Inspection on 18/05/10 for Ferndale Crescent, 10

This is the latest available inspection report for this service, carried out on 18th May 2010.

CQC found this care home to be providing an Adequate 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.

Other inspections for this house

Ferndale Crescent, 10 03/07/08

Ferndale Crescent, 10 14/02/07

Ferndale Crescent, 10 10/11/05

Ferndale Crescent, 10 04/05/05

Ferndale Crescent, 10 23/09/04

Ferndale Crescent, 10 26/04/04

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Polesworth Group Pooley Heights

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Ferndale Crescent, 10 Ferndale Crescent, 10 Moseley Birmingham West Midlands B12 0HF The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter Date: 1 8 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 38 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 38 Information about the care home Name of care home: Address: Ferndale Crescent, 10 Ferndale Crescent, 10 Moseley Birmingham West Midlands B12 0HF 01217721885 01217666856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trident Housing Association Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 8 Number of places (if applicable): Under 65 Over 65 8 8 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 8 Physical Disability (PD) 8 Date of last inspection 3 0 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home The home is located in a small road near to the centre of Birmingham. It is close to local bus routes and shops. The home has some parking spaces for cars to the front of the home. The home supports up to eight adults who have a physical and learning disability. When we visited there were six people living in the home. All bedrooms are single and have their own shower room. There are six bedrooms on the ground floor and two on the first floor. There is a Care Homes for Adults (18-65 years) Page 5 of 38 stairlift to help people who cannot use the stairs. There is an open plan lounge and dining room, kitchen and sensory room on the ground floor. The laundry is situated on the first floor. The home has a small rear garden. A copy of the service user guide is available in the home, this tells people about the home. It costs between £940 and £1065 to live there per week. Copies of previous inspection reports are available in the home for people to read if they want to. Care Homes for Adults (18-65 years) Page 6 of 38 Care Homes for Adults (18-65 years) Page 7 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 38 How we did our inspection: This is what the inspector did when they were at the care home This inspection was carried out by one inspector over one day. The home did not know we were going to visit. The manager sent us information about the home before our visit. We met with people who live at the home but due to their communication difficulties some were not able to tell us what they thought of the home. We therefore asked staff about their needs. We looked at the care plans, health records and daily notes for two people. This is called case tracking. Care Homes for Adults (18-65 years) Page 9 of 38 We looked at staff and health and safety records. We looked at some areas of the home including some peoples bedrooms. We sent surveys to the home to give to staff and people who live there. What the care home does well Care Homes for Adults (18-65 years) Page 10 of 38 There are systems so that peoples needs would be assessed before they moved into the home, so that they know the home could meet their needs. Each person has a care plan to help staff know how to help them to meet their needs and goals. The people living there go out and do things they enjoy. People all have their own bedrooms that contain their personal things. Care Homes for Adults (18-65 years) Page 11 of 38 Staff have training to help keep people safe from abuse. Most staff have a qualification in care so they should know how to meet the needs of the people living there. There is equipment that is in good order to help people be moved safely. Staff help the people living there to keep in touch with their families and the people that are important to them. Care Homes for Adults (18-65 years) Page 12 of 38 What has got better from the last inspection A weekly picture activity board is on display in the home. This helps people to know what activities they have planned. The systems for giving medication have been improved to help make sure people get the medication they need safely. The complaints procedure has our new address so that people can contact us if they need to. Care Homes for Adults (18-65 years) Page 13 of 38 Staff have had more training so they know how to help people to meet their individual needs. A staff photo board has been developed. This has a photograph of the staff on duty that day so that people know who will be supporting them. The frequency of staff supervision has been increased to make sure that staff get the support they need to do their job well. There are reports in the home about how it is being run to help make sure it is being well run. Care Homes for Adults (18-65 years) Page 14 of 38 Systems are in place to help run the home in the best interests of the people who live there. What the care home could do better Some care plans and risk assessments need to be improved to make sure staff know how to support people in the way they prefer. Records should clearly show how much fruit and vegetables people eat to make sure they have a healthy diet. Care Homes for Adults (18-65 years) Page 15 of 38 Improve the information available so that staff know when to give people their medication. This will help to make sure people get the medication they need safely. Improve the way people are supported to spend their money to make sure it is well looked after. Reduce the number of different agency staff who are used so that people are supported by staff who know their needs well. Health and safety of bed rails used needs to improve to ensure that people are safe. Care Homes for Adults (18-65 years) Page 16 of 38 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kerry Coulter CQC West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4WH Tel 0300 616161 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 line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 17 of 38 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 18 of 38 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. Arrangements are in place so that people have the information they need and they can be confident that their needs will be met on admission. Evidence: The home has a service user guide that tells people about the home to help them decide if they would like to