Inspection on 17/02/09 for 20 Waterloo 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

20 Waterloo Road 03/03/07

20 Waterloo Road 12/01/06

20 Waterloo Road 27/07/05

20 Waterloo Road 13/02/05

20 Waterloo Road 26/07/04

20 Waterloo Road 15/03/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Waterloo Road 20 Waterloo Road South Yardley Birmingham West Midlands B25 8JR     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: Kerry Coulter     Date: 1 7 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. 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. 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 20 Waterloo Road 20 Waterloo Road South Yardley Birmingham West Midlands B25 8JR 01217074673 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) : mohan_roger@hotmail.com Mr Rajeshwar Mohan,Mrs Manju Mohan care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Date of last inspection Brief description of the care home 20 Waterloo Road provides accommodation, care and support for up to three people with learning disabilities. The house is a three bedroom terraced property situated in the South Yardley area of Birmingham. The home is well served by public transport and is in close proximity to community facilities and amenities. The Registered Manager is also the co-owner of the property with her husband, and both work as part of the care team along with their son and another support worker. On the ground floor is a front lounge, which gives access to the street via the front door of the house. There is a further lounge / dining room leading through to the kitchen at the rear of the property. The bathroom and toilet are also situated on the ground floor, and these Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home are accessed through the kitchen. On the first floor are three single bedrooms, two of which are quite small and if someone had a lot of furniture, possessions or mobility needs they may not be big enough to accomodate this. The staircase is quite steep, so this house would not be suitable for people with significant mobility problems. To the rear of the property is a long garden, with a lawn and patio area with seating. Parking space is generally available on the road at the front of the house. The home is located close to local shopping areas and public transport links. The home has a service user guide but this did not record the range of fees to live there. For current fee information the manager of the home should be contacted. Our previous reports of the home are available in the home on request. Care Homes for Adults (18-65 years) Page 5 of 30 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 peterchart Poor Adequate Good Excellent How we did our inspection: The visit was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. Our last key inspection was carried out on 3rd March 2007. The focus of inspections we, the commission, undertake 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, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home. The Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 6 of 30 (AQAA) that provides information about how they think they are meeting the regulations was returned to us prior to the inspection. We also sent surveys to the two people who live at the home and two members of staff, these were returned to us. Surveys were sent to care professional but none of these were returned. Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, 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. One person was at home when we visited and we spent time talking with them and both of the owners. Time was also spent observing care practices, interactions and support from staff. We looked around some parts of the home. Care, staff and health and safety records were looked at. What the care home does well: What has improved since the last inspection? What they could do better: The service user guide should be updated to include the range of fees charged by the home so that people know how much it costs to live there. Care plans need further development so that staff know how to support people appropriately. Risk assessments must be in place for all risks identified to individuals to ensure their safety. Health action plans should be developed for each person to enhance health care planning to help people to stay healthy. Care Homes for Adults (18-65 years) Page 8 of 30 Records of training undertaken by the staff team should be improved to fully evidence all the training that they have undertaken. Quality assurance systems in the home should be further improved to ensure that the home is well run and improvements are made that take into account the views of the people who live there, their relatives and involved care professionals. Some areas of health and safety practice in the home needs to be improved to make sure that the health and safety of people at the home is promoted and protected. 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 –03000 616161. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need to help them decide if the home can meet their needs and if they would like to live there. Evidence: The home has a service user guide in place that tells people about the home. This is kept in the lounge so that people have easy access to it. The guide includes most of the information that people need to know but did not include the range of fees. This needs to be included so that people have an idea of how much it would cost to live there. Surveys we received from people who live at the home indicate that they were provided with enough information about the home before they moved in. No new people have moved into the home since we last visited in 2007. The people who currently live at the home have been there for several years. The home currently has one vacancy. Discussion with one of the owners indicates that there has been some interest in the vacancy but as yet there have been no firm referrals. Discussion with Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: the owner indicates that people would not be admitted to the home until a full assessment had been carried out to make sure the home could meet their needs. Care Homes for Adults (18-65 years) Page 12 of 30 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. Staff do not have all the information they need to be able to support individuals to meet their needs and reduce the risks to their safety, which could impact on their well being. People are able to make choices and decisions about their lives so that they can do the things they want to do. Evidence: We looked at the care files for both people who live at the home. Each person had an assessment of their needs