Inspection on 17/02/09 for 185 Passage Road

This inspection was carried out on 17th February 2009.

CSCI found this care home to be providing an Adequate 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

185 Passage Road 31/12/07

185 Passage Road 03/04/07

185 Passage Road 10/04/06

185 Passage Road 15/09/05

185 Passage Road 21/04/05

185 Passage Road 13/09/04

185 Passage Road 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 185 Passage Road 185 Passage Road Brentry Bristol BS10 7DJ The quality rating for this care home is: one star adequate 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: Sandra Jones Date: 1 8 0 2 2 0 0 9 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. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 185 Passage Road 185 Passage Road Brentry Bristol BS10 7DJ 01179509586 01179699000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.brandontrust.org The Brandon Trust care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 7 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home This home is registered to accommodate 7 male residents with a learning disability. The current resident group have a variety of complex needs whose ages range from 43-88 years. The Registered Providers for this home are the Brandon Trust. This single level home is situated on Passage Road and is close to local amenities. There are local bus stops providing easy access to the city centre and to Cribbs Causeway and its shopping facilities. The home blends easily into the local community and is in keeping with the neighbouring properties. The home is fully accessible to the current resident group providing ground floor accommodation. However a ramp is needed to ensure full access to the grounds for residents whose mobility has deteriorated. There is a large wellkept garden mainly laid to lawn with fruit trees. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home This key inspection was conducted unannounced over two days in February 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection and this information was used to plan the inspection visit. This included the Annual Quality Assurance Assessment (AQAA) and notifications from the home. There are seven individuals currently living at the home and four people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. One member of staff was consulted about Care Homes for Adults (18-65 years) Page 7 of 33 the conduct of the home and feedback from two people living at the home were also sought. One person did not wish to be involved in the inspection. Documentation was examined relating to the people living at the home and to the general running of the home and health and safety issues What the care home does well What has got better from the last inspection Some areas of the home were refurbished to improve the environment for the people at the home. Since the last inspection care plan reviews have taken place to ensure that changing needs of the people at the home can continue to be met. Care Homes for Adults (18-65 years) Page 8 of 33 Health Action plans are being introduced and this will ensure that the individuals health care is monitored. What the care home could do better One requirement is outstanding from the last inspection and relates to training that must be provided to ensure that staff can meet the changing needs of the people living at the home. Requirements arising from this inspection are based on care planning and associated risk assessments, medication, training and reviewing systems. The registered manager must ensure that before people move into the home an assessment of need is conducted to ensure their needs can be met by the staff at the home. Support plans must be developed from the care plan review and must guide the staff a to consistently meet the individuals needs. Incorporating individuals wishes, likes and preferred routines will show that people have a say about the way their care is delivered. For people with communications needs their support plans must include the way they make decisions about all aspects of their care. For people that exhibit aggressive and violent behaviours, risk assessments must include the actions that staff must take to divert and diffuse inappropriate behaviours. Their spiritual, social and educational needs must also form part of their care planning process to ensure all Care Homes for Adults (18-65 years) Page 9 of 33 areas of need are assessed and met by the staff. Protocols must be devised for people that have when required medications to ensure that medications are administered by the staff as prescribed. The correct procedure must be followed when people make complaints this will ensure their feedback is valued and taken seriously at the home. Training that is specific to the needs of the people at the home must be provided to ensure their changing needs are met in a way that follows good practise. Fire risk assessments must be reviewed to ensure that where the potential for fire is identified action is taken to lower the risk. 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 Sandra Jones Care Homes for Adults (18-65 years) Page 10 of 33 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. 