live there. The guide has been updated and is in a format that includes pictures making it easier for people to understand. The guide included most of the information people would need, for example about menus, activities and how much it costs to live there. However the guide was misleading with regards to the registered provider for the home. The guide should be amended to reflect that Trident Housing Association are the registered provider. The annual quality assurance assessment, completed by the manager, indicates that a comprehensive assessment would be completed of any potential new person to make sure the home would be able to meet their needs. The people currently living at the home have done so for a number of years. The home has two vacant bedrooms but no new Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: people have moved in since our last inspection. This is because it is planned to refurbish the home and reduce the number of people the home is registered to accommodate. Care Homes for Adults (18-65 years) Page 20 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments do not always give staff the information they need to support people to meet all their needs and achieve their goals. People who live in the home are supported to make decisions about their lives to enhance their independence. Evidence: The care provided to two people living at the home was tracked. The care files for the people living in the home included care plans which gave information about the individuals, what they liked and what they needed support with. Some of the information included in the care plans was well detailed. They showed how people wanted to be supported and were very clear about how staff were to deliver their care. In this respect care plans were quite person centred. However, there were some areas that needed improvement. For example, one person was on medication to prevent constipation but there was no care plan in place to help prevent them becoming constipated. There was also some information in plans that was not signed or dated. It was therefore difficult to establish who had been involved in the information and if it was up to date. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: Each month the keyworker completes a review of the persons needs, to include making sure their care plans and risk assessments are up to date. One persons latest review recorded that all their care plans were up to date. However we saw that their care plans needed to be updated to reflect a change in their mobility. A hand written note to this effect had been made on the care plan by the home. This persons mobility had decreased several months earlier yet their care plan stated they had average mobility. The key worker reviews sampled recorded that the person had been present for the review. However the review did not record the persons views. This should be improved to show that people are included in reviewing their care. Some people at the home have difficulties in communicating. Staff spoken with were able to describe how people with communication difficulties are supported to make choices. Staff were observed throughout the visit giving people choices about what they wanted to do, eat, drink, what they wanted to watch on television or where they wanted to spend their time. People told us that they either usually or always make decisions about what they want to do. Discussions with one member of staff showed that people who live at the home had been involved in their recruitment. This is good practice as it means people have a say about who they would like to support them. Meetings are held regularly with people at the home to help seek their views on the running of the home. Topics discussed include meals, activities, things people are not happy about, holidays and decor of the home. Recently some of the minutes of these meetings have been made available to people in an easy read format that includes pictures. This makes them easier for people to understand. Peoples records included individual risk assessments. Assessments had been completed for areas such as pressure care, manual handling, bed rails, using public transport and responding to the fire alarms. Some improvements were needed to risk assessments. The manual handling assessment for one person had not been fully completed and did not reflect the persons current needs. This had already been identified in a report of a senior managers visit to the home dated March. It is therefore disappointing that we found this still needed to be updated. Some people at the home use bed rails. We looked at the assessment completed for one person regarding their use and found it was inadequate. It did not assess why the bed rails were needed or satisfactorily assess if the rails were safe. This is further detailed in the management section of this report. Care Homes for Adults (18-65 years) Page 22 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place so that people living at the home experience a meaningful lifestyle that includes doing activities they enjoy. Evidence: Most of the people at the home go to day centres and some attend college courses during the week. Records and discussions with people and staff show that activities on offer include shopping, visits to museums, indoor bowls, walks, gardening, cooking, church, cinema and meals out. The homes annual quality assurance assessment told us that one person has been supported to get a voluntary administrative job at the headquarters of Trident. The annual quality assurance assessment stated An activity board is in place with different activities available to customers. Symbols are used with staff sitting down with customers to choose any activity they wish to participate in on weekly basis. These symbols have been introduced alongside an activity folder to meet customers communication methods. When we visited we saw the activity board was in use and Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: accurately reflected the activities people were doing when we visited. Most people went out to activities during our visit. One person did not go out and stayed at home playing cards and watching television. They told us they were happy staying at home. One person spoken with told us theres lots to do. People have the opportunity to go on holiday if they want to, when we visited one person was away in Germany. The home have introduced aspects of Eden Alternatives into the home. This is where peoples well being is promoted through contacts that include animals and plants. The home has pet birds and has recently introduced a fish tank. An ex member of staff regularly brings their pet dog to visit people at the home. There