that indicated where they needed staff support. Each person had a care plan that had been reviewed in the last six months. The records of the review indicated that the person had been consulted about their care. The care plans in place were very brief and did not always detail the support people needed from staff. For example where plans recorded that people were being encouraged to make tea and toast there was no detail about what they could do for themselves and what they needed staff to help them with. There were not care plans Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: in place for all identified areas of need. For example, assessment of need identified that one person needed assistance with bathing but there was no plan in place describing how the person needed to be supported. Recently one persons needs have significantly changed following an accident and they are now temporarily using a walking aid around the home. Their care plan had not been updated to reflect this and the additional support that they may now require. Discussions with the owners indicate that there is a good deal of knowledge about peoples care needs within the care team, but it is important that this knowledge is recorded appropriately in their personal care plans. Throughout our visit the person who was at home was observed to be encouraged by staff to make his own choices, for example what he wanted to eat and drink. We saw that he was sitting with the remote control for the television and was able to choose what he wanted to watch. Surveys received from both people at the home record that they can make their own decisions. Improvement is needed to ensure risks to people at the home are fully assessed. For example as stated earlier one person was using a new walking aid. Records suggested that the physiotherapist had assessed them in hospital and said they were able to use the stairs. However the home had not assessed the risks, this needed to be done given that the stairs at the home are very steep. A risk assessment also needed to be completed to make sure the person was safe getting in and out of the bath. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that people living there experience a meaningful lifestyle that ensures their self-esteem and well being is promoted. People are offered a healthy diet and enjoy their meals. Evidence: Surveys from people at the home recorded that they could do what they wanted to during the day and at weekends. During our visit one person told us its a lovely place to live, theres lots to do, went on holiday last year and enjoyed it. Records showed that people undertake activities that they prefer and enjoy, this includes attending the day centre, personal shopping, visits to parks and the library, going to the pub and having lunch out. Where people want to they are supported to attend religious services. People are also encouraged to participate in keeping their Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: bedrooms clean and tidy and to participate in domestic activities such as making toast and drinks. Records showed that one person had been on holiday abroad for the first time last year, the home is going to assist the other person to renew their passport so that they can also have the option of a holiday abroad in the future. Records sampled showed and people said that they can visit their family and friends when they want to. If needed staff support them to do this so they can keep in touch with the people important to them. One person at the home told us that the food at the home was lovely, he said he was glad to be home from the hospital as the food there had been horrible. We saw that the person was able to choose what he wanted to eat and drink at lunchtime. Healthy options of fresh fruit and fruit juice were offered with the meal. It was good that staff eat with people making mealtimes a pleasant and social occasion. The owners told us that the consult with people about what meals they would like on the menu. Records showed that people have the opportunity to go food shopping with staff to help choose what food they would like. We looked at the menus, these showed that meals were varied, healthy and culturally appropriate for the people living at the home. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health needs of individuals are generally met so ensuring their well being. Evidence: One person was at home during our visit. We saw that they were well dressed in a style that was appropriate to their age, the weather and their cultural background. It was observed that they had been supported to pay attention to their personal care and hygiene so ensuring their self esteem. Records showed that people are supported by staff to go shopping to choose their own clothing and to go for regular haircuts. Records sampled showed that health professionals are involved in peoples care when needed to ensure their well being. For example one person has regular input from their psychiatrist. The home keeps clear records of all health appointments attended by people, this showed that people attend regular health checks such as the dentist and optician. Records showed that where one person had a fall prompt medical attention was sought. Further medical advice was also sought by the home when staff were concerned that the persons injury was not healing as well as expected. During our visit Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: the person complained of being in pain and it was good that this was responded to by one of the owners who offered painkillers. Discussion with the owners indicates that people do not have a health action plan.This is an individual plan about what the person needs to be well and what health care services they need to access. This is something the Government said all people with a learning disability should have by 2005. It is recommended that these are developed by the home to enhance health care planning to help people to stay healthy. Medication is stored in a locked cabinet. Records are kept of all medication received. However the home does not make photocopies of the prescriptions. This should be done so that staff can ensure that what is provided by the pharmacist is what has been prescribed by the doctor. Records showed that people have their medication regularly reviewed by their GP or psychiatrist to ensure that it is still effective in meeting their health needs. Medication Administration Records (MAR) sampled had been signed when staff had given the person their medication and indicated that people always had their medication as prescribed. Written guidance is available for the administration of paracetamol medication so that staff know when it should be given. Both owners said they had completed training in medication but were unable to find certificates to evidence this during our visit. A certificate of training was available for staff. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on and they are safeguarded from abuse. Evidence: The homes annual quality assurance assessment stated that there has been no complaints received by the home in the last 12 months and we have not received any complaints about this service. The home has a complaints procedure available and this is readily available to people in a folder in the lounge. The procedure is in a written format but is not available in an easy read version with pictures. However surveys from people who live at the home record that they know how to make a complaint and who to speak to if they are unhappy. Development of an easy read format may enhance the information available to people. Surveys from staff recorded that they knew what to do if people or their relatives had a concern about the home. Staff meeting minutes and discussions with the owners indicate that they and the two staff they employ have undertaken refresher training in safeguarding adults from abuse. This was done in house via a DVD and workbook. The home has a policy on safeguarding people from abuse and on whistle blowing, as well as a copy of the Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Birmingham multi agency safeguarding procedures. These help staff to know what to do if they suspect that abuse has occurred. Discussion with the owners indicates they have both attended workshops about the new Mental Capacity Act. The Mental Capacity Act came into force in April 2007 and requires an assessment of the persons capacity if there is any doubt they may not have the capacity to make a decision about their welfare. Neither of the people who live at the home is able to manage money independently, due to their degree of learning disability, therefore the home assists them to look after their money. We sampled the records for one of the people at the home. They have their own bank account into which their benefits are paid. Individual expenditure is subsidised throughout the month by the Manager, with records and receipts retained appropriately. Each account is then settled at the end of the month. It is good that the person is encouraged to sign for the expenditures, however it should also be signed by the member of staff making the record. Receipts indicate that the person was not paying for items that the home should be responsible for purchasing. Care Homes for Adults (18-65 years) Page 20 of 30 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 live in a homely, comfortable and clean environment that meets their individual needs. Evidence: The home is a small terraced house that blends in with the other homes in the road and is not distinguishable as a care home from the outside. The premises are very homely in style and was generally clean and warm when we visited. Since the last inspection one of the lounges and one bedroom have been redecorated. Surveys from people at the home told us that the home is usually clean. Generally the home is well maintained although we noticed that the kitchen area was quite worn in appearance. The annual quality assurance assessment records that it is planned to redecorate this area in the next twelve months. The home does not have a separate laundry and so the washing machine is located in the kitchen. It is positioned at the kitchen entrance so that staff do not have to carry soiled laundry right through the kitchen. Care records show that people at the home do not have incontinence and so generally there would not be any heavily soiled items. We looked at the homes policys and procedures and saw that there was one in place Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: for infection control. However it is recommended that this is further expanded with regard to the infection control procedures for soiled laundry to reduce the risk of infection. The home has a bathroom located on the ground floor of the home, this is accessed via the kitchen. There are no toilet or bathing facilities situated on the first floor of the home where peoples bedrooms are located. The person who was at home did not raise any concerns about this but ideally toilets and bathing facilities should also be located close to peoples bedrooms. However as the home is a small terraced house there does not appear to be much potential to improve the bathing facilities. Each person has their own bedroom. Bedrooms were personalised according to individual needs, tastes and interests. Bedrooms included photographs of people important to the person and if appropriate to the individual religious pictures so ensuring their religious and cultural needs are considered. Care Homes for Adults (18-65 years) Page 22 of 30 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. The arrangements for staffing, their support and development generally ensure that the needs of the people living there are met. The recruitment practices help to ensure that the people living there are safeguarded from abuse. Evidence: The care team at Waterloo Road comprises three family members (husband and wife owners and their son) and one other worker. All of them have been at the home for some years and this means that people who live there are supported by staff that they know well. The two staff do not have a National Vocational Qualification (NVQ) in care although information from the owners indicates that one is due to start an NVQ this year. During our visit we observed interactions between people at the home and the owners and staff. The owners and staff treated people with respect and spoke to them in a friendly manner, interactions were positive. Surveys returned by people at the home recorded that staff always treated them well. The staff rota and discussions with the owners indicate that at night there is one waking staff on duty and during the day levels vary from one to two staff depending on peoples activities. This appears sufficient to meet the needs of the two people currently living at the home. Surveys received from the two staff record that there are Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: always enough staff on duty to meet peoples needs. As staffing arrangements in the home have remain unchanged for several years we only briefly looked at staff recruitment information. We looked at the files for two staff. These included evidence that a satisfactory Criminal Record Bureau (CRB) check had been completed to ensure that suitable people are employed to work with the people living there. Staff had received training in 2006 using the Mulberry House Electronic Tool and Training manual covering a broad spectrum of social care, protection and related issues. However at the time of our visit the owners could not find the homes training matrix that shows all of the training that the staff team have done. This was faxed to us the day after our visit. As already commented earlier in this report certificates were not available to show that staff who administer medication had received appropriate training to do so. Certificates of training should be available in the home to evidence the training that staff have done. Not all of the staff have completed first aid training, this is further detailed in the management section of this report. As stated earlier in this report staff have received refresher training in safeguarding people from abuse. Records sampled and surveys received from staff show that they receive supervision every other month so that they are supported in their role. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not always ensure that the home is run in the best interests of the people living there to ensure their safety and well being. Evidence: As previously stated in this report both the owners of the home work there on a day to day basis, one of them is the registered manager of the home. Both are qualified to NVQ level 4 and hold the registered managers award. Discussions with the owners indicate they have kept themselves up to date with current care issues such as attending seminars on the new Mental Capacity Act and health and safety. The Annual Quality Assurance Assessment (AQAA), which tells us how the home thinks they are meeting the regulations and standards, was returned to us when we asked for it. The home uses a quality assurance system called Practical Quality Assurance System for Small Organisations. Whilst this does indicate that there has been some consultation with people at the home it focuses on management systems rather than on peoples views. As at previous inspections, it is recommended that quality assurance Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: systems are further improved to include the views of people at the home. Consideration should also be given to seeking the views of peoples relatives and involved care professionals. Fire records showed that staff test the fire equipment regularly to make sure it is working and that regular fire drills are held so that people know what to do if the fire alarms sound. However discussions with the owner indicated that the home had not completed a fire risk assessment to ensure that the fire precautions in place were satisfactory. Following our inspection the owner said they had obtained a format to complete an assessment and that this would be done. The home was visited after our inspection by the West Midlands Fire Service who told us they were satisfied with the fire precautions in the home. The home has a cupboard for the storage of COSHH items, these were seen to be securely stored at the time of our visit. Certificates were available to show that the gas and electrical installations in the home had been tested by qualified engineers who stated that these were safe. Discussion with the owners indicate that the home does not have a system for monitoring the temperature of the water. We hand tested the hot water to the bath during our visit and found it to be safe, however the home needs to introduce regular monitoring to make sure people are not put at risk of scalding. Training records show that not all staff have had training in first aid and some undertook this training several years ago. The home needs to ensure that everyone who works there has had satisfactory first aid training that is regularly refreshed so that they know what to do should an emergency arise to promote peoples health and safety. The home had completed a basic risk assessment regarding the premises. As stated earlier in this report further assessment was needed of the use of the steep stairs and the bath by one person whose mobility had changed. Assessment is needed to make sure they are not at a significant risk of accidents when using the stairs and the bath. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 9 13 Risk assessments must be in 03/04/2009 place for all risks identified to individuals. To ensure that people are safe. 2 42 13 The home needs to make sure there are sufficient numbers of staff on duty who are trained in first aid. To ensure that there are staff on duty who know how to respond in an emergency. 01/05/2009 3 42 13 A system for monitoring the hot water temperature at the bath needs to be introduced. To ensure that people are not put at risk of being scalded. 03/04/2009 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. Care Homes for Adults (18-65 years) Page 28 of 30 No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to include the range of fees charged by the home so that people know how much it costs to live there. Care plans should be further developed to make sure that they clearly record all the support that each person needs so that people can be sure their needs will be met. Plans should also be updated where individuals needs have changed so that staff know how to support people appropriately. Health action plans should be developed for each person to enhance healthcare planning to help people to stay healthy. Copies of prescriptions should be retained by the home so that staff can check that the medication received into the home is as prescribed by the GP so that people get the medication they need. Consideration should be given to developing the complaints procedure into alternative formats that are easier for people who have difficulties in reading to understand. Entries made by staff on peoples financial records should be signed by them to show clearly who made the entry and to improve the financial safeguarding arrangements in place. Records of training undertaken by the staff team should be improved to fully evidence all the training that they have undertaken. Quality assurance systems in the home should be further improved to ensure that the home is well run and improvements are made that take into account the views of the people who live there, their relatives and involved care professionals. The home should have a fire risk assessment that is reviewed on an annual basis to make sure that fire precautions in the home are satisfactory and people are safe. 2 6 3 4 19 20 5 22 6 23 7 35 8 39 9 42 Care Homes for Adults (18-65 years) Page 29 of 30 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). 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. 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