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 11 of 33 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 12 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide must be reviewed to ensure people have full and up to date information to make choices about living at the home. People at the home must be reassured that the home has the skills to meet their needs. Evidence: There is a Statement of Purpose and Service User Guide in place, which is symbolised with some pictures and words. The aims and values of the Trust is included along with the Mission Statement that is to support and enable people to live the lives they choose. While the format is in easy read, the Statement of Purpose and Service User Guide need to be reviewed to ensure that up to date information is provided for people wishing to live at the home. Information required by legislation is missing from the documents and must be added, to ensure that people wishing to live at the home can make informed decisions about moving to the home. The privacy and dignity procedure, sizes of the room, range of needs and, arrangements for activities and visitors must be appended onto the Statement of Purpose. The in-house admission procedure is included in the Statement of Purpose and confirms that the admissions are based on social workers needs assessment. It stipulates that introductory visits and trial periods are offered to establish compatibility with the other people living at the home. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Two people were admitted to the home since the last inspection. These individuals moved from other homes within the Brandon Trust and the information held within their case files relate to their previous homes. A social workers needs assessment is missing for one person and there is little evidence that the staff at the home conducted an assessment. An assessment of needs will ensure that the will ensure that the staff have the skills needed to meet the individuals needs. One person that recently moved into the home was asked about living at the home. This individuals said that the home was not suitable and the manager has said that this placement has not been made permanent. Care Homes for Adults (18-65 years) Page 14 of 33 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. People at the home are cannot be reassured that they will be supported to lead independent lifestyles. Care planning, decision-making and risk assessments must be addressed to ensure people have consistent and individualised care. Evidence: Person Centred Planning meetings were convened to review of the needs of the people at the home. However, support plans about the way the individuals changing needs are to be met, are not in place. The manager said that support plans are being developed with the person and their link staff in a person centred approach. A person centred approach will ensure that people have a say in the way their care is to be delivered. Feedback about the care planning process was sought from a member of staff on duty. The member of staff recognised that support plans are not always used as a point of reference to maintain abreast of individuals changing needs. The staff on duty was also consulted about the way individuals are empowered to make decisions. It was stated that people are supported to make decisions about the food they eat, clothing and activities. Photographs are used with individuals that have communications needs and for others there are opportunities to make decisions from two choices given. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Two people at the home have communication needs. However, communication plans on the way people make decisions that are in a format that they can understand are not in place. A person centred approach where people have an input into the way their needs are to be met, their case records must then be in a format that they can understand. One person with communication needs was referred to Speech and Language, this will ensure that the staff are able to support this person to make choices. The other person relates to photographs and will communicate in this way. Support plans for people that have communication needs will ensure that people at the home are empowered to make decisions. One person currently displays inappropriate behaviours, another person can become aggressive and input from the Community Learning Disabilities team (CLDT) has been sought for this individual. A third person at times will present with aggressive and violent behaviour and behaviour plans are in place. Risk assessments that include behaviour plans must be reviewed to ensure they follow current good practice guidelines. For the individual that may display inappropriate behaviour, the manager will be developing a risk assessment that contains guidance for staff to consistently manage these behaviours. The member of staff on duty confirmed that there are individuals accommodated that may at times present with aggressive, violent and inappropriate behaviours. It was further stated that the behaviour is as a result of frustration because they are not heard and generally resolved with comforting words. Risk assessments are in place for activities that may involve an element of risk . At present staff hold cigarettes for one person and a contract is in place on the way smoking is to be managed at the home. This contract is not signed by the person to indicate agreement with the plan. Risk assessments are written in a complicated manner using jargon. Risk assessments must be written in a format that can be easily understood by the staff to provide consistency of approach. The purpose of the risk assessments is to allow the person to take risks safely and not to prevent people from taking risks. Members of staff record observations, outcomes of visits and behaviours exhibited by the person. Generally, the reports are factual and give an adequate account of the event. Care Homes for Adults (18-65 years) Page 16 of 33 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 at the home undertake activities, their educational, social and occupational needs must form part of the care planning process. Their spiritual needs must be met to ensure they lead fulfilling lives. Meals at the home are varied. Evidence: Seven people currently live at the home, three people are in paid employment, one attends day care service and another has allocated one to one paid day care service, with two people choosing not to participate in structured day care. Individuals needs for social, education and occupational needs were reviewed through the Person Centred meeting. Support plans on the way the needs identified through the meeting are not in place at present. Records of the activities undertaken by the person with the staff are maintained and show that people undertake varied activities. People at the home are supported to access community facilities. There is a house vehicle for the people living at the home and they contribute towards the running cost of the house car. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: It is evident from the records that one person has spiritual needs and is stated that this person will celebrate religious festivals. However, these needs were labelled as ritualised behaviours under mental health care needs. The manager must ensure that individuals spiritual needs are addressed using a person centred approach. While there is an in-house Visitors policy, the arrangements for visitors is not specified within the homes Statement of Purpose. The Statement of Purpose must specify the arrangements for visiting the home to ensure people have full information about the home so that decisions about moving there can be made. The manager said that at present four people maintain contact with family and friends. The manager said that the people at the home are encouraged to take part in the running of the home, for example, loading the diswasher and clearing the table. The Privacy and Dignity policy is not currently incorporated into the Statement of Purpose and must be included to inform people about the way their rights will be respected. Feedback was sought from the manager about the way individuals are respected, the manager said that bedrooms are personalised, staff listen to individuals and staff facilitate the individuals preferred activities. We were also told that things are starting to change in terms of group activities. The rolling menu in place shows that people have a continental style breakfast, a light lunch and a cooked evening meal. The range org frozen, tinned and fresh food support that the meals served at the home are varied. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home have appropriate health care, support plans must be developed on the way their personal care needs are to be met. The manager must ensure that people at the home need when required medications for agitation. Evidence: Brandon Trust recently introduced Health Action plans for people living in their registered services, a member of staff is delegated from each care home with the responsibility of introducing the system. This person will then represent the home at meetings to discuss the progress made with the introduction of the plans. In future each person will have a Health Action plan file and a Mental Capacity Act statement about the persons capacity to make health care decisions will be included. For example, the persons preference with health care and routine checks will be specified in their Health Care action plan. Health check questionnaires are in the first instance completed by the GP about the persons health, medication and routine checks. Serving the purpose of providing information to external agencies in the event of a hospital admission. People at the home have access to NHS facilities which includes regular checks with the dentist, optician and chiropodist. There is involvement from psychiatrists, Speech and Language therapists through the Community Learning Disabilities (CLDT) which Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: provides support to the people at the home. People at the home have a GP and the reports of health care visits show that people visit their GP regularly. Staff giving feedback on health care said that people at the home are accompanied on health care visits. Care plans, handovers and daily notes are the systems used to ensure that staff follow medical advise. One person is a wheelchair user and staff support this individual with transfers and risk assessments guide staff to undertake safe handling techniques. In terms of staff supporting this person to achieve some Independence with walking, risk assessments must be clear about the assistance to be provided by the staff. Medications are administered through a monitored dosage system by the staff. Records of administration are signed by the staff following administration and codes are used to indicate the reason for not administering the medication prescribed. Medication profiles are in place and state the medications prescribed, the purpose and their side effects. For people on when required medications, protocols guide staff on administering medications as intended by the prescriber. It was noted during the examination of the medication systems that each person is prescribed with Lorazepan when required, a benzodiazepine used for their sedative and anxiety-relieving effect. For people on trial periods, protocol must be devised for when required medications are to be administered. The manager must ensure that the all the people at the home require medications for agitation. Staff confirmed that medication training is provided to ensure that staff administering medication are competed. As previously mentioned within the body of this report support plans on the way individuals needs identifeid through their review meeting must be devised. Care Homes for Adults (18-65 years) Page 20 of 33 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. People at the home cannot be reassured that complaints will be taken seriously by the staff. People at the home are safeguarded from abuse. Evidence: The Brandon Trust Complaints procedure is appended onto the Statement of Purpose. There was one recorded complaint since the last inpsection from one