Inspection on 12/01/10 for 17 Park Avenue

This inspection was carried out on 12th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

17 Park Avenue 08/04/10

17 Park Avenue 17/02/09

17 Park Avenue 23/11/07

17 Park Avenue 26/01/07

17 Park Avenue 25/05/06

17 Park Avenue 10/11/05

17 Park Avenue 16/05/05

17 Park Avenue 24/01/05

17 Park Avenue 23/11/04

17 Park Avenue 17/03/04

17 Park Avenue 09/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 17 Park Avenue Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND     The quality rating for this care home is:   zero star poor 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: Brenda ONeill     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 36 Information about the care home Name of care home: Address: 17 Park Avenue Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND 01215233712 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: faisalazam@london.com Park Avenue Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 22 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: Mental Disorder, excluding learning disability or dementia (MD) 22 Date of last inspection Brief description of the care home 17 Park Avenue is a care home for up to 22 adults that are experiencing mental ill health. The home is situated close to local amenities such as shops, places of worship and public transport links. There are six shared bedrooms and ten single bedrooms, none of which have en suite facilities. There are two lounges on the ground floor. The home has a passenger lift and there is ramped access to the front of the building. Some adaptations have been made to bathrooms to enable people with a physical disability to shower and bathe. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 22 1 8 0 2 2 0 0 9 Brief description of the care home Information is shared with people who live at the home during house meetings and there are leaflets describing how to make complaints available in the entrance hall. Many of the people living in the home do not speak English as a first language. The staff team have the skills collectively to communicate with people in their first languages. The range of fees charged for living at the home was not detailed in the service user guide. People should contact the home direct for this information. Care Homes for Adults (18-65 years) Page 5 of 36 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over two days by two inspectors. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were Care Homes for Adults (18-65 years) Page 6 of 36 case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with six of the people living in the home, the acting manager and three staff to get their views on the home. We sent seven Have your Say surveys to people who live in the home and seven to staff members. A total of five were returned, three from people living in and two from staff. These views have been included in the report. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The home should be able to show that peoples needs have been assessed before they were admitted to the home and how the decision was made that staff could meet their needs. Care plans should reflect all the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. The confidentiality of the people living in the home could be further enhanced. People could have more meaningful lives if they were encouraged to develop their independent living skills. Staffing levels should allow people to take part in the activities that they choose to Care Homes for Adults (18-65 years) Page 8 of 36 ensure they lead fulfilling lives. The systems in place to ensure the people living in the home stay healthy needed to be much more robust to ensure peoples well being. Medication must be given to people as prescribed to ensure their health and well being. Staff should ensure people receive their personal care in the way they prefer. Information must be available to show staff have been checked to ensure they are safe to work with the people living in the home before they start work there. The home must have a registered manager so that the people living in the home can be assured the home is being run in their best interests. The quality of the service being offered to the people living in the home needs to be regularly reviewed. Fire risk assessments must be in place to ensure that the risks of there being a fire are minimised and staff know how to support individuals in an emergency. Evidence must be available that all the equipment used in the home is safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available for people to determine if the home could meet their needs needed to be updated to ensure it was current and available in formats appropriate for them. Arrangements are in place to ensure people can be confident their needs can be met at the home but it could not be shown these were consistently applied. Evidence: The service user guide for the home had been updated in June 2009 however the address and phone number for the Commission was incorrect. This means people who wished to contact us may find it difficult. The guide did not include any information about the range of fees charged at the home. People should have this information so they know how much they are paying and what it includes. There were copies of the service user guide available in different languages but these were hand written and we were told these had not been updated. These needed to be current and readily available as English was not the first language of many of the people living in the home. It was discussed with the manager that the service user guide could also be made available in other formats, for example, audio and pictorial so that it could be assured the information was accessible to all the people living in the home. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: The pre admission procedure was looked at for one person who had been admitted to the home since the last inspection. The individuals file included copies of a learning disability specialist nursing assessment and the assessment undertaken by the social worker who had been involved in the admission. These were quite extensive and included a lot of information about the needs of the individual. There was no evidence on the file to show that an assessment of the persons needs had been undertaken by the staff at the home. The acting manager said this would have been undertaken by the person in charge at the time. A copy of the form that would have been used was seen. This was mainly a tick box form with some space for additional observations. It did cover most areas of the persons life but there was no where for a summary to show if the home could meet the persons needs and how this decision had been made. There was no evidence on the persons file to indicate they had visited the home before admission to see if they liked it and thought it was suitable for them. The acting manager did not think this had happened but thought the family had visited. The person concerned was not able to comment on this. It was evident from the assessments that had been undertaken that the person concerned had a learning disability. The home is not registered to admit people with a learning disability and as there was no pre admission documentation available for the home it could not be determined how the decision had been made that the staff at the home could meet this individuals needs. The individual was spoken with and seemed fairly settled and content but did comment they were not well. The placement had been reviewed and comments indicated that the person had settled well and that the family were also generally satisfied. Care Homes for Adults (18-65 years) Page 12 of 36 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. The lack of detail in the care plans could lead to people not having their needs met in the way they prefer. People that live in the home received support to make choices and decisions about their lifestyles. Evidence: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. We looked at two peoples care files in detail and partly reviewed another. The formats for the care plans had changed and they included sections for the identified need, long and short term aims for the individual and what staff were to do to help people achieve their aims. Care plans were in place for such things as daily activities, physical health and well being, mental health, socialisation and relationships, medication, finance and welfare. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: The detail in most of the care plans had improved and they were more individualised to try and ensure people received the care they needed in the way they wanted. For example it was clear from one persons care plan that she liked a particular colour clothing, liked shopping and going to the temple. She confirmed she did do these activities and was seen to be dressed in her preferred style. However for another person there was little in the care plan about her personal care needs or preferences. It was evident from the daily records and discussions with staff this person had a lot of assistance with her personal care. There was some mention of her needs and preferences in a risk assessment, for example, how she liked her hair. When speaking to this person she clearly had some very specific needs in relation to wearing jewelery and having access to some soft toys. She was wearing her jewelery and did have access to the toys but there was no mention of this in the care plan. Staff did tell us about this persons needs but with new staff starting they would need to know where to look for all the information about this person. Individual needs and how they are to be met not being recorded could mean the individual would not get her care needs met. The care plans gave only minimal details about the cultural needs of the people living in the home. There were some comments about the preferred languages and places of worship for the people living in the home. The staff group were from different cultural backgrounds and could not be expected to know the cultural needs of all the people living in the home. These needed to be clearly detailed in the care plans to ensure peoples needs were met. There were still some areas of the care plans with some conflicting information. For example for one person the care plan stated the person was not able to manage their finances independently. The interventions by staff stated manages finances independently discussions with the acting manager and the records on site showed the person did manage their own finances. Information for staff needed to be consistent so that they knew exactly how to support people to meet their needs. Some of the language used in the care plans was quite clinical and some of the statements not easy to understand and were being used in the majority of the care plans. This should be looked into to ensure all staff can understand what they are to do to help meet peoples needs. If staff are unsure what statements mean peoples needs may not be met as they would want. There were several risk assessments in place for the people living in the home. The areas covered by these included, access to the community, behaviour, manual handling, personal care and health related issues. The detail in the risk assessments Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: had improved in most cases and informed staff as to how they were to reduce the risks and ensure people were safe. Staff were able to tell us how they ensured one person was moved safely and how they managed peoples challenging behaviours. What they told us generally cross referenced to peoples risk management plans ensuring people were kept safe. It was noted that one of the management plans for challenging behaviour was not as detailed as the others however staff were aware of how to manage the