Inspection on 24/03/10 for Middlemore

This is the latest available inspection report for this service, carried out on 24th March 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

Polesworth Group 32 Station Road

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 70 Long Street

10 Whitfield Avenue

1a White Ladies Close

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Middlemore 21a Elvetham Road Edgbaston Birmingham West Midlands B15 2LY     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: Donna Ahern     Date: 2 4 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 29 Information about the care home Name of care home: Address: Middlemore 21a Elvetham Road Edgbaston Birmingham West Midlands B15 2LY 01214403179 01214403179 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Real Life Options Name of registered manager (if applicable) Ms Fiona Cass Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: The maximum number of service users to be accommodated is: 5 The registered person may provide the following category of service only: Care home only code PC To service users of the following gender Both Whose primary care needs on admission to the home are within the following categories Sensory Impairment code SI Learning disability -code LD Date of last inspection Brief description of the care home The home has been open for several years but has recently been re-registered with us as the care in now provided by Real Life Options. The home is registered for five people with a learning disability. Each person has their own bedroom. There is a bathroom with adapted bathing facilities and shower room with walk in shower so that people with mobility difficulties can use them. There is a large kitchen a dining room and lounge. There is an office and a sensory room. There is some space at the front of Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 5 5 Brief description of the care home the home for car parking. There is a large garden at the rear of the home. The fees range from £1771.54 per week. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the home was undertaken by one inspector over one day. We, the commission were assisted throughout the day by the manager. The home did not know that we were visiting that day. There were five people living there. Information was gathered from speaking to people and observing care and support. Three staff were spoken to. Two peoples care was case tracked. Case tracking involves discovering individual experiences of living at the home by meeting or observing people, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experience of people who use the service. Staff files and health and safety records were looked at. Before our visit we reviewed any notifications received about the home, these are reports about things that have happened in the home that they must tell us about. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think Care Homes for Adults (18-65 years) Page 6 of 29 they are doing well and where they need to improve. It also gives us some numerical information about the staff and the people who live at the home. Prior to our visit we sent out surveys to the five people who live at the home and we enclosed a copy for their relative or advocate if they wanted to pass one on to them. At the time of writing this report we have received one completed survey. The comments we received are included in the report. The home has been open for several years but has recently been re-registered with us as the care is now provided by Real Life Options. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: 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. Care Homes for Adults (18-65 years) Page 8 of 29 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their representatives have the information they need so they can make a choice about living there. Evidence: The home had a change of provider and re-registered with us in December 2009. A new statement of purpose and service user guide has been completed to reflect the new arrangements. The servive user guide had been completed in an easy read format so it was easy to understand. We spoke to the manager about how the service user guide and other information about the home could be produced in an audio format as all of the people who live there have a visual impairment. The manager stated that they are keen to produce information in audio and will be exploring how this can be done with the new provider. All of the people living there have done so for a number of years and there were no vacancies. We saw that there are detailed admission and assessment procedures in place indicating that if there was a vacancy a full assessment of peoples needs would take place prior to admission. Care Homes for Adults (18-65 years) Page 11 of 29 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. Systems in place do not always ensure that staff have the information to support people safely and in a way they prefer. Evidence: We case tracked the care provided to two people. Each person had a care plan. Care plans are records that are used to say what help people need and how staff should provide that care. The care plans had a lot of information about people collected over a long time, however we sometimes found it difficult to find what we were looking for. We found that one of the peoples profiles, which gives an overview of a persons needs had not been dated so it was unclear if the information was up to date. Parts of the care plan had been added to when needs had changed. Sometimes it was difficult to track specific care needs between the care plan and the guidelines section of the care plan. One of the peoples guidelines states they should never be left alone with food or drink Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: as they have difficulty swallowing and could be at risk of choking. We saw a staff member hand the person a drink and leave the lounge returning several minutes later with a drink for another person. This practice puts people at risk of danger. The manager told us that the new provider will be introducing a new care plan format and all the peoples care plans will be changed over to the new format. The manager said the new care plans will be written in a way that is more personal to the person and should ensure people individual needs are well planned for. We observed the care and support that people got during the day. The manager was very postive with her approach to people and engaged with people throughout the time she supported them. We saw that some staffs communication with people