Inspection on 17/06/09 for 2-4 St Ives Close

This inspection was carried out on 17th June 2009.

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

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

Other inspections for this house

2-4 St Ives Close 03/11/08

2-4 St Ives Close 25/06/08

2-4 St Ives Close 20/07/06

2-4 St Ives Close 04/10/05

2-4 St Ives Close 17/05/05

2-4 St Ives Close 25/01/05

2-4 St Ives Close 06/09/04

2-4 St Ives Close 08/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 2-4 St Ives Close 2-4 St Ives Close Leyfields Tamworth Staffordshire B79 8HL The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Capron Date: 2 2 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 37 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 37 Information about the care home Name of care home: Address: 2-4 St Ives Close 2-4 St Ives Close Leyfields Tamworth Staffordshire B79 8HL 0182768517 F/P0182768517 h6029@mencap.org.uk www.mencap.org.uk Royal Mencap Society care home 9 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) : Number of places (if applicable): Under 65 Over 65 9 5 1 0 learning disability physical disability Additional conditions: Date of last inspection 2 5 0 6 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home 9 people live at the home. It is not far from the centre of Tamworth. The home is suitable for people that use wheelchairs. Everyone has a bedroom of their own. People can bring in their own things. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: 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 37 How we did our inspection: This is what the inspector did when they were at the care home We spoke to some staff that work at the home. We looked at two care plans to make sure the staff know how to support you in the way you want. We looked round the home to check if it is a nice place to live. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well You like the staff and some of them have worked with you for many years. You have good care plans that tell staff the support you need. Staff ask you how you want your care giving. Care Homes for Adults (18-65 years) Page 8 of 37 Staff give information in different ways to help you to understand things better. The home arranges things for you to do. They ask you what you want to do. You can choose where to go on holiday. Care Homes for Adults (18-65 years) Page 9 of 37 You can go to church if you want to. Staff will support you to do this. You help choose the meals and go shoppping for food and for things you need to buy. The home makes sure you are healthy. You go to see the doctor if you are ill and have eye and dental checks. Care Homes for Adults (18-65 years) Page 10 of 37 You have the medicine you should do. Medicine is checked to make sure it it is the right one. The home is a nice place to live. It is clean and tidy. Care Homes for Adults (18-65 years) Page 11 of 37 You have special equipment to help you to be as independent as possible What has got better from the last inspection The staff have training to look after you when you find things difficult and to keep you safe. Care Homes for Adults (18-65 years) Page 12 of 37 The home has procedures to make sure your money is spent properly. The home gives you information about the home. What the care home could do better Care Homes for Adults (18-65 years) Page 13 of 37 The staff must do the things specialist nurses ask them to do as this will make your life better. When you need to be weighed the home has to do this. This will help them to know if you become ill. The home must make sure it tells the right people if they feel you may have been hurt. Care Homes for Adults (18-65 years) Page 14 of 37 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 Jane Capron 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 15 of 37 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 16 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using the service are provided with information about what the service offers. People can be assured that an assessment of their needs will be made to decide if the service can meet their needs. Evidence: The services Annual Quality Assurance Assessment(AQAA) states that they provide information about the service in an accessible format and that an assessment is completed for anyone considering using the service. Copies of service user guides are available at the service and a copy is provided to people that live there. The current guide provides information about the service and is completed in an easy read format. The service tells us it intends to develop information in an even more easily accessible formats such as on disc or in an audio format. The information describes the areas that the fees cover including the cost of transport although does not give the overall level of fees. Responses to our surveys confirm that people or their representatives are included in the decision for people to move to the service and that they have enough information to decide of the service can meet their needs. Page 17 of 37 Care Homes for Adults (18-65 years) Evidence: Examination of a sample of files confirms that assessments are completed to identify peoples needs to decide if the service can meet their needs. Although there have been no admissions since our last visit the services procedure is to complete their own assessment. This assessment includes gathering information about peoples health and personal care needs, any communication needs, social care needs as well as any issues relating to their spiritual and cultural needs. Care Homes for Adults (18-65 years) Page 18 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that plans are in place to provide staff with information about how to meet their needs. People living at the service are supported to make some decisions about their lives. Evidence: The AQAA states there are support plans in place and that any changes are recorded and that they strife to ensure that all people receive an annual