Inspection on 14/10/09 for Natalie House

This is the latest available inspection report for this service, carried out on 14th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Natalie House 05/12/07

Natalie House 17/01/07

Natalie House 17/11/05

Natalie House 23/06/05

Natalie House 18/03/05

Natalie House 25/05/04

Natalie House 27/01/04

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Polesworth Group Pooley Heights

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Polesworth Group 70 Long Street

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG 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 4 1 0 2 0 0 9 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 43 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG 01214579592 01214579592 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Notknown Alphonsus Homes care home 5 Number of places (if applicable): Under 65 Over 65 5 5 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can 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: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Physical disability (PD) 5 Date of last inspection 0 3 1 1 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 43 A bit about the care home Natalie House provides care for up to five adults with learning and physical disabilities. It is in a quiet residential area on the edge of the Lickey Hills in Rednal, Birmingham. It is close to public bus routes and the shopping centre at Rubery is nearby. The home is a specially built bungalow and is furnished and decorated to a good standard. Each single bedroom has en-suite facilities, including shower and hand wash basin. Care Homes for Adults (18-65 years) Page 5 of 43 Bedrooms are decorated in homely and appropriate styles. There is a comfortable lounge and a separate dining room. There is a well equipped kitchen, laundry and office. The home has a good sized garden. There is some off-road parking at the front of the building. Smoking is not allowed in the Home. Copies of the homes previous inspection reports are available in the home on request. The service users guide stated that the fees charged to people who live there are from one thousand to one thousand four hundred pounds per Care Homes for Adults (18-65 years) Page 6 of 43 week.. Care Homes for Adults (18-65 years) Page 7 of 43 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 Care Homes for Adults (18-65 years) Page 8 of 43 How we did our inspection: This is what the inspector did when they were at the care home This inspection took one day, the home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We met with people who live at the home but due to their communication difficulties they were not able to tell us what they thought of the home. We asked staff about their needs. Care Homes for Adults (18-65 years) Page 9 of 43 We looked at the care plans, health records and daily notes for two people. This is called case tracking. We also looked at all parts of the home, staff and health and safety records. Surveys were sent to the home to give to eight staff and five relatives. We also sent surveys to four care professionals. Only one care professional survey was returned, we did not receive any from staff or relatives. What the care home does well Staff treat each person as an individual and talk to people in a way that shows they respect them. Care Homes for Adults (18-65 years) Page 10 of 43 Staff support people to make decisions about their day-today lives by spending time observing their gestures, facial expressions and their nonverbal communication. The food is nice and people have a healthy diet with lots of fruit and vegetables. People are involved in food shopping trips so that they participate in the weekly menu planning. People are encouraged and supported to maintain relationships with their families. The people living there were well dressed and had been supported with their personal care helping to raise their selfesteem and well being. Care Homes for Adults (18-65 years) Page 11 of 43 Each person living there has their own bedroom. These included their personal things. The home is clean and well decorated so it is a nice place to live. Staff know the people living there well. The right checks are done on new staff before they start work so that people are not put at risk of having unsuitable people working with them. Care Homes for Adults (18-65 years) Page 12 of 43 There are regular maintenance checks and servicing of most of the equipment used at the home so that they are safe to use. What has got better from the last inspection The hall carpet has been replaced so that the hallway now looks welcoming and well maintained. There are now usually enough staff on duty to meet peoples needs so that they do not have to wait for staff support. Care Homes for Adults (18-65 years) Page 13 of 43 More staff have had manual handling training so that they know how to help people to move safely. Staff have had training to help them communicate with people. Repairs to electrical installations have been done so that people are kept safe. What the care home could do better Care Homes for Adults (18-65 years) Page 14 of 43 Care planning and risk assessment needs to be better so that staff know how to support people so that they get the care they need. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and have different experiences. Consideration needs to be given to peoples preferences in regard to the gender of the staff who support them with personal care, so that peoples preferences are respected. Medication practice needs to improve to make sure that people get the medication they need, safely. Care Homes for Adults (18-65 years) Page 15 of 43 The home needs to improve how it records complaints so that people can be sure their complaint will be listened to. The home should have a bath that is suitable for people so that they can choose to have a bath if they want to. Proceed with plans to carry out further staff training to make sure all staff receive the training they need to enable them to meet peoples needs. Quality assurance systems need to be improved so that the home is run in the best interests of the people who live there. Care Homes for Adults (18-65 years) Page 16 of 43 Improve the assessments for the use of bed rails to make sure that people are not at risk of being hurt. 