was poor. We saw one staff member tap a person on their hand and told them in front of the other people living there that they had to go to the toilet. We saw people sit for long periods of time with little or no interaction from the staff on duty. All of the people living there have limited verbal communication. There was some information on the care plans about how the person may express themselves but this information was limited. There were no communication passports in place which would identify how the person communicates basic needs and choices. The manager told us there are plans to develop these for each of the people who live there. We saw that a number of risk assessment are in place for people. These should tell staff how to support people with activities and minimise any risks to their safety. We saw assessments for traveling in the minibus, use of taxi, fire evacuation, eating and use of wheelchair. The risk assessment for eating did not refer to the person guidelines or specific specialist advice that had been sought for the person. Inconsistent information could jeopardise the persons well being. The wheelchair assessment did not detail the safe use of the lap belt and when it should be in place, which could put the persons safety at risk. Care Homes for Adults (18-65 years) Page 13 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not always ensure that peoples individual needs are met. Evidence: We looked at peoples care plans and daily records and spoke to staff to establish that people are leading meaningful lifestyles. It was positive to hear that the new provider has provided a mini bus for people to use. The manager said that this has enabled people to enjoy more community based activities. However because of the seat layout of the transport and peoples needs there are limitations to when it can be used for safety reasons. There is also only three staff who are approved drivers which limits the opportunity for people to go out. We saw that weekly trips are made to black space which is a sensory facility specifically designed for people with complex needs. The manager said people attend this on a rota basis. Weekly activity plans indicated that people go to the cinema and Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: park and do personal and food shopping. In house activities include room cleaning, arts and craft, music and hand massage. There was limited information recorded about peoples response to the activity so a judgement can be made if the person is still enjoying the activity. From reading records and talking to staff about how the choices of activity had been made for people it seemed that people were offered very similar choices of things to do. Daily records list what people do and include recording such as assisted in the kitchen and went shopping. During our visit one of the people went out to help with the household shopping. In the afternoon people sat in the lounge with the television on whilst a staff meeting took place in the dining room. We saw that some of the people moved freely around the home and did make a choice about where they wanted to sit. It was positive to hear that three of the people are supported to go to church. Two people alternate attending Church. One of the people has recently been supported to return to attending church. Staff said the person seems to get a lot from this activity however sometimes they have to leave and return to the home before the service is over to fit in with transport commitments and the availability of drivers. People are well supported by staff to maintain any links with family and friends and information about important relationships is detailed in their file. A log of all calls and contacts is kept on the persons file. There is an open visiting policy so people are free to visit when they chose to. Meal times are taken in two sittings staff told us that this is so people get the individual support they need. We observed the lunch time meal. People got good support from staff and people were seen to eat at their own pace. Menus seen offered a variety of food. Staff said the menu is planned around what they know people like. Some people have eating difficulties and specialist advice had been sought from the speech and language therapists and guidelines were in place for staff to follow. It was difficult to establish what treats or snacks are made available to people in accordance with their individual specific health or dietary needs. When we asked staff we were told that one of the people didnt have treats as they were on a diet. One person asked for crisps and were told none of the low salt crisps were left until the shopping was done. It is understandable that snacks will run out or some people due to their health needs will have limitations on what they can have. However this information did not form part of their care plan so staff can ensure that these needs are met. When we looked at the records of food and drinks there were several days when there was no evidence that people had been offered a drink for a large part of the day. Their care plans says ensure they get a lot of fluid intake. These records are significant as most people living there are not able to ask or get themselves a drink. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not always ensure that the health care needs of people are met. People do not always receive personal care in a way that they prefer. Evidence: People have complex needs and require a lot of support with meeting their personal care needs. We saw staff give people support when they needed it. However one staff member spoke out loudly in front of other people and told the person repeatedly to go to the toilet. This did not promote the privacy and dignity of the person. People were dressed in clothes that were appropriate to their age, gender, culture and the weather. A physiotherapist has devised an exercise programme for one of the people. We were told that this is done as part of their daily routine although there was no care plan in place to support this and to record any progress. When we looked in peoples bedrooms we saw that some of the people had bed sides and covers which are used to help prevent people falling out of bed. There were no Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: risk assessments in place to support this practice and ensure that these were in place in the best interest of the person. A care plan was in place for the management of constipation however there was no information about what staff should be looking for and what is normal for that