were lots of photographs available of people enjoying themselves doing the gardening. We were told that the home has recently been successful in securing some additional funding to develop a sensory garden. Information about contact with family and friends was available in peoples care plans, this included how contact needs to be promoted. The home has organised meetings with peoples relatives to seek their views on the service and tell them about future plans. Relatives have also been invited to the home for a meal. People are also supported to maintain and develop new friendships. The annual quality assurance assessment told us We have identified a new disco in the community, staff will support customers to attend. Some of our customers like to socialise and network. This club gives them a sense of belonging whilst providing the opportunity of developing new friends. Menus show that meals at the home are nutritious and varied. There is a menu board in the kitchen, this shows what meals are planned in a picture format. Records and discussions with staff show that people help with planning the menus in advance. Menus recorded a choice of meal for breakfast and for lunch but there was only one recorded option for the evening meal. Staff told us that if people did not like what was on the menu then an alternative was always offered. At lunchtime we saw that people were given a choice of what they would like to eat. One person told us lunch was nice and another said food is alright, I have a choice. We sampled the food records for two people. Staff had not completed these in sufficient detail to enable them to track if people were having a healthy diet. Records usually did not record the type or quantity of vegetables that people had and there was little evidence that people had fruit in their diet. We did however see that fresh fruit was available in the home and one person ate some fruit during our visit. One of the people whose records we looked at is at risk of constipation. It is therefore important that their records are detailed so that staff can ensure they are having a healthy diet and the risk of constipation is reduced. Care Homes for Adults (18-65 years) Page 24 of 38 Personal and health care 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. Staff usually support people well so that their health and personal care needs are met so ensuring their well being. Evidence: Attention had been paid to peoples appearance and they were well dressed in clothes that were appropriate to their age, gender and culture. Interactions between the people living in the home and staff showed that both were comfortable in each others company, and support was given with friendliness. Generally staff gave people the support they needed with respect. However we saw one staff move one person back wards in their wheelchair without first consulting them or telling them they were going to do this. This is not good practice and is not respectful of the person. This was raised with the manager during our visit who said it would be addressed. Peoples care records included health action plans. This is a personal plan about what a person needs to be healthy and what health care services they need to access. Health records showed that people have regular health checks, for example with the dentist and optician. Staff said and records showed that a range of other health professionals are involved in the care of individuals. For example one person whose mobility has decreased has had Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: input from a physiotherapist. Records show that some people have input from the dietitian and go to the weight clinic. Records sampled show that where people have been unwell medical advice has been sought. We looked at medication procedures in the home. Since our last visit staff have received refresher training regarding administering medication. A system is also in place so that staff have their competency assessed to make sure they are safe to administer medication to people. We saw that regular medication audits are completed to make sure people are receiving their medication as prescribed. Medication is stored in a locked cabinet. The cabinet was clean and organised into sections for each person to help ensure that it is clear which medication belongs to whom. Each person has their own guidelines that inform staff how they like to take their medication. There is a photograph of the individual at the front of their Medication Administration Records (MARS) to ensure that it is clear who to give the medication to. One person is prescribed medication on a variable dose basis, this means that staff can give them either one or two tablets. At our last visit the MAR did not indicate how many tablets have been given. This has improved and a system is in place to identify if one or two tablets are given. Some people have medication administered on an as required basis. For some of these there was a protocol in place describing when it needed to be given. However this was not in place for all as required medication. One person was prescribed two different as required medications for the same health condition. Protocols did not make clear when which one should be administered or if it was safe for the person to have both medications. One person was prescribed a mild pain killer but there was no guidance available about when this should be used. Care Homes for Adults (18-65 years) Page 26 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and systems usually ensure they are protected from harm. Evidence: The complaint procedure was on display in the home, this is in an easy read format that includes pictures. It has been updated to include our new contact details. The home also has a comments and compliments book available in the entrance hall where people can record any informal comments they may have about the home. Staff who returned surveys to us told us they knew what to do if someone had concerns about the home. Some of the people who live at the home may not be able to make a complaint due to their communication needs and would rely on other people, such as relatives or staff to know when they are unhappy about something. Staff spoken with were able to describe how they would know if people were unhappy about something, for example by their body language. We have not received any concerns or complaints about this home in the last twelve months. The home had received one complaint directly about noise levels. Information was available to show that the complaint had been looked at and action taken to reduce noise levels. The home has polices and procedures on safeguarding people at the home, these are