Inspection on 13/11/08 for Tudor Gardens, 29

This is the latest available inspection report for this service, carried out on 13th November 2008.

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

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

Other inspections for this house

Tudor Gardens, 29 09/01/06

Tudor Gardens, 29 26/07/05

Tudor Gardens, 29 24/01/05

Tudor Gardens, 29 14/09/04

Tudor Gardens, 29 25/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tudor Gardens, 29 Tudor Gardens, 29 Erdington Birmingham West Midlands B23 6ED The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Brown Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Tudor Gardens, 29 Tudor Gardens, 29 Erdington Birmingham West Midlands B23 6ED 01213863073 01213863073 tudorgardens@tudorthree.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Jaffray Care Society Name of registered manager (if applicable) Miss Jeanette Shiel Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 15 0 care home 15 learning disability Additional conditions: Residents must be aged under 65 years. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home 27, 28 & 29 Tudor Gardens are purpose built bungalows each accommodating in total fifteen adults who have a learning disability, with associated sensory and physical impairments. The service is located on a new housing development off Fentham Road, Erdington. There is good access to both rail and bus services for Birmingham and Sutton Coldfield. There is a range of community facilities close by and Erdington shopping centre is within walking distance. Each bungalow has a spacious entrance hall and corridor leading to an office, kitchen, lounge and dining room. The bedrooms are single and have level access en-suite shower rooms. There are large bathrooms with suitably adapted facilities for assisted bathing. There are adequate toilet facilities available for service users and staff. Separate laundry facilities are located away from the lounge and dining areas. Each bungalow has a garden to the rear, mainly lawn and there is a patio area. There is off road parking to the front of the properties. The fees are determined by the care needs of the person and the person is assessed by Social Services for the amount they can afford to pay. Further details are available on request from the Home. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this home 2 star. This means people who use this service experience good outcomes. We visited the home unannounced on a day in November and stayed for over 10 hours. We undertook a key inspection and this means we looked at all the core standards that the home should achieve. During this inspection we spoke to 2 staff and the manager, looked at a persons care plan and looked at the care given to them. We also looked at parts of another 3 care plans. We had a look round the three bungalows looking at the communal areas and saw a number of peoples bedrooms. We looked at a number of records do with the administration of medication, health and safety of the building, staff files and records of money belonging to people living in the home and so on. Before the inspection we received 5 comment cards from relatives or carers and 4 from health professionals involved with the care of these people. Almost all of the people living in this home do not have spoken communication and these comments and observations at this inspection have helped form the basis of this report. Page 7 of 34 Care Homes for Adults (18-65 years) We also took into account information we had received from all sources about the home since the last key inspection. Services are required to complete an Annual Quality Assurance Assessment(AQAA) on a yearly basis and this is used as part of this report. We have had no complaints about this home. What the care home does well People living in this home look well cared for and appear to have their personal hygiene needs met. Carers said about this home: They have changed my relatives life for the better. They are contented have better health, are clean well dressed, have a better social life and are happier. They care for the residents They find stimulating things for her to do such as college courses and horse riding. Peoples needs and risks are identified and plans put in place to meet the needs and minimise the risks. This means that people can be kept as well as possible and enjoy activities safely. This home works well with health professionals to meet the health needs of people. Care Homes for Adults (18-65 years) Page 8 of 34 Health professionals said: no concerns this is a friendly and homeley service, There is good communication between and professionals.... we are told about hospital stays in a timely way. The staff follow advice given and care plans. A well run home. People have the opportunity to experience a range of activites: - going out for pub lunches, college, hydrotherapy, horse riding, going on holiday and so on. This helps to ensure a good quality of life for people. The management of the home has a good understanding of issues that may mean people need safeguarding and are up to date with changing laws. This means that people can be protected properly. There was adequate numbers of well trained staff and this means that people have their care delivered well. Carers and health professionals said about the staff: Staff appear to have the appropriate skills and I have no reason to doubt otherwise. Regularly trained and exerienced staff with good communication, Good competent staff team. Seems to be a consistent staff team. Page 9 of 34 Care Homes for Adults (18-65 years) The home had appropriate records in place to demonstrate that the maintenance and inspection of the home was such that it was a safe place for people to live. The home was well run. What has got better from the last inspection The amount of care plans that have been reviewed has improved with few gaps and this means that changes in peoples well being and care needs can be monitored. Improvements have been made in ensuring that peoples dietary needs are monitored