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Inspection on 08/10/09 for 47-49 All Saints Road

Also see our care home review for 47-49 All Saints Road for more information

This is the latest available inspection report for this service, carried out on 8th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home makes sure it knows what care people need, before and after they move into the home. Staff know how to give the support that is needed with people’s physical and mental health.47-49 All Saints RoadDS0000061835.V377963.R01.S.docVersion 5.3People living in the home can lead ordinary lives. Staff do not restrict their freedom. Daily life is varied, visitors are welcome, and the food is good. People go out of the home to a variety of different activities in the community. People living in the home know they can tell staff if they have a problem, and staff know what to do if this happens. The home provides a comfortable and homely environment. Staff are well trained and qualified, so they know how best to support the residents. They do not start work in the home unless proper checks have been done, to make it less likely that poor quality staff work there. The manager is experienced and people living in the home like her. The home checks what it is doing on a regular basis, to see how it can do things better for the residents.

What has improved since the last inspection?

The home has been refurbished by the Trust. Bedrooms, bathrooms and shared areas of the home have been decorated and have new carpets. Damages have been repaired. The home is a much more pleasant environment for the people who live there. The written instructions for giving medication were clearer, so the risk of incorrect doses being given to people had been reduced. The registered manager has almost completed her registered manager’s training and had found it helped her work more effectively in the home.

What the care home could do better:

We told the manager about an unsafe way they were keeping some medicines, and the manager changed this to make it safer. If the home get their own medication policy, this will help staff to always know they are doing the safest thing with people’s medicines. The home should carry on with efforts to improve people’s ability to make informed decisions and to feel they have more control over their lives.

Key inspection report CARE HOME ADULTS 18-65 47-49 All Saints Road 47-49 All Saints Road Bromsgrove Worcestershire B61 0AQ Lead Inspector Debra Lewis Key Unannounced Inspection 8th October 2009 11:50 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 1 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. 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 home adults 18-65 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. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 2 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 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 47-49 All Saints Road Address 47-49 All Saints Road Bromsgrove Worcestershire B61 0AQ 01527 579520 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Worcestershire Mental Health Partnership NHS Trust Mrs Amanda Deborah Jeffries Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (MD) 5 The maximum number of service users who can be accommodated is: 5 18th September 2008 Date of last inspection Brief Description of the Service: 47-49 All Saints Road is a traditional two storey detached house in a residential street within a mile of Bromsgrove town centre. Each person living in the home has their own bedroom, individually decorated and furnished, with 2 shared lounges, a dining area and kitchen. Local shops, public transport, the Mental Health Resource Centre and voluntary sector day centres are nearby. The home aims to provide a domestic environment promoting independence and dignity. People living in the home receive care and support to live as ordinary a life as possible in the community. The manager at the home is Amanda Jeffries, who was registered as the manager of the home in January 2005. The registered provider is the Worcestershire Mental Health Partnership NHS Trust. The responsible individual for the Trust is Mr Simon Cox. The Trust has been the registered provider since July 2004. The home’s service users’ guide states that its current charges are £785 per week. Extra charges are made for items such as toiletries, transport, holidays, hairdressing and chiropody. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is 2 star. This means the people who use this service experience good quality outcomes. We, the Care Quality Commission, undertook an unannounced inspection of this service over one day from late morning until early evening. This was a Key Inspection of the service, which means that we checked all of the standards that have most impact on service users. The home manager and staff did not know we were coming. This type of inspection seeks to establish evidence which shows that residents are safe and experience positive outcomes. This report includes what we found during the visit to the home, as well as any relevant information that we have received about the home since the last inspection. We met and talked with most of the people living in the home, with staff on duty and with the registered manager. We looked at the building and whether it is well kept and safe. We checked records that staff keep, for example about what care they are giving to the people living in the home. We looked at what had changed since the last inspection. Before the inspection an Annual Quality Assurance Assessment (AQAA) was completed by the manager. The AQAA is a self assessment and a collection of information that each registered provider has to complete each and send to us within agreed timescales. The document tells us about how providers of services have are meeting the needs of people living there, and is an opportunity for them to share with us what aspects of the service they are doing well and what their plans are for the service. We have not received any complaints about the home since the last inspection. What the service does well: The home makes sure it knows what care people need, before and after they move into the home. Staff know how to give the support that is needed with people’s physical and mental health. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 6 People living in the home can lead ordinary lives. Staff do not restrict their freedom. Daily life is varied, visitors are welcome, and the food is good. People go out of the home to a variety of different activities in the community. People living in the home know they can tell staff if they have a problem, and staff know what to do if this happens. The home provides a comfortable and homely environment. Staff are well trained and qualified, so they know how best to support the residents. They do not start work in the home unless proper checks have been done, to make it less likely that poor quality staff work there. The manager is experienced and people living in the home like her. The home checks what it is doing on a regular basis, to see how it can do things better for the residents. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 4. People using the 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 may want to move into the home can get clear information about the home and the service provided there. Before they move in, the home will make sure it checks what support they need and if the home can provide this support. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as the Statement of Purpose, service users’ guide, and assessments of people’s needs. We also took into account what people had told us when they replied to our surveys. Written information about the home was available and was suitable for people who may wish to move into the home. The Statement of Purpose should explicitly state that the home does not provide nursing care. The service users’ guide contains the old contact details 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 9 for the Commission, which have recently changed, so should be amended to reflect this. People living in the home mostly told us they had enough information about the home and were happy with how they had moved in. One person was unhappy with the procedure, and felt they had no choice; we checked this and found it was to do with legal restrictions concerning this person, and was not within the remit of the home. Records of pre-admission information and needs assessments clearly recorded the relevant information. There were no new people in the home and no current referrals. The registered manager told us that the usual procedure was as follows: “Residents receive a CPA assessment prior to admission carried out by their care coordinator. Prior to acceptance by the home the staff will carry out a pre admission assessment to determine whether the home can meet needs. A statement or purpose and service user guide is given to prospective residents and others. Residents and relevant others are encouraged to visit the home on a number of occasions. Overnight and weekend stays are encouraged prior to placement. If accepted a contract / licence to occupy is issued. A three month trial to assess suitability can be offered. A key worker is appointed. A care plan is drawn up, risk assessments are completed, residents are registered with a GP and a full physical health check is organised. We will inform referrers that we have a pre admission check list and that we will not proceed until they have supplied us with relevant background papers.” 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work regularly with people living in the home to decide what care and support they need. This support is clearly recorded so staff know how to give the right support that people want and need. People living in the home make their own decisions as much as possible. They can live ordinary lives. Staff do what they can to keep people safe, without interfering unnecessarily in their lives. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as care plans and 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 11 risk assessments. We also took into account what people had told us when they replied to our surveys. People who lived at the home had an individual plan of care, which identified their specific needs in relation to care and support. Each individual had a named key worker who had some responsibility for ensuring that assessed needs were being met. The plans we saw were detailed and up to date, with clear written and verbal evidence that people living in the home were involved with planning their care. The care plans included the aims, aspirations and goals of those who live at the home and details of how the home would support each individual in achieving these, and what progress was being made. These plans were being reviewed monthly, together with the person the plan belonged to. Progress notes were kept for each plan, so it was easy to see what support was being given and how the person was progressing towards meeting their goals. This was good practice. For example, someone had wanted to learn a foreign language; this had resulted in them taking up language lessons. In addition, a six-monthly review meeting was held for each individual. The home invited all relevant professionals from outside the home, such as social worker, consultant, GP, and family members (if the person wanted) to the meeting with the individual, to review and address any changing needs or aspirations. Evidence was recorded in the plans of care, which showed individuals were assisted in making decisions about their lives, and this was confirmed from conversation with people living in the home. However