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 West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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 Care Homes for Adults (18-65 years) Page 17 of 43 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 18 of 43 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 19 of 43 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 have the information they need about the home so they can make a choice as to whether or not they want to live there. Evidence: People who live at the home have a copy of the service user guide. This includes pictures so that it is easier for people to understand. The range of fees is included so that people know how much it costs to live at the home. The guide is due for review and when this is done will need to be updated to reflect that the home is now regulated and inspected by the Care Quality Commission. The home currently has no vacancies and the last time someone new moved into the home was in 2003. Therefore, the standard relating to the assessment process was not fully looked at. However, the home has an admission procedure that indicates a full assessment would be carried out before any new person was admitted to the home. Care Homes for Adults (18-65 years) Page 20 of 43 Care Homes for Adults (18-65 years) Page 21 of 43 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. Arrangements do not always ensure that staff have the information they need to be able to meet individuals needs so ensuring their safety and well being. Evidence: We looked at the care records of two people who live at the home. Each person had a care plan, this included information on how staff are to support the person with their daily living skills, at night, their activities, personal care, communication and health needs. Plans were generally brief in content and would benefit from further development to make sure staff have the information they need to be able to meet peoples needs. The majority of information in peoples care plans had not been reviewed in the last twelve months. This needs to be done to make sure that staff have up to date information about peoples needs. The manager told us that the home was planning to introduce a new care planning system and that people would soon have new care plans in place. During the course of the visit, it was possible to observe members of staff supporting Care Homes for Adults (18-65 years) Page 22 of 43 Evidence: people to make choices about what they wanted to do. Sometimes this was limited because of peoples communication support needs and learning disabilities. Since we last visited the home has worked with a Speech and Language Therapist and people now have a communication passport. This gives staff more information on the ways each person uses to communicate. We looked at the risk assessments for two people, and as identified at previous inspections some improvements are needed. Assessments had been completed for risks such as choking, hot water, using the kitchen and using the mini bus. At our last inspection we asked the home to risk assess the way in which some people were getting in to the bath. This was because the bath is quite high and some people needed to use a step to get in. At this inspection we found that a written risk assessment had not been completed. However discussion with staff and daily records indicate that people were now not using the step and were having showers instead. One persons records identified they were at risk of falls, the accident book showed they had some falls. However there was not a falls risk assessment in place. The manager told us that this was because the person was currently being assessed by a physiotherapist and that a risk assessment would then be completed. Some people at the home use bed rails to help prevent them falling out of bed. For one person the assessment was quite detailed, however for another person the assessment was quite brief and did not fully assess all areas of risk. As with care plans the majority of risk assessments had not been reviewed in the last twelve months, this needs to be done to make sure the information is up to date. Care Homes for Adults (18-65 years) Page 23 of 43 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 to ensure that the people living there usually experience a meaningful lifestyle. People are offered a varied and healthy diet so ensuring their health and well being. Evidence: The home have day care workers, whose main role is to help support people to undertake activities. The home has its own mini bus that helps people get out to activities in the community. During our visit to the home everyone who lives there had the opportunity to go out to a shopping centre and to have lunch out. Staff told us that people were being supported to do some early Christmas shopping. People who live at the home participate in a range of activities based on their interests and abilities including aromatherapy, hydrotherapy, parks, horse riding, shopping trips, day trips and meals out. People are also encouraged to participate in house hold tasks and cooking with the full support of staff. The homes annual quality assurance assessment told us that they are hoping to develop pictorial activity diaries for people in Care Homes for Adults (18-65 years) Page 24 of 43 Evidence: the next twelve months. Most of the activities that people take part in are during the day Monday to Friday. One staff told us it would be nice if people could go out more in the evening, perhaps to some sort of club. Previous inspections have identified that people have not had opportunities to go on holiday if they want to because of staffing issues. People have not been on holiday in the last year. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences and places. Records showed and staff said that people are supported to keep in contact with their family and friends where appropriate. This is through visits and telephone calls. Staff also support people to buy presents and cards for their relatives at special times such as Mothers day. We spoke with one relative during our visit, they told us that staff always make them feel welcome at the home. Menus sampled showed that people living there are offered a variety of food that includes fresh fruit and vegetables to ensure their diet is healthy. An alternative is offered for each meal and the menu meets peoples cultural requirements and preferences. People are offered a choice of main meal each day and a take away meal is purchased once a week. The people living there often go with staff to shop for their food and are sometimes involved in preparing meals. Staff showed us that they were in the process of taking photographs of the meals people have. The photographs are then enlarged and will give people a visual aid to help them choose the meals they would like. Care Homes for Adults (18-65 years) Page 25 of 43 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 may not always ensure that the health needs of people are met, which could impact on their well being. Evidence: All people at the home need support from staff with their personal care. When we visited we saw that people looked smart and had been well supported with their personal care. Where people needed assistance in going to the toilet staff offered assistance in a discreet and respectful manner. Peoples care plans did not show that their preferences had been considered with regard to the gender of staff who support them with their personal care. Records showed that people go out with staff to buy their own toiletries, clothes and to go to the hairdresser. During the visit the patio doors in the lounge were open. The lounge was therefore quite cold. One person was sat by the open door for over twenty five minutes. They were wearing a short sleeved top and were likely to be quite cold. However the person was unable to move from the door as they were in a wheelchair and needed staff support. When one staff came into the lounge they commented how cold it was. It was therefore very disappointing that they did not take action to meet the persons support needs and that they left the patio doors open. The doors were not closed until another person who lives at the home came into the lounge and did this. Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: Records sampled included an individual health action plan. This is a personal plan about what support a person needs to be healthy and what health care services they need to access. Records generally showed that where appropriate people are referred to health professionals to get the help they need to meet their health needs. Two health professionals told us that the home usually meet peoples health needs. We looked at the health records of two people. It was difficult to fully track that people had attended health checks such as with the dentist. This was because records of health appointments were being recorded in three different places. The home needs to improve the system of recording and tracking appointments to help make sure people attend check ups when they need to. One person at the home was assessed at being at risk of pressure ulcers (sore skin). We saw that the assessment had not been reviewed for over twelve months, this needs review to make sure the assessment is accurate. Health plans were written for any health concerns that individuals may have, for example epilepsy. Discussions with staff showed they were aware of peoples health care needs. Medication is stored in locked cabinets. At the front of each persons medication administration record (MAR) there was a photograph of them so that unfamiliar staff would know who to give medication to. Only staff who have received training administer medication. Currently only half of the staff team are trained and the manager said arrangements were being made for more staff to do this. One person at the home sometimes has medication that staff need to administer when they have a seizure. Records show that several staff have been trained to do this by the community nurse. Evidence was available to show that the manager is currently in the process of arranging refresher training for staff so that they can continue to do this. Some people are prescribed PRN (as required) medication. There were generally individual protocols in place stating when and why this should be given to ensure it is given only when needed and not misused. However for one medication the protocol could not be found when we visited and some protocols were seen to be overdue for review. This needs to be done to make sure the information in them is still current. One persons MAR recorded that they had not had one of their medications for the last two days as there was none available in the home. However investigation by the deputy manager showed that there was some of the medication in stock but in a cupboard that only senior staff had access to. Arrangements need to improve to make sure that the medication people are prescribed is available when needed. The home had retained copies of the previous months prescriptions