and met. The organisation has recruited a night manager to oversee the performance of night staff over their homes. A more comprehensive induction programme for new staff. The organisation have now consultants in fire safety and health and safety for all their sites. Care Homes for Adults (18-65 years) Page 10 of 34 What the care home could do better The information in the service user guide needs to updated so as to ensure that people have the up to policies and contact information. The home need to develop ways to make the care plans and risk assessments more easy to navigate and ensure that staff have the information in a way to be a workign tool for them. Carers would like more regular up dates on what their relative has been doing and how they have been. Equipment such as bedrails must not be used where there hasnt been a risk assessment as this could mean people get injuries. Where equipment is used any specified details as to its safe use should be recorded in a care plan Although the home was generally clean and fresh on the day of the inspection en suite showers in some bedrooms needed a deep clean or replacement of grouting. Although checks were undertaken via the Criminal Records Bureau and references details of employment history and any other checks and outcomes of these should be on file. This is to ensure that people have not moved from job to job. People living in this homes take time to Care Homes for Adults (18-65 years) Page 11 of 34 build up relationships with people and this should be reflected in the people the home employ. The home has completed an annual quality assurance assessment well. This and comments from people living in the home, family significant others and professionals should build into a plan for further improvement. 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 Jill Brown 33 Greycoat Street London SW1P 2QF 02079792000 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. Care Homes for Adults (18-65 years) Page 12 of 34 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 13 of 34 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 14 of 34 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 in this home will be given information and experience what it is like to live in this home before they are admitted. Information is collected about the person to ensure that the home can be sure that they can meet their needs and aspirations before they are admitted. Evidence: We looked at information available to prospective new people to the home and found that the information needing some updating but also noted that the home has had no new residents in the last 12 months. In particular information about contacts to the commission in policies needed to be updated and ensure that the policies are the latest copy. Information supplied by the home in their Annual Quality Assurance Assessment (AQAA) suggests that the process of admission had not changed from previous inspections. A preadmission assessment would be undertaken with information being gathered from Health and Social Services about the care needs of the person. They would also talk to the person, their advocate and family to determine their life style Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: and aspirations so as to ensure that they can provide the service wants. There are then a series of visits so the person can experience life at the home including going out with them on trips, meeting staff and other people living in the home and staying over night. This process helps to ensure that people feel familiar with the home before they are admitted and the home has enough information to care for the person and minimise any risks. Information is collected about a persons ethnic background, lifestyle and religion and this helps the home ensure that these needs are met. Care Homes for Adults (18-65 years) Page 16 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in this home can be assured that plans are in place to meet their care needs and minimise the risks to them. Evidence: During the inspection we looked at one persons care plan in depth and parts of another three peoples plans. We found that there was detailed information about the people and instructions to staff about how to meet their needs. Plans took into account peoples health needs such as epilepsy and cerebral palsy. Risk management plans were in place where risks in a persons day-to-day life were identified. Care plans were personalised, they had information about what people liked and disliked both in how care was provided and choices they were likely to make about for example about food. Plans had information in them to enable new staff communicate such as ask if had teeth done will give the thumbs up sign if they have and when a person is upset the sign for their sister. This enables people to be involved in their Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: care, maintain independence and be empowered to express themselves. We found that risk assessments were in place for identified risks. These risk assessments were used to enable people to enjoy activities and minimise risk rather than to prevent them undertaking them, for example there were risk assessments for activities such as horse riding. Health risk assessments were also carried out and actions determined for example for the prevention of choking. We found that specialists were contacted about any health or behavioural issues that may cause risk to the person including speech and language specialists, psychologists and so on. Outcomes of these consultations were recorded and actions suggested put in to the persons plan. People were observed to maintain skills such as moving themselves from place to place by shuffling in a seated position rather than taking this independence away by placing them in wheelchairs. We also noted that efforts were being made to improve on peoples communication skills. For one person this was use of pictures for events through the day. This is important as it showed that the home was continuing to try maximise the persons skills