there was also a range of opinions from people, and some uncertainty, about whether they could choose what to do in the evenings and at weekends. Staff explained that, although there were not regularly staff on duty in sufficient numbers to allow people to have staff company going out in the evenings or at weekends (and several people were not confident to go out alone at these times), if there was a specific event then extra staff would be put on the rota to enable people to go out. The limitation of this approach is that it does not allow spontaneous outings, and also may create a perception of being restricted among the people living there – they may well feel unable to make assertive requests of staff. One person also mentioned his personal care routine and how he felt it was too onerous. He agreed we could discuss this with staff. Staff said they would be very happy to alter his care plans as he wished, and were surprised it had not been mentioned to them before. It is possible that this is another instance of people living in the home finding it difficult to make assertive requests, due to a history of having to comply with inpatient treatment. It would be positive if staff continued to focus on this perception of lack of choice, as a specific issue 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 12 to be addressed over a period of time. They had begun to hold joint staff and service user meetings, which discussed issues such as the Trust management arrangements, key workers, care planning, inspections by this Commission, and evacuation plans in case of fire. This was a positive step which helped to involve people in the daily life of the home. Some individuals had complex and challenging needs; where appropriate individual risk assessments had been carried out. These were up to date and covered relevant areas of risk. Care plans were held on computer, but were also being printed when updated to ensure they were easily accessible at all times. People living in the home signed their names to record that they had been invited to assist with their care plans, and to show whether they had been involved. People told us that they were involved, if they wanted, with their care plans. In addition, the manager had started to do monthly care plan audits, to check on any amendments needed or anything which could be improved. This was good practice. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: We looked at standards 12, 13, 14, 15, 16 and 17. People using the 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 in the home lead varied and independent lives, and take part in a variety of activities in the community. Daily life in the home is flexible, and does not stick to fixed routines. Some people would like to do more in the evenings or at weekends. Family and friends are welcome in the home, and people living in the home like the food. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as care plans and food records. We also took into account what people had told us when they replied to our surveys. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 14 We found that people living in the home attend various educational, occupational and leisure activities on a full or part-time basis, some within specialist care services and some within the wider community. Examples of these included: • • • • • • • Access to community based specialist mental health services Going to yoga classes Attending foreign language classes Going out for meals or to pubs Attending day care settings Visits to the library Visits to the theatre Records were being kept so staff could easily see what activities (including ordinary day to day things like visiting the shops) each person had done. This helped staff to be aware in case anyone needed extra support with their chosen lifestyle. Staff also talked with people living in the home on a regular basis about their interests, and made people aware of local events and activities. Some people living in the home did not always feel they could choose what to do in the evenings and at weekends, if they needed staff support outside of the home. Staff explained that, although there were not regularly staff on duty in sufficient numbers to allow people to have staff company going out in the evenings or at weekends (and several people were not confident to go out alone at these times), if there was a specific event then extra staff would be put on the rota to enable people to go out. The limitation of this approach, as stated in the previous section, is that it does not allow spontaneous outings, and also may create a perception of being restricted among the people living there – they may well feel unable to make assertive requests of staff. Staff and people living in the home confirmed that family and friends are welcome to visit; individual bedrooms can be used for privacy during visits. The home had a telephone that could be used in private. People living in the home said they receive their mail unopened and that they have keys for their bedrooms. All those who live at the home were registered to vote and were supported to do so if they wish. The ethos of the home is to support individuals to be as self-caring as they are able, to encourage independence and empowerment according to individual need. Staff provided assistance with developing social and domestic skills, and we saw some care plans that focused on increasing independent living skills, such as cooking, money management and food shopping. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 15 Mealtimes were flexible. People living in the home got their own breakfast, with assistance and support from staff where necessary. Individuals took turns to prepare and cook the evening meal, with staff support where needed, and staff cook Sunday lunch. Individual risk assessments were in place for domestic and catering tasks. During the inspection the kitchen area was seen and was well stocked. There was a good range of food including fresh vegetables and fruit. People living in the home said they liked the food. There were many compliments from them in the Complaints / compliments book, about how good particular meals had been. Staff also encouraged healthy eating, and evidence of this was seen in the notes from residents’ meetings, where menus were discussed. This work on healthy eating needs to continue, as some records of food eaten suggested that some people were not always quite getting the recommended 5 portions of fruit and vegetables each day. Mealtimes were being seen as a source of pleasure and socialisation, and regular outings had begun, in order to sample food from different countries in local restaurants. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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 in the home work with staff to agree what support they need with physical and emotional health, and with any personal care. Staff keep records of this so they always know what support each person needs. Staff look after most medication and this is usually done safely. The home is making some improvements to how they manage medication for people living there. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as care plans and medication records. We also took into account what people had told us when they replied to our surveys. Plans of care seen during the inspection gave clear details of health care needs and personal care support needs, and were up to date. For example, a plan 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 17 for supporting someone with a particular health need showed a programme of regular checks with relevant professional services, all recorded with clear results and actions. Support is provided for individuals to access community health services such as optician, chiropodist, dentist, and audiologist. Mental health reviews are held as necessary with community mental health professionals. Any such appointments were monitored and recorded. Physical health needs were being recorded in separate physical health plans, and we saw records of regular checks such as well-man checks and annual health checks, which is good practice as in a service for people with mental health needs it is vital to ensure that physical health needs are not overlooked. The home had the Trust’s written policy and procedure for the administration of medication. It was not always relevant to the home and did not cover all procedures within the home, such as self-medication and taking medication when out of the home e.g. on visits to family. This meant that it was not always clear what the official policy was within the home. At the time of the inspection, none of the people living at the home were fully self-medicating, but one person was in the early stages of developing his skills, with suitable staff support. This had been properly assessed to see if he was be able to take steps towards in handling his own medication reliably and safely. Staff had received training in the administration and safekeeping of medicines. The home has access to pharmacy advice via the Trust pharmacist. We saw records of medication received in the home, administered to residents, and returned to the pharmacy (if no longer needed). Records were clear and we did not see any errors or omissions. We noted that handwritten instructions had been signed by a senior person in the home to ensure their accuracy and their authenticity. There was a record of approved staff signatures in order to identify who had given any specific dose. Medication was mostly stored safely, but there was no dedicated storage for controlled drugs (CD). The home did not have any and was unlikely to do so, but it is now good practice to have this storage available, to avoid the possibility of breaking the law with illegal storage in the event of any future prescription for a controlled drug. There was a separate lockable container available, but this did not meet legal requirements for CD storage. Medication was mostly administered in a safe way, but one medication was being supplied outside of the usual packaged system, and had been transferred into daily containers. This was an unsafe practice which increases the risks of the wrong medication being given. Medication must be kept in its original packaging with original instructions up to the point when it is given to the person. We discussed this with the home manager, who said she would stop this practice now it had been pointed out as unsafe. She confirmed after the inspection that their system had been changed. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 in the home know they can tell staff if they have a concern or complaint, and feel confident staff will act on it. Staff know what to do if they have any concerns about any person living in the home. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as the record of complaints and compliments. We also took into account what people had told us when they replied to our surveys. The home had a suitable complaints policy, and everyone living in the home said they knew what to do if they had a concern. People were confident that staff would respond to their concerns. There had been a misunderstanding about payment for curtains, which was explained to us. It could possibly benefit from a formal written response as a record of what had led to the misunderstanding. We saw the record of concerns, which did not include this incident. It did include a complaint from the summer, of low staffing levels. This had been a result of sickness and annual leave coinciding. The response was included but perhaps more action could have been taken, such as making 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 19 arrangements for having more bank