so that staff could check medication received matched the medication prescribed with the GP. However this has not been the usual practice and should be done with all the prescriptions. Care Homes for Adults (18-65 years) Page 27 of 43 Evidence: Care Homes for Adults (18-65 years) Page 28 of 43 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 may not always ensure that the views of the people living there are listened to and they are safeguarded from abuse. Evidence: Since the last inspection we have not received any complaints about the service provided at Natalie House. The home has a complaints procedure that includes photographs to try and make it easier for people to understand. This was not on display to people when we visited. The manager told us this was because the procedure was being updated with new photographs. The people living at Natalie House have communication support needs, and a formal complaints procedure has little relevance for them. They are reliant on the vigilance of relatives or staff members who know them well to interpret changes in demeanor, behaviour or body language, to alert them to the fact that something is amiss. As stated earlier in this report communication passports have been developed for people. These help staff to know when people are unhappy about something. The home are also intending to send out copies of the complaints procedure to peoples relatives to make sure they know how to make a complaint if they need to. We spoke with one relative who told us that if he does have any concerns they are always addressed by the manager. The annual quality assurance assessment for the home recorded that the home had not received any complaints directly. The manager told us that if any complaints were received they would be recorded in the Occurrence book. This book did not record any Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: complaints. However, the homes communication book made a brief reference to a complaint from a neighbour about noise levels at the home. There was no formal record of this complaint and no record of the action taken to respond to it. The manager told us that she had spoken with the complainant, this needs to be recorded so that people can be sure their complaints will be dealt with. Staff cover safeguarding procedures on induction to the home and most staff have completed training in the protection of vulnerable adults. The manager told us that training was being arranged for those staff who needed it. Policies and procedures to include whistle blowing are readily available to staff. We spoke with staff about what they would do if they suspected abuse and they were able to give satisfactory answers that would protect people. The manager said and records showed that staff had not had training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS).However since the homes last inspection the manager has attended MCA training. The manager said that this training is planned for all staff to do so that they are all aware of how this legislation may affect the people living there. A secure facility for the safekeeping of small amounts of individuals money was provided at the Home. A sample check of two peoples financial records was undertaken. Receipts and items were available to verify expenditure. The area manager for the home had recently completed an audit of peoples money to make sure it was being looked after. Care Homes for Adults (18-65 years) Page 30 of 43 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 are provided with a clean and comfortable living environment in which they are generally safe and secure. Evidence: Natalie House provides a homely and well maintained living environment for people living there. It was free from unpleasant odours, well decorated and furnished throughout in a homely style. Since the homes last inspection a new carpet has been fitted in the hallway. This makes this area of the home look welcoming and well maintained. The home has a well maintained garden that people can access via a ramp from the lounge. The homes annual quality assurance document told us that in the next twelve month the home hopes to develop a vegetable garden. We noticed that the picture quality of the television in the lounge was poor making it difficult for people to comfortably watch it. Staff told us that this was due to poor television aerial reception in the local area. During our visit a replacement television was delivered to the home, staff hoped that this would help to improve the picture quality. Peoples bedrooms were in good decorative order in an appropriate style to reflect the gender, age, culture and interests of the individual. Bedrooms contained personal possessions, ornaments, televisions and DVD players so that they felt comfortable. All Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: bedrooms were for single occupancy and had an en suite toilet, shower and hand basin facility. Previous inspections have identified that the bathing facilities in the home were not of an ideal design to meet the needs of the people living there. Last year a new bath had been installed but that this was not one specifically designed for people with mobility difficulties. Discussion with the manager appeared to indicate that the new bath was chosen due to the cost rather than the needs of the people at the home. Discussion with staff at this visit indicates that the bath has only been suitable for one person and other people in the home are having showers. This restricts peoples choice to have a bath if they want to. The manager told us that an alternative design of bath was now under consideration. It is advised that the home seeks input from an occupational therapist to make sure that the new bath is the right design to safely meet peoples needs. Infection