review. Examination of a sample of two files confirms that support plans are in place. These are completed in a person centred way identifying peoples full needs and showing the action staff need to take to ensure needs are met. Plans include peoples preferred daily routines and includes peoples likes and dislikes. Plans cover such areas as health and personal care needs, daily living tasks, social care needs, financial management and any spiritual needs. Where people have specialist communication these are recorded although to date not all full communication plans are in place. The service tells us they are still working on these. If a person has some diffcult behaviours a plan is in place to advise staff how to respond. There is evidence that plans are reviewed monthly and that some Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: people have had a person centred multi agency review completed. Plans are not yet in an accessible format but the service tells us it has started working on these. Risk management systems are in place. For example one persons file contains information about the support they need to safely access the community, another person has a risk management plan in place due to their swallowing difficulties. Risk assessments are reviewed and updated. The service understands peoples rights to make decisions about their lives and is improving the way it promotes peoples choices. People have advocates to support them make important decisions. The service is increasing the use of different communication methods to aid people to make choices. Staff recently undertook training in makaton and staff tell us that this helps them to communicate with one person. We saw that the service uses pictures to aid people to choose meals, and we saw that one person uses non verbal communication to show what they want to do. When we spoke to staff they are able to describe how one person uses pictures to choose their meals and can choose what to wear when given two different items of clothing or by using different coloursed clothing. The AQAA also tells that people choose the colour and decor of their bedrooms. Further work does need to continue to to support people to make decisions about how they live. For example a speech and language therapist has provided advice in March 2009 on the use of object reference to support one person to make choices but this has not yet been put into place. Care Homes for Adults (18-65 years) Page 20 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service are supported to take part in a range of activities and the service is working to increase peoples choices about their lifestyle. People are supported to maintain and develop relationships. People are provided with a varied diet that meets their dietary needs. Evidence: The services AQAA states that each person that lives at the service has an individual day care programme that includes a varied range of activities chosen by that person. Examination of a sample of support plans shows that individual activity schedules are in place. Where possbile this is devised with the input from the person themselves. Where this is not possible activities are based on what has been successful in the past and through the knowledge that staff and relatives have about the person. The introduction of a staff member responsible for day activities has led to improved plans being in place and an improved range of activities being offered. One person we case tracked regularly goes to the pub, has meals out, goes shopping, goes bowling, goes for walks and spends time Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: in the garden. This person is also due to go on holiday. Other people take part in a number of activities both in and out of the service. Staff support people to take part in such tasks as crafts, watching DVDs, baking and gardening. Plans are also in place for people to take part in daily living tasks including cleaning and laundryand shopping. One person with sensory needs takes part in some activities and accessed the community. However the service acknowledges that work is still needed to develop a programme that fully met this persons needs and has started to put plans in place. This will be further developed when the second day care staff member starts work. The service is working to increase the amount of activities suitable for people and several people attend college. One person is supported to go to church with their family. The service supports people to maintain contact with their family. This is done through regular visits and for one person by email. There is evidence that people are supported to send birthday cards and we saw that one person was supported to attend a relatives wedding. Routines within the service tend to be quite relaxed. Times for getting up and going to bed depend on individual wishes. There are no set mealtimes and people regularly go out for lunch. Although activity schedules are in place the service tends to follow these flexibly taking into account peoples wishes. The AQAA states that they encourage people to choose healthy food when choosing menus. Most people that live at the service are involved in choosing the food they eat. However the service needs to develop ways for people with sensory needs to be more involved. We saw that a pictorial menu is in place and that the service is starting to use pictures to help people to take a more active part in the weekly shopping. Examination of the menus shows that people have a varied diet. A number of people have special diets and when we spoke to staff they could tell us about peoples dietary needs, for example one person needed a soft diet and another had a diabetic diet. The service supports people to eat as independently as possible providing them with equipment such as lipped plates. Care Homes for Adults (18-65 years) Page 22 of 37 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. The service ensures that people using the service have their personal care needs met. The