We received four survey forms back from staff and they commented on the positive relationships they have with people living at the home. We also spoke to two staff at the time of our visit and they presented as well informed as to the needs of the people they cared for, this as reflected in peoples individual plans. They also told us about how staffing arrangements allow for individuals preferences as well as reflecting a gender mix so as to ensure female carers are available if needed. All the staff we met and spoke to presented as happy, cheerful and enthusiastic. We saw that people have access to their rooms as wished and staff respect their privacy. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: We found that health pathways are in place that support peoples individual plans and serve as a useful planner to ensure that health care needs are met. Appointments with health professionals are supported in accord with individual need. We saw that the dates when people see health professionals are clearly documented and showed contact with a full range of health services including psychology, chiropody, dentist, community nurses and such like. We looked the homes systems for the management of medication and saw that staff encourage people to have control where possible, this in accordance with risk checks. We spoke to staff about management of one persons insulin controlled diabetes and coupled with records that we saw, found they are knowledgeable as to how to manage this so as to encourage self administration. We looked at medication records and found these to be well completed with no gaps or errors in those we saw. Recording of medications that are disposed of we saw to be more robust, with the pharmacy signing to evidence their receipt. At the time of the last main inspection we had concerns about the homes storage of controlled drugs. These concerns are now addressed through fitting of an appropriate storage cupboard. We saw that there is also accurate and appropriate recording of the controlled drugs held at the home. The last audit of the homes systems for medication management by the homes contracted pharmacist (November 2009) indicated that they had no concerns that are not now resolved. The homes medication procedures whilst updated do not cover the how staff check out/in medication for people living at the home when they are on home leave. Most staff either hold or are completing accredited medication training and we saw and heard from staff that they have to complete a competency assessment with the manager before administering medication. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have means by which they can express their concerns and are aware of the homes complaints procedure. The way staff promote the protection of people living at the home has improved. Evidence: The service has a pictorial complaints procedure available, this not on display at the time we visited the home though. The manager told us that this is due to the fact that some people living at the home like to use paper for tearing and as drawing paper. The manager has considered how to gain peoples views as to their satisfaction, and asks people at regular meetings if there are any issues. The manager also told us that she is looking to commence a feelings board to help the staff pick up on any worries or concerns that people may have. Two of the people living at the home who responded to our surveys said that they are aware of the home complaints procedure and that staff do listen and respond to what they say. We saw that the home has an appropriate procedure in respect of safeguarding, this supplemented by the local authorities multi agency procedures that we saw to be readily available. The manager showed a good understanding of when safeguarding referrals are to be made and has demonstrated this through her practice. She also explained to us how the home should respond appropriately if a deprivation of liberty issue arose, with written information seen to be available to supplement this. Staff we spoke to also show a good awareness of their responsibilities in terms of protecting people living at the Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: home, this underlining the training that the majority of the staff have now received. We had concerns about the homes systems for behaviour management at the time of the last main inspection. We saw that the behaviour plans that the home now has in place are far clearer and that staff we spoke to understand the triggers and responses that are required so as to better manage challenges. Responses to behaviours are now based on diversion techniques as opposed to physical intervention. We also saw that recording of incidents is now far better documented than previously. Nearly all the staff now have training in behaviour management, with those without having training dates booked. We saw that the home now has guidance available to staff from B.I.L.D ( British institute for learning disabilities) in respect of behaviour management. We saw that systems are in place to account for peoples money and expenditure. Records are detailed but recent entries have only one signature recorded to verify the transaction. This is not in accordance with the homes policies. We saw that inventories of peoples property are in place. Care Homes for Adults (18-65 years) Page 26 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. The house provides a well maintained, homely and stimulating environment for the people that live there. The homes approach to the management of infection control could be improved. Evidence: The premises provide light, bright and modern living accommodation which is fresh clean and odour free throughout. The house presents as a family house in an established residential area. The house has a large garden area that the provider is looking to develop, this in accordance with plans discussed with people that live at the home. It was positive to see recreational equipment in the garden such as a trampoline, swing ball, paddling pool, garden furniture and raised beds. There is also a pet rabbit that people living at the home have involvement in caring for. We look at the servicing records for equipment in the house and found that these are all up to date, ensuring that the former is safe. From sight of peoples bedrooms and the communal areas of the home we could see that the building meets peoples needs and that bedrooms reflect individual personalities. There was an issue at our last main inspection in respect of window restrictors which management have approached through risk checks following a visit from Environmental Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: Health in May of this year. This has informed the allocation of ground floor bedrooms due to the potential danger of falls from windows. As stated earlier in the report decisions in respect of people not having keys to their rooms and the front door should be explored in risk checks. We saw that some ensuite shower rooms now have screening fitted, although there are issues with fitting in some due to people pulling them down, or the restriction of available space when people need assistance with personal care. The manager was able to verbally justify which showers had screening fitted for the former reasons, this not currently documented in the form of a risk check though. We identified an issue with a lock on the laundry door at the time of our last main inspection. Following discussion with the Fire Prevention officer it is clear this is not a risk to fire precautions at the home. We also noted that there is still no access to radiators temperature controls, this meaning that people have no control over the temperature in their rooms. We saw that the home has improved methods for the maintenance of infection control with the introduction of red laundry bags for soiled washing. We noted that hand wash and paper towels are not to hand, this as the manager told us these items would be removed by people living at the home and could present as a hazard. We advised the manager to obtain a copy of the code of practice for health and adult social care on the prevention and control of infections, this to assist in the drawing up of a risk check of the homes methods for managing and preventing infection. The provision of hand wash and paper towels so that they are accessible, yet safe, is one