individual. This could lead to a delay in further advice being sought. We saw information on a medical letter referring to a person as having epilepsy. However there was no information on the persons care plan referring to this health need. The manager said that there was no record or information about the person having epilepsy and no epilepsy monitoring was in place. A lack of clarity around peoples needs could put them at risk of harm. We looked at peoples health action plans. This is a personal plan about what help a person needs to be healthy and stay healthy. These had not been used as an active document and updated as needs changed. People had been supported to attend medical appointments including doctor, dental and hospital appointments. The outcome of these appointments had been recorded so peoples wellbeing could be monitored. Medication is stored securely. We saw two staff give out medication. This helps to minimise any risks. Copies of each persons prescriptions are kept so that staff can check what is provided by the pharmacists is what has been prescribed by the doctor.We saw that on some occasions the Medication Administration Records (MAR) had not been signed. The manager said that the gaps were when people were out on activities or for medication given on an as needed basis. The correct codes should be entered on the MAR sheet so the records are an accurate recording of what has been given. Diagrams had been used to inform staff about applying creams to peoples bodies accurately. The manager told us that further medication training is being provided by the new provider. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place should ensure that people are listened to and protected from abuse. Evidence: We have not received any complaints about this home and the manager told us they have not received any complaints directly. A new complaints procedure detailing the new provider details was available. It is well produced in an easy read format with pictures so it is easy to understand. However it states that people can contact CQC if they are not happy with how the home or provider has dealt with a complaint. CQC can be contacted at any time in the complaints process. Therefore the procedure could be misleading to people who are unsure of what their rights are. We saw the policy the home uses in the event of abuse being suspected or reported and this would ensure concerns are responded to quickly and the right people informed. Staff we spoke with all knew what abuse was and who they should report it to. Staff have completed safeguarding training and three staff have completed Mental Capacity Act and Deprivation of Liberty Safeguards training. The manager said the rest of the staff team will be completing this training. This should ensure that staff have an understanding of this important legislation and the impact it has on people living in the home. The new provider has been involved in supporting people to have their own bank Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: accounts. Some aspects of peoples finances were still in the process of being changed over to the responsibility of the new provider. We looked briefly at the personal finances for two people. Accurate records of in and outgoing amounts are recorded. Receipts are kept for some items. All personal monies are counted and signed for at the beginning of each shift . This should ensure that peoples money is safeguarded. Care Homes for Adults (18-65 years) Page 19 of 29 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 safe, comfortable environment that meets their individual needs. Evidence: The home is a purpose built bungalow situated down a private driveway. It is located near to another registered home of the same design and owned by the same provider. Local shops and leisure facilities are within walking distance of the home, which is important for the people living there. We looked at the communal areas of the home and at peoples bedrooms. The manager told us that many parts of the home had been recently painted. Contrasting colours had been used on walls, doors and frames so that the environment was more suitable for people with a visual impairment. The home was generally clean and free from offensive odours. The lounge temperature felt very hot on the day of the visit and this should be monitored so it is comfortable for people. It was good to see that people had been supported to make their bedrooms very individual and personal. One of the people had lovely textured paper on the wall and finishing touches had been added to make it a pleasant room. Some of the people Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: were waiting on replacement curtains and bedlinen so the rooms looked more finished and welcoming for them. We noticed in the lounge that the sofa covers looked dirty. We were told that these are washed weekly and a second set of covers is available to allow this to happen. The carpet throughout the hall way and corridor of the home looked dirty and stained. The manager told us that it had been cleaned and contact had been made with the manufacture over the quality of the carpet and she was waiting on feedback from them. In its current condition it detracts from the overall appearance of the home. There is a shower room with level access and a bathroom with an assisted bath so peoples personal care needs can be safely met and a choice of bath or shower offered. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure that people are supported by a staff team who are fully competent to meet their needs. Evidence: The manager told us and rotas looked at showed that there are between three and four staff on duty throughout the day. Since Real Life Options became the provider there has been some changes to the rota. There has been some reduction in staffing levels and the manager works two days a week providing direct care to people. On the day that we visited there was one permanent staff member, one agency and the manager on shift. People generally got the support they needed but there wasnt really the opportunity for people to go out or take part in spontaneous activities because staffing arrangements would not have allowed this. In the afternoon there was four staff on duty so greater flexibility provided the opportunity for one of the people to go out. The manager said that there is flexibility with the rota and one person was going to a football match at the weekend. Extra staff will be on duty so the person gets the support they need to do this activity. There has been some reduction in the use of bank and