service is making progress in responding to the complex health care needs of the people that live there. Evidence: The service states it uses Health Action Plans to identify and support people to have their health and personal care needs met. They say that they support people to access medical care from a range of health professionals. An examination of sample of files confirms that personal care and health care needs are identified and the service is in the process of putting in Health Action Plans. One file we saw shows that there is comprehensive information to show staff how to provide personal care in the way the person wishes. When we spoke to staff they are aware of how to provide this care. Observing this person shows them to be dressed appropriately and to have received hair and nail care. Staff are aware of privacy and dignity issues. Staff could tell us how they promote peoples privacy and dignity when they complete personal care tasks. For example one person said that when showering they always make sure the curtains are closed and that they support the person to get dressed in the shower room afterwards. Another staff Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: member said that they always check the corridors and shower room to check no -one is around and make sure people are always covered. We did notice that since the office has moved this gives direct visual access to a bathroom. We raised this issue with the service. Files identify peoples health care needs and we saw records to show that people attend for dental and eye checks and that a chiropodist visits regularly. We also saw that people attend the doctor when ill. Staff are supporting people to have their primary health care needs met. For example one person needs specific dental care and staff are ensuring that he receives this. This person also developed a pressure area and the staff took immediate action to address this. Another person has diabetes and the service works with the District Nurses to ensure he has the support needed to manage the condition. In order that this person can go on holiday staff have been trained to administer insulin. Several people require pressure sore care due to spending long periods in the same position. The tissue viability nurse has been involved and people have the specialist equipment needed. The service has procedures in place to montor peoples weight. However the two files we checked show lengthy gaps between weights. In one file it states weighing should be two weekly and it has only been completed twice this year. Many of the people living at the service have complex needs that require significant support from staff to ensure their care needs are met and they are supported to be as independent as possible. There is therefore heavy involvement from a range of specialist staff including physiotherapists, occupational therapists, Speech and Language therapists and Community nurses. These staff have undertaken a range of assessments and provide the service with advice and training on how to fully meet peoples needs. Concern has been expressed by some professionals about the services ability to follow through consistently on advice provided and to monitor how recommendations are working. We understand that progress in this area is being made and staff have a positive attitude to learning new skills. However we did see that the service was only just addressing part of a recommendation to aid one persons communication and that a recommendation by a psychologist to complete behaviour charts is not being properly put into practice. This would mean that when these charts are evaluated they would not provide correct information. The service states that it has developed a medication pen picture of each person and that staff receive training to support them to administer medication. The service does have good information about peoples medication including information about the reason for the medication and any side effects. Medication is stored in a locked cabinet in a locked cupboard. A secure cabinet is available for the storage of Controlled Drugs. A check on two peoples medication shows that it is being administered correctly and there are no gaps in the records. The service has alerted us, the commission, to some drug errors but provided us with information that these had been dealt with appropriately. Some people have their medication in yoghurt and the service showed us information from the doctor to support this method of administration. The service also has some people with epilepsy Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: that are prescribed rescue medication. In these cases there are protocols in place to show staff when it should be administered. We asked one staff member about this and she is aware of the content of the protocols. Staff we spoke to confirm they have had medication training and we are aware that staff completed a medication awareness course given a community nurse recently. The service also has a system in place to assess staff continued competency to administer medication. Care Homes for Adults (18-65 years) Page 25 of 37 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 that use the service have access to a complaints procedure but records of complaints does not always confirm the action taken. People are supported by staff that are aware of the signs of abuse but cannot always be completely confident that incidents are referred correctly. Evidence: The AQAA states that the people we support are encouraged to raise concerns. They also state that they respond to complaints. The AQAA states that five complaints have been received since we visited last and one was upheld. We saw information about complaints was in the entrance hall although this referred to the national procedure. We did see in files that information is present about complaints. People that live at the service said in their surveys that they know how to make a complaint. These surveys however were completed with staff