issue that should be considered within this risk check. Care Homes for Adults (18-65 years) Page 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by an effective staff team who have a good skill and knowledge mix. Recruitment practice is now safer and support for staff through appropriate training has improved. Evidence: We saw at the time we visited that the staff group is young, enthusiastic and energetic. Some of the newer staff are however more mature and this balances out what the staff team can offer with a mix between enthusiasm and life experience. Interaction that we saw between the staff and the people living at the home was very positive and we noted a relaxed yet vibrant and happy atmosphere in the home. We saw people living at the home moving around the house as they wished and we saw lots of smiles and laughter. Comments we received from four staff that completed our survey forms told us that feel well supported by the manager, so they are better able to do their job. They also told us that they feel they provide a good service through such as 1 to 1 care, providing activities and therefore a good lifestyle for people living at the home. They all said that they received sufficient training. These comments we found to be reflected by the views of the staff we spoke to when we visited the home. We looked at the homes staffing rota and found this reflected the staff that were on duty on the day of our visit. We also saw that staffing levels reflected the needs of people Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: living at the home based on the checks carried out by social workers, with one to one support available for individuals during the daytime. We saw that the staffing rotas are now clearer and easier to follow showing exactly how many staff and which staff are available at any given time. Staff who responded to our surveys and those we spoke to at the time of our visits all felt that there are enough of them available to meet peoples needs. We looked at the records for two staff in respect of their recruitment checks. We saw that these are far more robust that we previously saw, the only omission the need for a risk check for any staff employed on a POVA 1st pending receipt of a full disclosure; this to set out the steps the home has taken to ensure the person is adequately supervised. We saw that a full disclosure is now available for the staff member this issue related to. The most recently employed member of staff did not however start work until after receipt of a full disclosure. We saw that the home has now developed a clear training record that reflects the certificates from staff training that we saw, and what staff told us. Overall, based on the training staff have received since the home has opened we judged staff to have good training input. There are some areas where staff training is required, although these are clearly identified within the training planner, and in most instances dates for the training are booked. The critical areas of training needed as we identified at the time of our last main inspection are now addressed. We saw that the majority of the staff team have a vocational qualification in care as well, this meaning they have a good grounding in good care practice. We saw that new staff participate in an induction that reflects national induction training standards. Care Homes for Adults (18-65 years) Page 30 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 management and administration of the home is now more robust and methods for checking that standards are kept are improving. Evidence: We looked at the homes certificate of registration that was on display in the homes foyer and saw that this is current, and reflects the needs of the people living at the home as well as the service currently provided. The management arrangements for the home are now clear with the manager having successfully completed her registration with us. This registration process has shown that she is fit to manage the home, having the appropriate skills and knowledge to successfully manage the home so as to meet the needs of the people living there. We saw through discussion with the operations manager that the registered manager is well supported with the management tasks. We saw that there is well documented evidence of the operations manager visiting the service on a regular basis to monitor standards at the home, with action plans drawn up to deal with any issues identified. Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: The outcomes from this inspection further evidence that the manger has the skills to improve and maintain the service so that people are safe and have a good quality of lifestyle. We spoke to the manager about the homes quality assurance(methods for checking standards are being kept) and she told us that this is developing, with the use of questionnaires for people living at the home, as well as regular meetings with them. We also saw evidence of regular staff meetings that reflect the support that staff told us they receive. As with the senior managers visit report, actions needed from meetings are identified and people responsible for dealing with them recorded. The information that the manager sent us before our visit was very clear about what the manager judged the home did well, and what they could do better. Our visit confirmed that this information was honest and accurate. The senior manager told us that she is looking at ways of developing the homes quality assurance further so as to improve how the homes can self check its performance. We saw that staff one to one support sessions are now more frequent and better planned, this to help them know what is expected of them by the management and allow them time to reflect on how they work. This improvement was confirmed by records and staff we spoke to. We saw that the homes has methods in place to promote the health and safety of people living at the home and to promote safe working practices. This includes written rules (procedures) that tell people how to work safely, the training of staff and regular documented checks of the building that highlight any areas of concern (with any changes needed leading to a written action plan). There are some areas where there is scope to improve though, one area being risk assessment of some areas such as Legionella (identified by Environmental Health), infection control and some areas where choice maybe limited due to risk (such as key holding, and fitting of shower screening). We discussed the homes methods for protecting peoples valuables earlier in this report but did not state that it would be beneficial for the home to have a written statement as to how peoples PIN numbers for bank cards and loyalty cards for shops are protected. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 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 Description 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 Description Timescale for action 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 9 To continue developing individuals risk assessments so as to reflect how peoples choices are protected and any potential risks minimized. The registered manager should produce a procedure for the booking out and booking in of peoples medication for those times when they maybe on such as home leave. The registered manager should ensure that all transactions relating to peoples monies in safekeeping are verified by two signatures, one which is preferably the individual whose monies they are. To adapt the covers for radiators so as to allow people to alter the temperature within their bedrooms/communal areas. The manager should obtain a copy of the code of practice for health and adult social care on the prevention and control of infections, this to assist in the drawing up of a Page 34 of 36 2 20 3 23 4 24 5 30 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 risk assessment of the homes methods for managing and preventing infection. 6 34 The registered manager should ensure that the methods the home employs to protect staff employed without a full enhanced disclosure are recorded in a risk assessment. The registered persons should develop a written procedure as to how peoples PIN numbers for bank cards and loyalty cards for shops are protected. 7 41 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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