issues safely. The care plans gave some examples of where people were able to make decisions, for example, their preferred activities. Staff spoke to us about people making decisions on a daily basis about what they wore, what they ate and where they went. People were able to manage their own money if they were able or with support from staff. People could choose to attend medical appointments on their own as long as this did not put them at any risk. One person was seen coming back from a medical appointment and informing staff of what had happened. The practice of keeping financial details about people on the files that were accessible to staff had ceased ensuring this was kept confidential. However it was noted that a lot of personal information about people was being kept in a communal communication book. This conflicts with the regulations in respect of data protection and does not ensure privacy for the people living in the home. All information regarding them should be kept on their personal files so that they can be assured it is only seen by people that need to know. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It could not be shown that all the people living in the home experience a lifestyle that is meaningful and meets their needs and expectations. People were offered a range of food that met their cultural needs and preferences. Evidence: There was little opportunity in the home for people to develop independent living skills. Discussions with staff and observations made indicated that people did little around the home. One person did some cooking and another person said the staff do the laundry because the machine is downstairs and she does not go down there. One person said they make a cup of tea with staff but this was not seen during the inspection. The main kitchen door was locked and there were no other facilities available for people to make their own drinks and snacks. Staff should encourage people to develop their independent living skills to bring more meaning to their lives. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: The files sampled included activities programmes for the people living in the home. Activities detailed on these included such things as going to the temple, progressive mobility, shopping, contact with family, day centre and college. The records in the home did not support that these activities were taking place on a regular basis. One person told us she had not been to the temple or shopping for some time as she was not well. She was spending most of her time in her room watching films and listening to music. The activity records in the home showed the individual had been joining in some in house activities such as ball games and colouring and had on occasions refused to go out. Staff told us they spend time with this person also but this was not recorded. This persons activity plan should be reviewed and include the activities she wants to do at this time. Records should be kept of what the individual is doing on an ongoing basis to show she is leading a fulfilling life. At the time of the inspection there had been some particularly bad weather and this had prevented some people from going out as they would have wished. At these times in house activities should be increased. We did see people playing skittles, using a Wii, watching Asian television channels and colouring. Some people appeared to be spending a lot of time in their rooms lying on their beds. It is of particular importance that records are kept to show what people are doing during the day, particularly where they are unable to comment, to show they lead meaningful lives. Staff told us that the staffing levels had been reduced and this was having an effect on the availability of staff to facilitate in house activities and to take people out who needed escorts. This must be reviewed to ensure that staffing levels do not impinge on the opportunity for people to lead fulfilling lives. Staff told us that the people living in the home used local facilities such as libraries and shops and went to the local parks in the better weather. The home did have their own transport to help when taking people out. Two people were attending a college course. Individuals were supported to keep in touch with people who were important to to them such as friends and families. One comment we received was brother visits daily and goes out with brother A range of food was offered to the people living in the home including vegetarian and Halal meals which is reflective of peoples cultural needs. There was a list of the foods available on the board in the dining room and people could choose from these on an ongoing basis. People spoken with were satisfied with the food in the home. Comments received included, food is good and I have rice and Dahl. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Staff thought the food in the home was good quality and there was a good choice for people. They spoke to us about trying to encourage people to eat healthily but how difficult this could be when people go out on their own and eat what they want when out. Records of food eaten were only being kept for people if staff were concerned about their appetites. These needed to be kept for all the people living in the home to show that people were receiving a varied and balanced diet on an ongoing basis. Care Homes for Adults (18-65 years) Page 18 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place to make sure people stay healthy and well were not robust and did not ensure the well being of the people living in the home. Evidence: There was some information in care plans about the personal care needs of the people living in the home however as previously stated this could have been further developed. The staff we spoke with were aware of the needs of the people living in the home in relation to their personal care. They were able to tell us how they supported people and what people were able to do for themselves. Where the preferences of the people living in the home were recorded in relation to personal care these were not always respected. One persons file was very clear that she prefers a bath to a shower and likes to be able to have a soak with some oils in the water. It was also clear that the person could become more agitated if showered. This person told us she was being showered but did prefer a bath. Staff also told us she was being showered not bathed. This means this person was not receiving her care in the way she wanted and this could be detrimental to her well being. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Staff were aware of the issues in relation to gender sensitive care. Male staff were very clear that they did not give personal care to the female people living in the home and that there were always female staff on duty. This ensures the choices and the dignity of the people living in the home are upheld. People had care plans in place for their physical health and well being. These detailed peoples ongoing heath concerns and some details of how these were to be managed. There were also health action plans in place which detailed some background and the professionals involved in the peoples care. Some of the information on these was not correct, for example, one health action plan stated the person needed help with eating and drinking due to arthritis. A review sheet for this person said they eat independently. Staff also told us this person had no problems eating. One person who has diabetes was having blood sugar levels checked. The records showed quite clearly the levels were fluctuating a lot. There was a management plan in place for the condition that stated when the reading was over a specified level the G.P. should be contacted. However the recorded levels were almost always reached and often exceeded and we could find no records of the G.P. being contacted. The manager was unsure of when the GP was last seen about this and some of the staff thought the level could be higher before the G.P. was contacted. Records indicated that the clinic was contacted in November 2009 but there were no records to indicate that this was followed through and the appointment attended. Many of the records for this person were in the communication book not on her file making them very difficult to track. The GP was contacted after the inspection. The person concerned was seen and spoken with and she appeared quite well but the lack of follow up to the condition could have a profound effect on the persons well being. One person was prone to developing pressure sores. There was a management plan in place for this which included that the person should be turned every two hours during the night. It would appear that there had been occasions when this was not happening as an incident form seen stated the individual was developing sores because of being left in the same position. Staff were recording that the individual was being turned every two hours. The manager was advised this person should have a turn chart and the turns are entered every two hours showing which side the person is on. Staff need to ensure they follow this management plan so that the person is not at risk of developing sore skin. One person had bed rails and only one of these had a protective pad on it. There were no details seen as to why these were in use and no risk assessment was seen. When the acting manager was asked he thought there was risk assessment in place. The Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: rationale for using bed rails must be documented and a risk assessment undertaken to show they are safe and that regular checks are undertaken. This will ensure people are safe and bed rails are only used when absolutely necessary. More details had been included on peoples files about their mental health and how staff would know if this was deteriorating and what they should do. This should ensure peoples mental health is monitored on an ongoing basis. People were being weighed on a regular basis to ensure they were not losing or gaining significant amounts of weight which could be a sign of underlying health concerns. People living in the home spoke to us about going to the dentist and optician. Records showed that people were attending appointments at the GPs, clinics, dentists and opticians. Attendance at appointments and the outcomes were not always recorded on the appropriate sheets making it very difficult to track that peoples health care needs were being met. The medicines in the home were stored in a locked medicine trolley that was secured to the wall when not in use. A lot of the medication was administered via a 28 day monitored dosage system. The medication for three people was audited. Medication that had been received into the home had not been acknowledged on the MAR (medication administration records). The majority of the balances of medication held at the end of the previous 28 day cycle had not always been brought forward to the current MAR making this difficult to audit. Records in the home indicated that staff had forgotten to order the medication for one of the people living in the home and did not realise until new medicines were delivered. This shows that the repeat prescriptions were not checked to ensure they were correct before going to the pharmacist. The consequence of this was that the person was without medication for 3 days. It was also noted during our audit that the same person was without other medication that was not in the monitored dosage system this had not been addressed. Clearly this person was not getting their medication as prescribed which would have an effect on their health and well being. The medicines audited for the other two people were in the home and being administered appropriately. One issue did arise that one person had a capsule that was to be administered once a month. The MAR showed that 2 capsules had