person living at the home. The manager wrote to the Trust on behalf of the person and the repair was undertaken. Through the examination of the records an account was found where a person at the home raised concerns with a member of staff about another member of staff. Instead of following the complaints procedure, this member of staff passed it to the staff concerned. The person living at the home then had to apologise for raising the concern and agreed to approach the member of staff that concerns about are raised. While the outcome of a complaints investigation may have been the same, the framework for resolving complaints must be through the complaints procedure. The essence of the complaints and safeguarding adults procedure is to reassure people at the home that they will be safeguarded from abuse and their concerns are valuded and taken seriouly. However, not following correct procedure, staff are pontentially putting people at risk from abuse. The manager must investigate the concern raised using the correct procedures. The manager made one safeguarding referral about sexual abuse by one person at the home towards another person living in the same home. A strategy meeting was held and as an outocme of the meeting the Community Learning Disability team was Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: involved and further training was provided to the staff. Three individuals living at the home were consulted about the people that would be approached with complaints. Two people named the person to be approached and the other said they had no experience of making complaints. Feedback was sought from a member of staff on duty about their responsibility towards supporting people to make complaints. The member of staff on duty said that the complaints procedure would be followed when people at the home raise complaints. We were also told that pictures would be used for people with communication needs to ensure they are clear about the procedures being followed. This member of staff was also consulted about their duties towards safeguarding adults. It was stated that refresher training was organised and their comments confirm clarity about the factors of abuse and the expectation to report the abuse to the manager. Care Homes for Adults (18-65 years) Page 22 of 33 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 people at the home live in a homely environment. Evidence: This single level home is situated on Passage Road and is close to local amenities. There are local bus stops providing easy access to the city centre and to Cribbs Causeway and its shopping facilities. The home blends easily into the local community and is in keeping with the neighbouring properties. The home is fully accessible from the front entrance to the people living at the home. However a ramp is needed to the rear to ensure full access from the rear. There is a large well-kept garden mainly laid to lawn with fruit trees. Communal areas and with the exception of one, bedrooms are on the ground floor. The office and one bedroom is on the first floor. Some refurbishment has taken place since the last inspection, the downstairs corridor and stairs were repainted and redecorated. During the tour of the property it was noted that the kitchen is in need of redecoration and action must be taken to ensure people live in a homely environment. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the people at the home are met by competent staff and to ensure their changing needs continue to be met, specific training must be provided. Evidence: The manager said that there are eleven support workers employed and a 37.5 vacancy exists which is to be advertised. It was also stated that the staff group is stable and have been working together as a team for a period of time. Comments about supervision, training and vocational qualifications was sought from a member of staff on duty. We were told that training is accessible and since the last inspection, first aid and manual handling training was attended. It was also confirmed that vocational qualification is encouraged and NVQ level 2 has been achieved. Members of staffs personnel records are held at the Brandon Trust office, and employment record sheets are kept at the home to confirm that the recruitment process is robust. These record sheets evidence that the manager saw Criminal Records Bureau (CRB) checks and references. While personal details were listed in the employment record sheets, there was no evidence to support that the manager had seen the CRB disclosures or references for three staff. The documentation in place must support that a robust recruitment process is followed for all staff at the home. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Since the last inspection the staff have attended Safeguarding Adults, First Aid, Manual Handling and Mental Capacity training and will be attending in-house fire and Manual Handling training. While it is accepted that staff will be attending training for behaviours that challenge, people at the home also have bipolar and autism diagnosis. For the staff to meet the needs of the people accommodated specific training must be provided. The manager currently undertakes 6-8 weekly supervision sessions with the staff which is based on the role of the worker, their performance and personal development. With the exception of two, all staff had supervisions with the manager in the last eight weeks. The manager must ensure that all staff have regular supervision, this will ensure that consistency of care is maintained. Feedback was sought from two people at the home about the staff. One person said that the staff were ok and the other said that staff are consulted about meals, places to go and bedtimes. Care Homes for Adults (18-65 years) Page 25 of 33 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. The