agency hours and four new staff have been appointed this should lead to improved consistency for people. The majority of staff have a National Vocational Qualification (NVQ) in care level 2 and Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: a number have achieved level 3. This should help towards ensuring staff have the skills and knowledge to meet peoples needs. As previously raised in the report some of the interactions we saw between staff and people living there were of a concern. Some staff did not interact well with people living there and we were concerned that staff did not know how to communicate properly with a person who has a visual impairment. We saw that some staff were focused on doing tasks in the home rather than engaging directly with people living there. The manager told us that new staff have a two week induction. Although new staff appointments are positive for the home the manager said there has been some impact of four staff starting at the same time as they make up almost a third of the staff team. We saw from looking at the training matrix that refresher training in a number of areas is now needed for staff who transfered over to the new provider. This training should have been provided by the previous owners. This includes training on epilepsy, visual impairment awareness, dysphasia (swallowing difficulties) medication and health and safety so they continue to have the required knowledge and skills. Newly appointed staff are currently working through completing the mandatory training. The provider has permission from us to store staff recruitment documents at their headquarters. We were informed that Real Life Opinions are arranging for staff who transferred form the previous owners to have new CRB (criminal records bureau) checks. Records showed that regular staff meetings take place so staff are kept updated on good practice issues and the changing needs of people. A handover takes place when staff start their shift which should provide continuity of care for people. Care Homes for Adults (18-65 years) Page 23 of 29 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. The management arrangements do not fully ensure the well being of the people living there. Evidence: The manager transferred over from the previous provider. She has a numbers of years experience of working with people who have a learning disability. The manager was open and welcomed the inspection process. She said she was getting the support from her senior managers to do the job. However with the new provider, the manager is now expected to work two shifts a week providing direct care to people which reduces the time she has to complete management tasks. As this was a recent change it was to early to comment if this was having a negative impact on the running of the home.The visit has highlighted that improvements need to be made to a number of areas as highlighted in this report and include care planning, risk assessment, staff training, meeting peoples communication needs, staff practices and levels of engagement with people. There needs to be assurances from the new provider that these issues will be addressed. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: We received the homes annual quality assurance assessment when we asked for it. It was not due to be returned to us until after the date of our visit. It generally reflected what we saw during the visit. It told us about some of the improvements that are planned to improve the service for people. The provider has different monitoring tools that are used to audit the service and get feedback from people about the home they live in. The manager told us a detailed quality audit had been completed but we did not see the outcome of this report. The manager said she is developing an action plan so the required improvements are made and surveys will be sent out to people to ask their views about the service. Monthly visits are done by the operations manager and we saw the report for one visit. Fire records showed that staff test the fire equipment regularly to ensure it is working. It is serviced by an engineer to ensure it is well maintained and would work if activated. Fire drills take place so staff know how to support the people living there if the alarm went off. The work place fire risk assessment required updating so any steps taken by the manager to minimise the risk of fire remain up to date and promote peoples safety. Certificates were in place for gas and electric safety tests. Water temperatures are monitored to minimise any risk to people of scalding. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 12 Peoples needs in relation to epilepsy must be clarified. So people get the support they need to meet their needs and to be safe. 16/05/2010 2 35 18 Staff must receive the training they need in mandatory areas. So they are competent to meet peoples needs. 03/06/2010 3 42 23 The work place fire risk assessment must be reviewed. To ensure that steps taken to ensure peoples safety remain adequate. 15/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should be kept up to date so staff have all the Page 27 of 29 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations information they need to meet peoples needs. 2 12 Consideration should be given to recording peoples response to in house and community activities. So people can be supported in their decision to make changes to what they chose to do. The range of activities available to people should be reviewed to ensure they meet the needs of the individual people who live in the home. Records should include details of drinks offered across the day to ensure peoples health and wellbeing. Care plans should include what food people like and how and when snacks and treats will be provided to people. In accordance with any specialist health care guidelines. Care plans should be in place for specific health care needs so people get the support they need to promote their health and well being. Risk assessments should be in place for the use of bed rails and covers so people get the support they need to be safe. Medication codes should be entered onto medication record sheets when medication is not given. So there is an accurate audit trail in place confirming what has been given and when. The complaints procedure should detail that CQC can be contacted at any stage in the complaint process so people are clear about their rights. Staff should have the right skills and attitude to support people with complex needs. 3 13 4 5 17 17 6 18 7 8 18 20 9 22 10 32 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!