been carried forward from the previous month but there was only one in the bottle and none had been signed as given. Care Homes for Adults (18-65 years) Page 21 of 36 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 generally ensure that the views of the people living in the home are listened to but do not always ensure that they are safeguarded from harm. Evidence: The complaints procedure for the home was on display in the entrance and available in a variety of languages to reflect the needs of the people living in the home. There were good interactions between staff and the people living in the home. People were very comfortable in the presence of the staff and were seen going to them for a variety of things during the inspection and staff being attentive. This would give the people the confidence to raise any issues. The home had not had any complaints raised with them since the last inspection. We have had some concerns raised with us since the last inspection. These were referred back to Social Care and Health under safeguarding procedures. This led to the homes contract with Birmingham City Council being suspended for a short period of time and the majority of the people living in the home had a review with their social workers. No significant issues were raised during this period and the contract has been reinstated. Staff spoken with confirmed they had received training in safeguarding issues. They were able to tell us what constitutes abuse and what they would do if they witnessed Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: or suspected any events of abuse. This should ensure people are safeguarded. Some of the people living in the home managed their own money others had support from the staff at the home. The systems in place for ensuring peoples money was safe were sampled. The practice of having peoples personal allowance paid into the business account has ceased. The records sampled showed all income and expenditure was recorded and receipts were available. It was recommended that when people received some of their own money this was clearly documented on the records. Some issues were raised with the acting manager about the staff recruitment procedures as there had been occasions when these were not robust and left people at risk. This is further commented on in the staffing section of this report. Care Homes for Adults (18-65 years) Page 23 of 36 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. The home provided the people living there with a comfortable environment in which to live. Facilities could be improved to enable people to be more independent. Evidence: 17 Park Avenue is situated off the Soho Road area of Hockley in Birmingham. The home is well placed for access to local amenities such as places of worship, public transport routes, shops, cafes and restaurants. This is important for the people who live there as they enjoy accessing community based activities. We toured the communal areas of the home and saw three bedrooms. There had been some further improvements made in the home including redecoration of the lounge, new flooring, lighting and blinds had been fitted in the lounge/diner. The flooring on the upper corridors and the stairs was showing signs of wear and tear and should be replaced as soon as possible. This will ensure it is kept to an acceptable standard for the people living in the home. We were told at the last inspection that a rehabilitation kitchen was to be installed in what was the former smoking room. This had not happened. We were told this was still planned. This should be pursued so that people have the facilities to make their own drinks and snacks if they are able to enhance their independence. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: Some issues were raised during the inspection these included. One of the radiators in the ground floor corridor was not working making the corridor quite cold, the flooring was lifting outside the shower room, this was addressed before we left. One of the toilets had a bolt on the inside it therefore if someone needed help staff would not be able to get into them. This was also being addressed before the inspection was completed. There were a range of toilets and assisted bathing/showering facilities located throughout the home for ease of access for those living there with a physical disability. The majority of these were quite basic and needed to have a face lift to make them pleasanter environments for the people living in the home. Three bedrooms were seen. Two of these were doubles. The people occupying one of the rooms at the time were quite comfortable. The other room was adequately furnished and decorated but the flooring was torn and needed to be replaced as it could be hazardous. The single bedroom that was seen was quite large and the occupant was quite comfortable and had some personal belongings around her. The room had recently been redecorated, had new carpet and furniture. The laundry was in the basement and there were appropriate systems in place for transporting any soiled linen to ensure good infection control procedures. The home was generally clean and people were comfortable and satisfied with the environment. Care Homes for Adults (18-65 years) Page 25 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally supported by well trained staff who have a good understanding of their needs. The lack of consistency in applying robust recruitment procedures places the people living in the home at risk. Evidence: Staff turnover at the home had increased. Discussions with the staff and the acting manager could not pin point why this was but there was some feeling that the lack of stability in the management of the home and the continual changes could be part of the reasons. Fortunately this did not appear to be affecting the people living in the home. We were told staffing levels had been reduced and as mentioned earlier this could impinge on the