people at the home can be reassured that the home is well managed and subject to ongoing monotoring. Fire risk assessments must be reviewed to ensure that where the potential for fire is identified, action is taken to reduce the risk. Evidence: The manager said that a coaching approach is used at the home and includes leading by example and keeping abreast of good practise. Communication books and supervision is used to maintain consistency of care at the home. Staff coments about the managers style of management. A member of staff on duty said that the manager is approachable and because of good communication there is team working. This member of staff also confirmed that supervision, handovers and team meetings occur. Comments about the home was sought from people at the home. One person said that it was ok and another person said that they did not like the home and would prefer somewhere else. The staff told us that this person in on a trial period and a decision about the placement has not been reached. The Brandon Trust operates a quality assurance system based on National Minimum Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Standards (NMS) which the staff use to audit the quality of the care provided and where standards are not met an action plan is developed. Fire risk assessments are in place. However, they have not been reviewed since 2007. A review of the fire risk assessments must be conducted to ensure that the potential risk is identified and where possible reduced. The manager complies with other legislation to ensure that the people at the home and staff work in a safe environment. This includes annual checks of portable electrical equipment, gas safety checks and hoists. There are facilities for the safekeeping of cash and valuables on behalf of the people at the home. A sample check of cash held was undertaken and the records confirmed the cash held in safekeeping. Recipes are used to further evidence the purchases made on behalf of the person. The duty rota in place shows that there are between three and two staff on duty throughout the day and at night. Care Homes for Adults (18-65 years) Page 27 of 33 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 1 35 18.1 (c) Ensure staff receive appropriate training for the work they perform and are updated in training considered compulsory. 01/05/2008 Partially met. Care Homes for Adults (18-65 years) Page 28 of 33 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 13 Risk assessments for inappropriate, aggressive and violent behaviours must guide staff on the way these behaviours are to be addressed by the staff. 01/04/2009 Risk assessments for people that present with inappropriate, violent and aggressive behaviour must be kept under review to ensure that there is a consistent approach by the staff. 2 14 An assessment of need must 27/03/2009 be conducted before individuals wishing to live at the home move into the home. An assessment of needs will ensure that the staff have Care Homes for Adults (18-65 years) Page 29 of 33 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 the skills needed to meet the individuals needs. 3 1 6 Information required by 06/04/2009 legislation is missing from the documents and must be added, to ensure that people wishing to live at the home can make informed decisions about moving to the home The privacy and dignity procedure, sizes of the room, range of needs and, arrangements for activities and visitors must be appended onto the Statement of Purpose. 4 6 15 People at the home must have a plan in place on how their assessed needs are to be met 01/04/2009 Support plans must be developed for each person to ensure their changing needs are met in a consistent approach. 5 7 12 01/04/2009 Support plans must be developed for people that have communications needs. Support plans for people with communication needs must incorporate the way they Care Homes for Adults (18-65 years) Page 30 of 33 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 make decisions about their care. 6 11 12 People at the home must have opportunities to fulfil their spiritual needs. 01/04/2009 The manager must ensure that individuals spiritual needs are met in a person centred way 7 12 12 Support plans must include their social, educational and occupational needs. 01/04/2009 Support plans must include action plans that specify the way individuals needs are to be met. 8 20 13 The registered person must 16/03/2009 ensure safe administration of medications The manager must ensure that the people living at the home all require when required sedatives for agitation. 9 22 22 The manager must ensure 31/03/2009 that complaints raised at the home are taken seriously and acted upon. The manager must ensure that when complaints are Care Homes for Adults (18-65 years) Page 31 of 33 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 made the staff follow the procedure. 10 35 18 The staff working at the 09/08/2009 home must be trained in the work they perform. Members of staff must attend training that meets the individuals needs. This includes Autism and Bipolar training. 11 42 23 The manager must comply with the Regulatory Reform (Fire Safety) Order 2005 31/03/2009 Fire risk assessments must be reviewed to ensure that where the potential for fire is assessed action is taken to minimise the level of risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 A person centred approach to meeting needs where the individuals likes, disliked and preferred routines is incorporated but be used to develop support plans. Support plans must be developed in a format that can be understood by the person. This will ensure that people have a say about the way their care is to be delivered. 2 7 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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