staff available in such cases, as the staff team is so small and easily affected by absences. Other entries were mainly compliments about the food. The home manager had identified before the inspection that it would be good practice to recognise more minor concerns. The Commission had received no complaints about this home. The home had a suitable policy and procedure on safeguarding people from abuse, which had been discussed during a staff meeting. All staff had done training in this subject and staff knew what the procedures were. Staff were trained in non-confrontational approaches to people who were angry or upset. People living in the home said they felt safe and that staff treated them well. Staff have new CRB (criminal records bureau) checks every 3 years, which is not a requirement but is good practice. There had been no issues concerning safeguarding, either reported by the home or referred to the Commission. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 People using the 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 home is clean, comfortable and well maintained. It has a pleasant and homely atmosphere, and there is a choice of comfortable shared areas together with individual bedrooms. EVIDENCE: We looked around most of the home, including one bedroom, shared bathrooms, smoking area and living and kitchen areas. We talked with people living in the home and with staff. Since the last inspection, when there were some repairs needing to be done by the Trust, the home has been refurbished. The bedrooms and shared areas of 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 21 the home, including bathrooms and lounges, have been redecorated and have new carpets. People have bought their own new curtains and bedding. People living in the home told us they chose their own colour scheme for their bedrooms, and discussed the shared area decoration. It was now a much more pleasant environment. There was a choice of two lounges, a dining area, a garden smoking room, and a good sized back garden. These provided a range of living areas which people could use in addition to their own private rooms. The home was clean and hygienic. Staff had all completed infection control training, with some now due to do an annual update, and all had food hygiene training. This is good practice as it will help reduce the risk of infections among the people living in the home. A recent infection control audit by the Trust had given the home a good score of 92 . 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 People using the 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 home has a stable staff team, who people living there like. Staff get the training they need to do their job properly. No-one works in the home before they have been checked to see if they are suitable people for this work. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as training records and staff rotas. We also took into account what people had told us when they replied to our surveys. The staff team is well established and experienced. People living in the home said staff were approachable and that they felt comfortable in their company, listened to and supported. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 23 Four of the five support workers had attained NVQ level 3, (supporting independence) and the 5th staff member is awaiting their NVQ2 award. We saw evidence that the registered manager has now completed 95 of the registered manager’s award and NVQ level 4, and is aiming to achieve this by the end of 2009. Such qualifications help to ensure that people living in the home have the benefit of staff who know what is good practice. Records of staff recruitment checks were seen at previous inspections in 2008 and found to be complete. There had been no new staff recruited since then. The right checks reduce the risk of recruiting staff who may be unsuitable to work with the residents. Staff training was well organised, with a clear and up to date training matrix available. This helped the manager to easily see who needed training, and to prioritise it accordingly. For example, all but one care staff had training in management of actual or potential aggression; all had had training in the Mental Capacity Act, food hygiene, infection control, first aid and medication. Some refreshers were due to be done this year and the manager could provide clear information about who required which training and when it was due to be done. In previous years staff have been able to access training which was more specific to the service, in specific mental health topics. This had not been available recently but the registered manager was seeking more opportunities for this type of training. This helped to keep the staff team up to date with good practice when working with the residents. We saw minutes of regular staff meetings (held approximately every 2 months) and of joint staff and service user meetings, which had been held twice this year. This is good practice for open discussion and sharing of important information among the team and among people living in the home. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 People using the 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 registered manager is experienced and competent, and well liked by staff and people living in the home. The home regularly checks what it is doing, to see what can be done to make the service better for the residents. The home is kept safe for people who live there. EVIDENCE: We talked with people living in the home, with the manager and staff. We looked at the home’s written records and information, such as checks on 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 25 quality and on health and safety. We also took into account what people had told us when they replied to our surveys. The manager is an experienced practitioner who has managed the home since 2004, and managed another home before then. She is a qualified registered mental health nurse. We saw evidence that she has completed 95 of the Registered Manager’s Award and NVQ level 4, and is aiming to complete it by the end of 2009. She described how it had informed and improved her practice in the home. People who live at the home and staff all spoke well of the registered manager, for example saying she was “Very friendly.” On previous inspections all have spoken well of her. She uses a “manager’s log” to assist her with completing work to required timescales. She returned the home’s AQAA (Annual Quality Assurance Assessment) to us on time, and it was completed fully and accurately, including identification of some areas in need of development. It is good practice for a service to recognise where it can improve. The home’s manager is overseen by a new senior manager, who visits the home regularly to keep an overview of the service. We saw copies of his monthly monitoring reports, which indicated that he visits regularly and checks on work in the home. The home has a full quality assurance system in place, which includes surveys to find out what people living in the home, relatives and external professionals think of the service provided. We saw the 2008 development report. The 2009 report has not yet been prepared, but surveys have been sent out and received back, earlier this year. The Trust carry out their own audit of most aspects of the service. We saw a copy from January 2009, in which the home scored 74 . Some aspects with lower scores were included as areas for improvement in the manager’s AQAA which showed that she was aware of work needing to be done. Within the home, routine safety checks and tests were mostly being done regularly; we saw evidence of up to date checks including fire drills, temperature tests on fridges and freezers, water temperatures, cleaning of kitchen equipment, gas safety and electrical safety certificates. Fire safety checks were usually being done regularly, but the monitoring system could be improved. For example, weekly fire alarm tests had stopped when the person who usually did them went away, and had not been done for 2-3 weeks. Monthly checks on equipment had not been recorded. The emergency lighting did not need routine checks as it emitted a noise if there 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 26 was a problem, but this was not recorded in the fire risk assessment. The fire risk assessment had been due for an update in May 2009; the consultant had visited the home but the assessment was not yet available. A staff member was due to attend a refresher fire warden’s course in the near future, and we advised that they ensure they obtain clear information about the frequency of required testing procedures etc., and ongoing monitoring systems within the home, in order to ensure they are fully complying with fire safety regulations. 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x 3 2 x Version 5.3 Page 28 47-49 All Saints Road DS0000061835.V377963.R01.S.doc no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement All medication must be kept in its original containers as provided by the pharmacy, until the point it is administered. This will help to reduce the risk of administering incorrect medication to people living in the home. (The manager informed us after the inspection that this requirement had been met.) Timescale for action 31/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The home should check any written information (Statement of purpose, service users’ guide) to ensure it is kept up to date and is absolutely clear about the service being provided. This should ensure that anyone thinking of moving into the home has accurate information to help them make an informed decision. DS0000061835.V377963.R01.S.doc Version 5.3 Page 29 47-49 All Saints Road 2. YA7 The home should consider what work can be done to continually improve people’s perception of what they are, and are not, allowed to do; and to ensure that all choices (even minor daily ones) are carefully considered. This should help to improve people’s confidence in their ability to make their own decisions. It is strongly recommended that the home obtains dedicated CD (controlled drugs) storage. This will ensure that, if anyone living in the home requires controlled drugs, the home will not be breaking the law through incorrect storage. It is strongly recommended that the home should have a medication policy which is specific to the home, and not just the generic Trust policy which largely applies to inpatient settings. The policy and procedure should comply with “The handling of medicines in social care”, guidance from the Royal Pharmaceutical Society of Great Britain. This will ensure that the home staff can have clear and specific guidance about procedures within the home for all aspects of medication handling, thus reducing the risks to people living in the home if staff were to be unclear about the authorised procedure. Any concern or disagreement about the service raised by people living in the home should be recorded, together with a full record of the situation and how it has been resolved. This will help to ensure that people feel their views are taken seriously and acted on. The home should review its staffing levels and availability to ensure there are sufficient regular or bank staff available to cover leave, sickness and out of hours shifts, to avoid limiting the service for people living in the home. The registered manager should check that the home has systems in place to ensure compliance with the Regulatory Reform (Fire Safety) Order 2005. 3. YA20 4. YA20 5. YA22 6. YA33 7. YA42 47-49 All Saints Road DS0000061835.V377963.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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