available to staff. It is good that there is also information available to people at the home Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: in an easy read format about prevention of abuse. Staff at the home have received training on safeguarding people from abuse and staff that we spoke to at this visit knew what to do to keep people safe. Records of staff meetings and supervisions show that safeguarding procedures are reinforced with staff during these meetings. Training records sampled showed that not all staff have completed training in the Mental Capacity Act. Staff need to be aware of this legislation and the implications it has for people living in a care home. However evidence was available to show that this training has been arranged. The financial records for two people who live at the home were sampled. Records had been signed by two members of staff and receipts were available for all expenditure. We saw that two people had recently been to the cinema, however it had cost one person twice as much as the other person as they had paid for the staff accompanying them. The manager was unaware that this had happened and said the money to pay for the staff should have come out of petty cash. She said the person would be reimbursed the money. We saw that one person had recently paid for a new wardrobe. We asked why they had paid for something that the home should provide. The manager told us she did not know why they had paid for this. The area manager told us that the provider contributes a basic amount towards furniture and that if people want something more expensive they have to pay the difference. We asked what this amount was but were informed this was undecided as the policy for this was currently being drafted. The manager told us there was no written evidence that the person had been consulted regarding the cost of the wardrobe and it was not clear if they have the ability to understand the cost implications. However there was evidence to show they had been supported by staff to choose their new furniture. Care Homes for Adults (18-65 years) Page 28 of 38 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. People live in a homely, comfortable, safe and clean environment that meets most of their individual needs. Evidence: We looked at all of the communal areas in the home and some of the bedrooms. The home was clean, free from unpleasant odours and a comfortable temperature. Decor was generally in good order. The home has an open plan lounge and dining room. People who live at the home have been involved in choosing the colours and layout of furniture. This home is intended to specifically meet the needs of people who have a physical disability. However the laundry is located on the first floor and can only be accessed by people who are able to use the stairs of the stair lift. The annual quality assurance assessment and discussion with the manager indicates that Trident is looking to make alterations to the home so that the laundry can be located on the ground floor. The kitchen was clean and had satisfactory hand washing facilities. We saw that a small section of the floor covering was worn. The manager told us that plans were in place to replace this. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: Peoples bedrooms are located on the ground floor, two bedrooms are on the first floor but these are not currently in use. Peoples bedrooms contained many personal possessions. Records show that people are consulted about their bedrooms and supported by staff to go out and choose personal items. Some people have mobility difficulties and so some bedrooms are fitted with overhead hoists so that staff can help them to transfer more easily. People have ensuite shower rooms with level access to the shower, this makes them easier for people to use. One person spoken with confirmed they were happy with their bedroom. The home has a small garden and as stated earlier in this report plans are in place to improve this with the addition of a sensory area. Care Homes for Adults (18-65 years) Page 30 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development mean that the needs of the people living there are met. Evidence: The annual quality assurance assessment stated that most the care staff have achieved a National Vocational Qualification in Care at level three. This exceeds the standard of 50 and means that people are supported by well qualified staff. Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. One person who lives at the home told us staff are nice to me. Since our last visit to the home a staff photo board has been developed. This has a photograph of the staff on duty that day so that people know who will be supporting them. 50 of staff who returned a survey to us said there were always enough staff on duty, 50 said sometimes there were enough staff. There were enough staff on duty at the time of our visit to meet peoples needs and we did not see people having to wait for staff support. The manager told us that usually there are three staff on duty during the day but sometimes this increases to four dependent on the activities people are doing. Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: Most of the staff have worked at the home for some time, only one new staff has started since we last visited. This means people are usually supported by staff they know well. However rotas sampled did show there has been some use of agency staff to cover for staff sickness and annual leave. From February there had been seven different agency staff used and this means that sometimes people are supported by staff who do not know them well. It is important that regular staff are used so that people are supported by staff who know their needs well. The records of three of the staff that work there were looked at. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. This helps to ensure that suitable people are employed to work with the people living there. Staff told us that their induction to the home had mostly covered what it needed to and the training they get is relevant to their role. A training matrix has been developed which helps to identify the training the staff team have completed. We looked at this, sampled individual staff records and spoke with staff about the training they had done. These showed that staff have done the training they need to meet peoples needs, where there are gaps, training has been arranged. Recently the manager has introduced training around peoples specific needs as part of staff meetings. Professionals have attended the meetings to talk to staff about specific topics, for example cerebral palsy. The next topic planned is about dysphagia (swallowing difficulties). Discussions with staff and sampled records indicate that staff have regular meetings and receive supervision. This means that staff have a formal opportunity to keep updated with the changing needs of the people living there, and with best practice and be involved in the running of the home. Care Homes for Adults (18-65 years) Page 32 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their views underpin all self-monitoring, review and development by the home. Arrangements in the home need to be improved to help make sure peoples health and safety is promoted and protected. Evidence: The home has been without a registered manager since September 2007. When we last visited the home there was a new manager in post and we made a requirement for them to apply for registration. Since then we did receive an application but this had to be returned. The manager has assured us this will be re-submitted soon. During the inspection there were some areas where the manager did not demonstrate things were being well managed. There were some issues regarding bed rails and discussions with the manager indicated she was not aware of how to make sure the bed rails in use were safe. We also asked the manager if staff had training in managing peoples behaviour but she did not know and had to ask the deputy manager. Given that there have been some recent incidents in the home we would expect the manager to have made herself aware if staff had received this training. Whilst some areas needs to improve it was evident that the manager has improved some outcomes for people who Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: live there and she demonstrated a clear commitment to improving the home further. One staff told us that the home was well managed, they said you can speak to the manager, she will help where she can another staff said can speak to the manager, shes brilliant, open. Have learnt a lot from her, she helps staff to develop new skills. The manager sent us the annual quality assurance assessment when we asked for it, this told us where the home thought they needed to improve and what they were going to do about it. A senior manager visits the home on a monthly basis to complete audits to make sure the home is being well managed. At the last inspection reports of these visits were not all available however at this visit the reports were available in the home. The reports show that all areas are looked at, for example care, staffing arrangements, medication and finances. Minutes of meetings held with people show that the home seeks and listens to their views. Not all people at the home are able to communicate their views and so it is good that arrangements are also in place to seek the views of peoples relatives. We looked at health and safety systems in the home and with the exception of bed rail safety things were generally well managed. The fire risk assessment had been reviewed as recommended at the last inspection. This ensures that action can be taken to minimise the risks of there being a fire. Fire records showed that staff test the equipment regularly to make sure it is working. There are regular fire drills so that staff and the people living there would know what to do if there was a fire. An engineer regularly services the fire equipment to ensure it is well maintained so would work if there was a fire. Staff have regular updated training in fire safety. As recommended at the last inspection more staff have had training in first aid so that they would know what to do in a medical emergency. Certificates were available to show that the hoists had been serviced and were safe for people to use. As stated earlier in this report the systems in place to assess the safety of bed rails were not satisfactory. Risk assessments did not include why people needed to use bed rails or assess satisfactorily if they were safe to use. Discussion with the manager shows she was not aware of the need to assess the size of gaps between the rails and the bed to make sure people are not at risk of entrapment. Not all bed rails had bumper covers fitted and the manager was not aware of when these needed to be used. Discussion with the manager and staff shows there is no system in place to formally check that the bed rails are safe to use. One staff spoken with told us they had not been shown how to check the rails were safe. We have told the area manager for the home about our concerns regarding bed rails safety. They have assured us that the issues will be addressed as a priority. Care Homes for Adults (18-65 years) Page 34 of 38 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 35 of 38 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 1 42 13 Where people use bed rails 11/06/2010 their use must be fully assessed and a system introduced to check they are safe. To make sure that people are not put at risk of injury or harm by their use. 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 1 The service user guide should be updated to include details of the current registered provider for the home. To make sure people do not have misleading information about who is registered with us to provide the service. Improve the care planning system to make sure up to date care plans are in place for all areas of need. So that people can be confident their needs will be met in the way they prefer. 2 6 Care Homes for Adults (18-65 years) Page 36 of 38 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 3 9 There should be satisfactory and up to date risk assessments in place for all identified risks. This will ensure people are not exposed to any unnecessary risks. Make sure food records are sufficiently detailed so that staff can ensure people are having a healthy diet. Improve the information available to staff regarding medication prescribed on an as required basis. This will help to make sure people get the medication they need safely. A clear policy needs to be in place regarding the use of peoples money to pay for items that the home should normally pay for, for example furniture. This will help to make sure peoples money is well looked. Where agency staff are used to cover staffing deficits the home should make sure regular agency staff are used who know people well. This will help to make sure people are supported by staff who are fully aware of their needs. The application to register the manager should be resubmitted to us as soon as possible. So that people can be assured the home is being managed by suitably experienced and qualified person. 4 5 17 20 6 23 7 33 8 37 Care Homes for Adults (18-65 years) Page 37 of 38 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. 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