support and it is unlikely that anyone living at the service could access the complaints procedure and would rely on staff or others to identify if they had any concerns. Responses from some other professionals indicates that they feel that service does not routinely respond appropriately if concerns are raised. The service keeps some information about complaints but does need to keep a full record showing details of the complaint, the investigation and any actions taken. The services AQAA states that their safeguarding procedures ensures any threat to people is identified and reported promptly. Over the last year there have been concerns raised by professionals over the services understanding of the agreed safeguarding referral process. Although improvements have been made we still feel that some Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: confusion still exists over the referral process. We also saw that the service had a copy of the old procedures pinned on the notice board. Speaking to staff confirms that they are trained in safeguarding issues and could describe symptom of possible abuse. They are aware of their internal prcedures to refer any concerns to the manager. We checked a sample of peoples finances and this shows that expenditure is accounted for and that receipts for expenditure kept. At our last key inspection some people had bought their own furniture. The service confirms to us, the Commission, that the service buys furniture for peoples bedrooms and pays for their bedroom to be decorated. The local authortiy has raised a concern that one person may have paid for items when this was not appropriate. The service is currently looking into this. At our last key inspection we raised issues over the management of behaviour that was a risk to other people. We did a random visit and saw that the service had received training in managing challenging behaviour and had put protocols in place to respond to one persons behaviour. On this visit we saw that one person had a behaviour management protocol in place that shows staff how they need to respond. This said that one person should be supervised at all times but we were told that due to staffing levels this is not always possible. The service has requested additional funding to support this person but to date this has not been provided. There is also an agreement that when this person displays behaviours that challenge charts will be completed in order that a psychologist can assess the behaviour and provide advice on managing the behaviour. An examination of records shows that completion of these is not always done. Care Homes for Adults (18-65 years) Page 27 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will live in accommodation that is clean, comfortable and meets their needs. Evidence: The services AQAA states we aim to provide an environment that is safe, secure and promotes the wellbeing of the indivudal. Examination of a sample of the accommodation shows that it meets the needs of the people that live there. The environment is well maintained. All areas including the garden are wheelchair accessible. Everyone has their own bedroom. There are sufficient toilets and bathrooms provided although bathrooms could be made more welcoming. The service provides specialist equipment including an assisted bath, a level access shower, hoisting equipment and people have their own specialist chairs. The service has started to develop the environment to asssist orientation for one person with sensory needs. A sensory room has been developed and a sensory garden is being developed. Viewing a sample of bedroom accommodations shows them to be well decorated and furnished and to be personalised. Communal areas provide sufficient seating and provide a comfortable place for people to sit and relax. The service is kept clean and tidy. Responses to our surveys from people that live there state that the service is always clean and fresh. One survey from a health professional Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: commented clean, hygienic environment. Infection control procedures are in place and staff tell us that there are always sufficent gloves and aprons available. The services AQAA tells us that all the staff have received training in infection control. Care Homes for Adults (18-65 years) Page 29 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can be confident that the way staff are recruited is protecting them. People are supported by staff in adequate numbers and how are qualified. People can be confident that staff are keen to develop their skills to provide them with the care they need. Evidence: The services AQAA states that they recognise that staff influence the quality of service. They state that all checks are made before staff are employed and that staff receive training. An examination of a sample of three staff files confirms that the service has an effective recruitment system that protects the people that live there. All files contain two references and confirmation of Criminal Records Bureau and Protection of Vulnerable Adult checks. Over the last year the service has experienced some staffing difficulties as the service has tried to move forward and develop the service. There have been staff absences and a need to use a extra staff as some peoples needs have increased. This meant a higer use of relief and agency staff. The manager tells us that this use of agency and relief staff has now reduced and that the service has now recruited its own bank staff to cover for staff vacancies and absences. This is better for people as these people know them and have Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: been trained by the service. An examination of the roster shows that the service provides adequate staffing levels to meet the needs of the people that live there. However on the day we visited we noticed that some people were left alone for some time as staff tended to other peoples personal care needs. The manager did tell us that there