control procedures were satisfactory. Hand wash and hand towels were available in the kitchen, laundry, bathroom and toilets so to reduce any risk of cross infection. The homes food hygiene arrangements have recently been awarded an excellent rating by the Environmental Health Officer. Care Homes for Adults (18-65 years) Page 32 of 43 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. The arrangements for staffing, their support and development are variable, which could impact on the well being of the people who live there. Evidence: 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. The home has a stable group of staff and this means that people are usually supported by staff who know them well. Six of the staff at the home have a National Vocational Qualification (NVQ) in care, this does not meet the standard of 50 of staff having this qualification. However other members of staff are currently working towards achieving this qualification. Discussion with the manager and observation of the staff rota indicates there are a minimum of three staff on duty during the day, sometimes four. During our visit to the home there were enough staff on duty and people did not have to wait for staff assistance. Minutes were available to show that staff meetings had been held recently so that staff know about the changing needs of the people who live there and are kept up to date with best practice. Care Homes for Adults (18-65 years) Page 33 of 43 Evidence: The AQAA stated that all staff have had satisfactory pre employment checks. The records of three of the staff that work there were looked at. These included the required recruitment records including a satisfactory Criminal Records Bureau (CRB) check to ensure that suitable staff are employed to work with the people living there. Discussions with staff and staff training records show that staff get most of the training they need, this includes an induction to the home for new staff. As stated earlier in this report there are some gaps in staff training with regards to safeguarding people from abuse and the new Mental Capacity and Deprivation of Liberty Safeguards Legislation. Some staff also needed to have training in first aid. We were told this is being arranged. Recently staff have received training in communication methods with people who live at the home. The professional who conducted this training told us that staff had been very enthusiastic about it. At the last inspection it was identified that several staff needed refresher training in manual handling. Most staff have now had this but it is still needed for some staff. The manager has recently completed training so that she can carry out manual handling training with staff. The manager said she will be doing this soon so that all staff will have the training they need. Discussion with the manager and looking at records show that staff at the home often do not receive regular supervision. One new member of staff had only one supervision in a seven month period. One long term member of staff had averaged one supervision a year in the last few years. The manager told us that some supervisions had been arranged with staff recently but that some staff had not turned up for these. Regular supervision is important to enable staff to develop and better support the people living there. Care Homes for Adults (18-65 years) Page 34 of 43 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 always ensure that the views of the people living there are considered and their health, safety and welfare is protected, which could impact on their well being. Evidence: The home has a registered manager in place who has worked there for some time. She was professional throughout the visit and observed to have a very caring attitude towards people at the home. Staff and a relative spoken with told us that the manager was very approachable. The manager has not yet achieved the Registered Managers Award (RMA) and at previous inspections has told us she hoped to finish it soon. At this visit we were told she was now meeting weekly with her assessor and had a date of February 2010 to complete this. It is important that the manager is pro active in finishing this as this inspection has found that some areas for people need to improve and progress towards this is often slow. Knowledge gained during completion of the RMA will hopefully help the manager to be more effective and improve outcomes for people. It may also be of benefit in enabling the home to be effectively managed if the facility of a computer and internet access was Care Homes for Adults (18-65 years) Page 35 of 43 Evidence: available. The manager completed the annual assessment (AQAA) for the home prior to the inspection taking place. The content did not always reflect what was actually happening in the home, for example it said the home had not received any complaints when this was not the case. It did not also record some of the improvements that the home had made. Quality assurance systems are in place but could be improve. Quality audits are completed by a manager of one of the providers other homes. The area manager also visits the home and writes a report of their visit. Reports provided showed these visits are usually done monthly. At previous inspections some of the reports said that satisfaction surveys needed to be sent to peoples relatives. The manager told us this had not been done yet but that new surveys had been designed and would be sent out in the next week. Due to people at the home having limited communication methods it is important that the home seeks the views of other people involved in their care such as their relatives or care professionals. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to make sure it is well maintained so it works well. Records show that staff have had fire training and drills so they know what to do in the event of a fire occurring. A fire risk assessment has been completed but has not been reviewed in the last twelve months. This needs to be reviewed to make sure fire precautions in the home are satisfactory. A certificate was available to show that the gas installations in the home were safe. An electrician completed the five yearly testing of the electrical wiring in September 2008 and stated that it was unsatisfactory. Records were available to show that remedial works have now taken place so that the electrical installations are safe. Whilst we were at the home the maintenance staff was there checking water temperatures to make sure they were not too hot and were safe for people. During our visit staff assisted one person to stand from their chair. This was done in a safe and supportive manner. As stated earlier in this report some people at the home use bedrails to help prevent them falling out of bed. We saw that one person who had bed rails also had a pressure relieving mattress on their bed. It appeared that the extra mattress height may have resulted in the bed rail being too low. The risk assessment for the bed rails did not take this into account. We brought this to the attention of the manager during our visit who put into place some short term measures to reduce the risk to the person. The home needs to ensure that detailed bed rails assessments are completed to make sure that the bed rails in use are safe. Care Homes for Adults (18-65 years) Page 36 of 43 Care Homes for Adults (18-65 years) Page 37 of 43 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 38 of 43 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 9 12 Where risks to people are 27/11/2009 identified these must be fully assessed, assessments must clearly state how staff are to support people. This will help to minimise the risks to their health and safety. 2 20 13 Medication prescribed to people must be available in the home. 06/11/2009 To make sure people receive the medication they need to stay healthy. 3 22 22 A record of all complaints 19/11/2009 received must be available in the home and record the action taken in response to the complaint. So that people can be sure Care Homes for Adults (18-65 years) Page 39 of 43 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 that their complaint will be taken seriously. 4 42 13 The risk assessment process 30/10/2009 for the use of bed rails in the home needs to improve. To make sure that the bed rails in use are safe and well maintained. 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 need to be developed further so that staff have all the information they need to meet peoples needs. Plans should also be reviewed and updated when peoples needs change. Complete an audit of risk assessments to ensure information within them is up to date and accurate. This will help staff know what they need to do to help keep people safe. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences. The home should consider expanding the leisure opportunities available to people at weekends and evenings to help improve peoples leisure time. Staff need to ensure they provide people with the support they need to be at a comfortable temperature, to help them stay well. Consideration needs to be given to peoples preferences in 2 9 3 14 4 14 5 18 6 18 Care Homes for Adults (18-65 years) Page 40 of 43 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 regard to the gender of the staff who support them with personal care, so that peoples preferences are respected. 7 19 Assessments of peoples healthcare needs, for example pressure care should be regularly reviewed to make sure they get the care they need to stay healthy. Record keeping needs to improve regarding when people have attended health appointments so that staff know when people have been to an appointment and when they need to go again. This will help people to stay healthy. The home should complete an audit of medication prescribed on an as required basis to make sure there is guidance on its use in place and the guidance is up to date. This will help to make sure people receive the medication they need. The home should retain copies of medication prescriptions so that staff can check that people are having medication as prescribed by the GP. Staff need to have training in the Mental Capacity Act and Deprivation Of Liberty Safeguards, so that they are aware of its implications for the people living at the home. Arrangements need to be in place to make sure that all staff have received training in safeguarding people from abuse so that staff know how to protect people. The home should have the facilities of a bath that meets peoples needs. Consultation with an occupational therapist would help to make sure that the new bath is the right design to safely meet peoples needs. Proceed with plans to carry out further staff training to make sure all staff receive the training they need to enable them to meet peoples needs. Staff supervisions should happen at least monthly to enable staff to develop and better support the people living there. 8 19 9 20 10 20 11 23 12 23 13 27 14 35 15 36 16 37 The manager should complete the registered managers Care Homes for Adults (18-65 years) Page 41 of 43 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 award so that she has the right knowledge and qualifications to ensure the home is well run. 17 39 Quality assurance systems need to be improved so that the home is run in the best interests of the people who live there. Care Homes for Adults (18-65 years) Page 42 of 43 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. 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 43 of 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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