opportunities people have to engage in activities both in and outside the home. We were told that there are four staff on duty through the day plus one staff member who provided 1 to 1 care to one person. In addition to this the manager was on duty during the week. The home also employed cooks and domestic staff. The rotas gave evidence of these staffing levels. We were told that another two of the people living in the home should be having 1 to 1 care for 8 hours a day. Therefore this would only leave two care staff to support the other people living in the home. These levels should be reviewed to ensure they are not impinging on the quality of life Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: for the people in the home and that people are actually getting the 1 to 1 staffing they are funded for. Clearly staff had good relationships with the people living in the home. Interactions seen were very positive. Staff were seen to spend as much time as possible with the people living in the home talking to them on a one to one basis, facilitating activities and providing support with personal care. The people living in the home were very positive about the staff team comments included enough staff, staff are nice and staff speak to me in my language. Staff spoken with were able to tell us what the needs of the people living in the home were and how they supported them to meet their needs. The recruitment records for three staff appointed since the last inspection were sampled. The records for two of these staff showed that they had started work at the home prior to all the appropriate checks being undertaken. For example, one person had completed their application form after their start date, their references, criminal records bureau check (CRB) and protection of vulnerable adults check (PoVA) had not arrived at the home until after the person had started. For the other person the CRB was dated after the person had started work and the PoVA check could not be found. There were also some issues with references not being on headed paper with mobile phone numbers which could have been from anyone and no indication that these had been checked. These shortfalls in the recruitment processes put the people in the home at risk of having inappropriate people working with them. The records for the third staff member were complete and had been obtained prior to the person commencing their employment. The acting manager at the time of the inspection stated he had not appointed the two people without appropriate records he had been working elsewhere at this time. Staff spoken with told us about the training they had received. One new staff member told us about his induction training and shadowing staff in the home. He told us it was explained to him about peoples challenging behaviours and how these should be managed to ensure both himself and the people in the home were kept safe. Other staff told us about undertaking training in topics such as manual handling, food hygiene, COSHH, medicine management and first aid. The training matrix for the home agreed with what staff told us and also indiacted training in other topics such as mental health awareness, diabetes awareness, challenging behaviour and autism awareness. Some of the dates indicated that training was also planned for later in January. The range of training staff receive should ensure they have the skills and knowledge to support people appropriately. It was noted that only only three of the Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: seventeen staff employed at the home had an NVQ qualification which is considerably less than the fifty percent stated in the National Minimum Standards. The staff files sampled indicated that the frequency of individual supervision sessions varied and would not reach the required target of six per year. This was needed to review the roles and responsibilities of the staff and identify any individual training needs to assist them to meet the needs of people who live in the home more effectively. Care Homes for Adults (18-65 years) Page 28 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs a stable management team to ensure it is managed in the best interests of the people living there on an ongoing basis. Evidence: The home has not had a registered manager for a considerable amount of time. The acting manager that was in post at the last inspection had been moved to another home just after the inspection and another acting manager had been appointed. This person had now left and the original acting manager was back at the home. These changes have clearly affected the running of the home and although there have been some improvements in the care planning and risk assessments other areas have deteriorated. For example staff recruitment, medicine management and staff following health management plans. These shortfalls leave the people in the home at risk of not having their needs met safely. The acting manager was receptive to the issues raised and showed a commitment to improving the home for the benefit of the people living there. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: At the last inspection we spoke with the new responsible individual for the home who told us of the plans for the home including enhancing activities and encouraging people to be more independent wherever possible. Installing a kitchen for the use of the people living in the home was one of the priorities. Clearly many of these things had not been done. There had been no further progress on the systems in the home for monitoring the quality of the service in the home. The acting manager was not aware of any formal quality monitoring system in the home or of any development plan for the home. There were some ways of monitoring the service, for example, meetings with the people living in the home to get their views, staff meetings and occasional satisfaction surveys. The surveys were done at various times throughout the year. Comments on them included I enjoy eating all my meals, staff listen to me and Im happy. We were told that a representative of the registered provider visits Park Avenue on a regular basis to comment on the standard of care provided, which contributes to the management of the home. The reports for some of these visits were seen but they were not available for visits after last September. The home needed to have some formal systems in place for monitoring the quality of the service. Information gained from monitoring systems should be compiled into a development plan for the home that shows how the service is to be improved for the people living in the home. There was some information in the AQAA about the servicing of the equipment in the home but not all of this had been completed. The records for servicing of the equipment that were held on site were sampled. The in house checks on the fire system were up to date and regular fire drills were being undertaken to ensure staff knew how to keep people safe in the event of a fire. There were two fire risk assessments on site. A decision needed to be made as to which one was applicable and then review it as neither had been recently reviewed. Evidence was on site that the majority of the equipment had been regularly serviced to ensure it was safe to use. However evidence of the most recent service on the gas cooker and the bath seat could not be found. Care Homes for Adults (18-65 years) Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The use of bed rails must be 12/02/2010 risk assessed. This will ensure people are safeguarded. 2 19 12 The registered person must ensure that any management plans that are in place for peoples health care needs are followed. This will ensure the well being of the people living in the home. 12/02/2010 3 20 13 There must be a robust system in place for management of the medicines in the home. This will ensure people receive their medication as prescribed. 12/02/2010 4 34 19 Robust recruitment procedures must be in place at the home and applied consistently. 12/02/2010 Care Homes for Adults (18-65 years) Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure people are safeguarded. 5 37 8 An application for the registration of the manager must be forwarded to the Commission. This will assure the people living in the home that someone has day to day responsibility for the management of the home. 6 39 24A The home must have a 12/03/2010 quality monitoring system in place. This will ensure the service is improved on an ongoing basis. 7 42 13 The fire risk assessment must be regularly reviewed and updated where necessary. This will ensure that the risks of there being a fire are reduced and that it is compliant with West Midlands Fire Service. 8 42 13 The registered person must ensure there is evidence on site that the equipment and appliances in the home are safe to use. 15/02/2010 15/02/2010 12/03/2010 Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure equipment is safe to use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to include all the current and necessary information that people would need to help them decide if the home could meet their needs. It should be made available in appropriate formats. Evidence should be available that peoples needs have been assessed prior to admission to the home and how the decision has been made that staff can meet the identified needs. Evidence should be available that people or their representatives have had the opportunity to visit the home before the admission to see if they like it. Information in the care plans should be consistent so that staff know exactly how to support people. Care plans should include all the individual needs of the people living in the home and include how staff are to support them to meet their needs. This will ensure people receive person centred care. All risk assessments should clearly detail how any risks are to be minimised. This will ensure people are safeguarded. To ensure the confidentiality of the people living in the home personal information should not be recorded in communal books. People should be encouraged to develop independent living skills so they have a more meaningful life. People should have the opportunity to take part in social and leisure activities that meet their needs and preferences. Staffing levels should not impinge on the leisure Page 34 of 36 2 2 3 4 4 5 6 6 6 7 9 10 8 9 11 13 10 13 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations opportunities available to the people living in the home. 11 17 Records of the food eaten by the people living in the home should be kept to show they are receiving a varied and balanced diet on an ongoing basis. Staff should ensure that people receive their personal care according to their preferences and as they want. The outcomes to and from health care professionals should be recorded on the appropriate sheets so that they are easy track. This will ensure staff have all the information necessary to care for people appropriately. All areas of the home must be kept at an ambient temperature to ensure people are warm and comfortable. The torn flooring in the bedroom should be addressed. This will ensure people are safe when in their room. Bathrooms and toilets should be redecorated/refurbished to make them more pleasant for the people living in the home. Facilities should be available to enable people to make snacks and rinks to enhance their independence. Fifty percent of staff should be qualified to NVQ level 2 or the equivalent. This will ensure staff have all the necessary skills and knowledge to support the people living in the home. Staff should receive regular supervision sessions so that it can be assured they can meet the needs of the people living in the home effectively. 12 13 18 19 14 15 16 24 26 27 17 18 29 32 19 36 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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