are plans to increase the staffing levels in order to provide five staff on duty throughout the day. The service is also in the process of appointing a second staff member to support people to undertake activities during the day. We observed that staff have positive relationships with people that live there and there is a relaxed atmosphere. We received positive comments about the staff from people that use the service although these surveys were completed with the support of staff. A health care staff member did comment that staff are caring and have a good rapport with the people that live there. The AQAA states that the service provides people with training and that 16 of the 19 staff have achieved at least NVQ level 2. People are provided with a range of training and all new staff have induction training. Recent training includes managing challenging behaviour, epilepsy, diabetes and medication awareness. Staff also tell us that they have received training in the Protection of Vulnerable Adults, the Mental Capacity Act, makaton and dementia. Comments from some professionals did indicate that they feel that staff do not always have the right skills to support the people that live at the service and they are providing specialist training to the staff to develop the knowledge and skills they need. This training includes training in communication techniques, medication awareness and developing staffs understanding of sleep systems that some people use. The manager did acknowledge there are some areas that staff need to develop. However we did feel that the staff are keen to develop and a professional tells us that training recently provided in medication awareness was well received by the staff. Another professional said that staff have a positive attitude to improving the way they communicate with staff. Care Homes for Adults (18-65 years) Page 31 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being satisfactorily led and is making improvement to the quality of life for the people that live there. People that live at the service are protected by the services Health and Safety procedures and where areas need to be improved these are being addressed. Evidence: The AQAA states the manager is trained in care and management and has seven years management experience. She states that she takes a proactive approach to her learning and development. She is registered with the commission. The manager has been in post for approximately 18 months. She demonstrates a wish to develop the service in a person centred way. Over the last year a number of concerns have been raised over the service including the knowledge of the staff and their ability to respond to challenging behaviour and people with complex needs. There have also been concerns over how the service has referred safeguarding issues. Concerns have been raised by other professionals about the communication systems within the service and the services ability to follow professional advice consistently. There is evidence that improvements are being made and that working relationships appear to be becoming more positive. There is an ongoing training programme for staff and regular staff meetings are held. Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: The service provided an AQAA when it was requested. This provided us with information about the service. It also told us its plans for the future. The service has systems in place to monitor and assess the quality of the service. These involve the people that live there and relatives. The service is monitored monthly by the organisations service manager and has had an audit by the local authority commissioning team and Mencaps own auditing team. The service also has a continuous improvement plan that identifies areas to improve. The service has health and safety procedures in place and records show that staff receive training in food safety, moving people, fire and infection control. Fire safety checks are completed and regular fire evacuations take place. A fire risk assessment is in place and the service is in the process of developing individual fire safety risk assessments. The service is also in the process of making sure that hot surfaces do not cause a hazard to the people that live there. A number of people use bed rails and their safety is checked monthly. We did advice the service to check that bed rails are still needed for everyone and that if needed that covers are in place. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 37 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 19 12 When recommendations are 03/08/2009 made by health care professionals these should be followed through, for example communication plans and behaviour charts. This will ensure that people have the correct care and support. 2 19 12 Where people need regular weighing this must be completed. 03/08/2009 This will make sure that any significant weight changes are identified and the necessary action taken. 3 22 22 When complaints are made these should be properly recorded to show the investigation that has taken place, the outcome and any actions taken. 03/08/2009 Care Homes for Adults (18-65 years) Page 35 of 37 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 This will confirm that appropriate action has been taken when complaints are made. 4 23 13 Staff must be aware of the correct procedure for referring safeguarding incidents. 03/08/2009 This will ensure that any safeguarding incidents can be acted upon in a timely manner. 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 2 6 7 Support plans should be developed in a way that makes them more accessible to people. Where people have specialist communication needs further work should take place to enable them to take more decisions and make choices over their lives. The service should look at how peoples privacy when using the bathroom opposite the office can be maintained. 3 18 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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