even though the person has been at the home some time. People in this home have complex care needs and this has meant the number of and detail on care and risk management plans is extensive. More aids to navigate these plans, putting plans together that enable a task such as personal hygiene and summary of key elements would be useful for staff providing the care. Reviews of plans were not co-ordinated so there was a risk of a review of a plan being missed. We found two plans where the review date had been missed and one plan without an evaluation record. Relatives and friends of people said: They care for the residents well I have always been happy with the care past and present. Two relatives suggested that they would like a monthly newsletter of what their relative had been doing and how they were over the past month. Another suggested that they be invited to a six monthly review of their relatives care. Care Homes for Adults (18-65 years) Page 18 of 34 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 . People living in this home are assisted to make choices about activities and their daily lives and this enables them to feel settled in the home environment. People are assisted to maintain meaningful relationships with families, friends and others that have been important to them and this gives the person someone to monitor the care given to them. Evidence: People living in the home have complex needs and communication impairments that make work an unlikely option. A number of people have lived together for a number of years and the activities are based on knowledge of the persons likes and dislikes. Some people attend college to undertake courses such as horse riding and art classes. We found that there was equipment in each of the bungalows for activities such as musical instruments as the usual TVs and music centres. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: The staff attempt to find community activities and social opportunities for the people they care for. People have the chance to be involved in various activities such as: going out to pubs for meals, attending art classes, going out for drives, trips, going to the cinema, going to college, going for hydrotherapy and shopping. people have opportunities to go on holiday. Daily records show that people are assisted to rise at times to fit with the activities that they have planned and on occasions can enjoy a longer time in bed. People can choose when they go to bed. Arrangements are made for people whose health conditions mean that they may be sleepy for example following a seizure to take rests. There are plans in place to assist people maintain and regain relationships with their families and people that were important to them. The home ensures where possible they information about a persons important contacts birthdays and when they can contact them. Carers comment cards said When I was unable to visit staff brought him to visit me. They have increased my relatives social skills, They find stimulating things for her to do such as college courses and horse riding. As stated in the section Individual Needs and Choices section some carers would like further information about their relatives life on regular basis. We looked at the meal prepared for people living in one bungalow and found that this was well presented. People were sharing the meal time with staff chatting about the days events. We looked at the information about peoples nutritional needs in one bungalow and found there was information about a person that was on low calorie snacks and prescribed additives for drinks for another held in the kitchen. Care plans showed people had particular preferences of food and in the kitchen we found a note of a persons dislike for raw carrot. This shows that the home ensures that information from the careplan is acted upon. Peoples nutritional welfare was linked to their checks at health clinics where their peoples weights were monitored. Care plans detail a range of weights within which it is considered healthy as a guide. A carers comment card said The meals are good and my relative goes into the community for pub lunches. Care Homes for Adults (18-65 years) Page 20 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People in this home can be assured that there health needs are monitored and changes are raised and discussed with health professionals. This means that peoples health needs are met in a timely way. Medication is stored safely and administered appropriately and this secures the health of the people in the home. Evidence: Care plans were personalised and contained information about how people liked things done for example MS likes his hair spiky and using gel. There was good interaction observed between staff and people that suggested that people were confident about what people liked. Only four out of the 15 people living in the home are female whist the majorityof staff are female. Assessments are undertaken on appropriate gender care however at times it must be difficult to provide this. Most of the residents are white British and the home has a culturally diverse staff group. People in the home were observed to be happy adn well dressed and efforts were made by staff to ensure that the residents felt at ease with strangers in their home space. Care plans looked at confirmed that peoples health needs were planned for in Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: consultation with health professionals such as speech and language therapists, psychiatrists, community nurses and so on as needed. Health issues such as seizures, falls and challenging behaviour and so on are recorded and this helps health professionals determine the possible causes and determine treatment if necessary. We received four comment cards from health professionals and they said: no concerns this is a friendly and homeley service, There is good communication between and professionals.... we are told about hospital stays in a timely way. The staff follow advice given and care plans. A well run home. The homes AQAA stated that people in the home have 3 to 6 monthly health clinic appointments with the consultant psychiatrist and a yearly health check. Where issues were raised such as challenging behaviour of a person increasing in its intensity this has been shared with professionals and plans put into place to try and resolve the issue. Daily records show people experienced a period of ill health this was checked with the persons GP. We were shown in one circumstance where the home were developing a picture board to aid a persons communication. This person has been at the home for some time adn the home were still developing new ways to communicate and interact with them. A carer commented They have changed (my relatives) life for the better. They are contented have better health are clean and well dressed , have a better socila life and are happier. Each bungalow has a separate medication cupboard and this makes administration easier. We looked at one units medication administration and found that this was safe and that generally medication was administered and recorded appropriately. One person was on as required medication adn this had not been needed for a number of months and it is suggested that the need for this medication be reviewed. Care Homes for Adults (18-65 years) Page 22 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People in this home can be assured that their concerns will be listened to and that measures are in place to identify risks and abuse so that they will be safeguarded from them. Evidence: The homes Annual Quality Assurance Assessment showed that the home had not had any complaints in the last 12 months and we have not received any concerns or complaints. The home has a complaint procedure displayed and this is also in the homes service user guide. People living in the home have a picture version of this that has a photo of the managers face to show who the person can talk to. Some information on the complaint procedure needs updating. (please see Choice of Home Section) People living in the home have weekly meetings to talk about leisure activities meals and other choices this helps people determine what they would like to do and offers an opportunity to raise matters in a non threatening environment. There is a policy and procedure in place to safeguard people living in the home and this is part of the service user guide. We spoke to both Home leaders and the Care Manager and they were very clear about both good practice issues and safeguarding the health and safety and rights of the people in their care. Referrals are made to social services when issues of concern are identified and the commission are contacted. Some staff have had training in the Mental Capacity Act and this has made them more aware of these issues. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: Staff were recruited following checks with Criminal Records Bureau and Protection on Vulnerable Adults list before they were employed and this helps to ensure peoples safety. We looked at the money held for three people in one of the units. Money held is checked twice a day against the record held. Receipts are kept of the money spent on peoples needs. One person had a small amount money more than the record suggested and the home leader thought this was because of difficulty getting change and would raise this with staff that checked the record that day. Money is held for people centrally when social services or the service is the appointee and money can be requested when needed so too much money is not stored on the unit. Care Homes for Adults (18-65 years) Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in this home can be assured that the environment is homely and mostly meets their needs. Evidence: We looked around the communal areas of all three bungalows and looked at some of the bedrooms in each bungalow. According to the homes service user guide peoples bedrooms meet the space required. however one unit has a number of people that require the use of hoists and space may be an issue in these rooms and this will be looked at more fully at the next inspection. Each unit has only five people and this means the units have a homely feel and staff and residents know each other. There was equipment available in peoples bedrooms where needed such as airflow and propad mattresses to ensure that peoples skin was maintained in a healthy condition. A person had an air flow mattress did not have the details of this contained in their care plan, nor information about what setting it should be on. This could mean that the mattress is not at the right setting for best effect however there were no concerns about the persons skin at that time. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: One persons care plan looked at documented that they had bed rails fitted and there was a risk assessment. Another person had a bed rail in place and this was not assessed for, did not have any cushioning and was not documented in their care plan. This could mean that the person could become entrapped. The care manager requested the maintenance personnel remove this bed rail that day whilst they were on site. Bedrooms were individualised with personal belongings. Some room had a lot of items showing the persons interests. Each of the units had a different feel suggesting there wasnt a corporate approach to decoration. Some of the ensuite shower areas had discoloured grouting and this needs to be rectified. Maintenance men were deep cleaning the corridors in one unit during the inspection. Generally the home appeared clean and fresh when walking around. The kitchens were clean as were the fridges that were inspected. People visiting the home commented: The home is bright, cheerful and welcoming, love the art work done by residents and the staff effort to achieve it. Perhaps in need of a decorative freshen up. The homes AQAA stated that staff are receiving infection control training and food hygiene training. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Systems are in place to ensure the people living in this have the benefit of enough qualified and competent staff to give them the care they need. Evidence: We looked at three staff files in one unit, the evidence about staff training, the staff rotas and looked at the comment cards sent to us. We found the home ensures that during the day three care staff are available on each unit, and where possible four. Throughout the night there is a member of night staff on each unit and another member of staff available that moves from unit to unit to assist. There appeared to be enough staff to ensure that people could attend activities through out the day and receive the care they needed. It was clear that at times it could be difficut to ensure they had enough driver carers to do the journeys to activities and health appointments and maintain staff within the home if it was a busy day. The homes Annual Qualtiy Assurance Assessment (AQAA) showed that the majority of staff have completed a skills for care induction or equivalent within the first few months of working in the home. This helps to ensure that people have the basic skills to care for people in the home. the AQAA told us that 79 of staff have an NVQ2 in health and social care or an equivalent qualification and we found evidence of many Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: NVQ2 certificates in the staff training files; this means that the workforce is trained well. There was evidence that refresher training was given to staff in such things as fire safety, epilepsy, first aid and so on. We were provided with matrix of training however staff files showed that staff had undertaken more training and the matrix needed to be updated. There was not enough evidence to confirm that all staff had moving and handling training up dates recently. Staff files showed that staff were not employed unless checks had been completed with the Criminal Records Bureau and references received. Some application forms needed did not have a full work history so that gaps in employment could not be explored before staff are recruited. Concerns were expressed about people being employed who could only work with the company for a short length of time. This, as with agency workers, has an affect on the people living in the home. Carers and health professionals commented:Staff appear to have the appropriate skills and I have no reason to doubt otherwise. Regularly trained and exerienced staff with good communication, Good competent staff team. Seems to be a consistent staff team. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in this home can be assured that it is well run and that the people involved wish for it to be an enjoyable place to live and meet their needs. Evidence: The home has a registered care manager Jeanette Shiel who has extensive experience in the care and has worked with adults with sensory impairments,adults and young adults with learning disabilities. She has achieved the Registered Managers Award which is the recognised qualification for this work. She updates her knowledge in issues that affect people living in the home and this includes information on the soon to be enacted Mental Capacity Act. The organisation have ways in which they monitor the service for example people representing the organisation visit, relatives are contacted and there are weekly meetings for people living in the home. The manager was unable to show me a plan for improvements based on the views of people living in the service, their representatives, professionals working with the home, staff and the homes internal audits. However the home has completed the Annual Quality Assurance Assessment(AQAA) well and we discussed this being the basis of an action plan for Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: improvement. We looked at some health and safety records in one unit. This unit had the appropriate health and safety records needed and fire drills had been undertaken. They have employed a fire consultant and the fire risk assessment has recently been undertaken and a health and safety consultant has also been approached to ensure that the home is safe for the people that live there. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 29 13 09/01/2009 Bed rails must not be used until a risk assessment is undertaken and this is found to be the most appropriate way of managing risk. Bedrails if used must have the appropriate covering. This is to ensure that rails are only used when this is the best option for the person and all efforts are made to ensure the person is not entrapped. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to ensure that contact details of agencies and policies and procedures are the latest version. The process of review of care and risk management plans Page 32 of 34 2 6 Care Homes for Adults (18-65 years) needs to be clearer so that individual plans are not missed. 3 6 It is recommended that the service look at how the information on the progress of people living in the home can be shared with peoples relatives or people that are important to them. Tools to ease the navigation around care plans and risk management plans and a system to ensure key information is quickly accessible would assist staff in undertaking the care. Where as required medication has not been used for several months it should be reviewed to determine if it continues to be needed. Where people have specialist equipment this should be recorded in their care plan as well as specifics about its use to meet the persons needs. This is to ensure the equipment is used appropriately and safely for the person En suite shower areas need be audited and where necessary discoloured grouting needs attention. Information about the full employment history of people should be collected before recruitment to ensure there are no gaps in employment. It is recommended that the Annual Quality Assurance Assessment be used as part of the homes Annual review and yearly planning. 4 6 5 20 6 29 7 8 30 34 9 39 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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. 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