Inspection on 09/06/09 for 225-227 Coleshill Road

This inspection was carried out on 9th 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

225-227 Coleshill Road 14/06/07

225-227 Coleshill Road 07/09/06

225-227 Coleshill Road 07/02/06

225-227 Coleshill Road 10/08/05

225-227 Coleshill Road 20/01/05

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: 225-227 Coleshill Road Coleshill Road, 225-227 Hodge Hill Birmingham West Midlands B36 8AE 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: Brenda ONeill Date: 0 9 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 33 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 33 Information about the care home Name of care home: Address: 225-227 Coleshill Road Coleshill Road, 225-227 Hodge Hill Birmingham West Midlands B36 8AE 01217475300 01217766843 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.efitzroy.org.uk Elizabeth Fitzroy Support care home 13 Number of places (if applicable): Under 65 Over 65 13 13 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 13 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) 13, Physical disability (PD) 13 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home 225 - 227 Coleshill Road are purpose built and owned by Elizabeth Fitzroy Support. The are two flats with a lounge, kitchen and dining room. The home can have thirteen people living in it. Everyone has their own bedroom. The houses have been adapted to meet the needs of the people living there. There is a pleasant well-maintained garden area and a newly built snoezelen room. This is accessed via a patio door from the dining room of the ground floor flat in 225. The inspection report is available in the home for visitors to read if they wish to. The range of fees charged at the home was not in the service user guide and people should contact the home for information about these. 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 We talked to some of the people living in the home. We talked to the manager and staff. We looked at how staff supported the people who live at the home. We looked at some care plans of people that live at the home. We looked at some of the paperwork the home has to keep. This included medication charts, menus, staff rotas, and fire alarm test records. Prior to the inspection we sent an AQAA (annual quality assurance assessment) to the home. This was completed and returned to us. This gave us some extra information about the home. What the care home does well There is good information to help people decide if the home would be suitable for them. Care plans told staff how people wanted their personal care needs met. Staff asked people what they would like to do during the day. Staff helped people to go on holiday if Care Homes for Adults (18-65 years) Page 7 of 33 they wanted to. Staff helped the people living in the home to keep in touch with families and friends. Staff gave people their medicine and tablets as prescribed by the doctor. People could see the doctor if they were unwell. Staff have training so they know how to help the people living there. Bedrooms are decorated in the way that each person chooses. They have the things they like in their bedroom. Equipment is provided so that people can be safely moved from one place to another. What has got better from the last inspection The information for staff about how to communicate with people was better. Staff were seen to be able to communicate with people effectively. Staff had undertaken more training so they were able to care for people safely. The people living there and their family and friends are asked what they like about the home and what could be better. Some areas had been redecorated and Care Homes for Adults (18-65 years) Page 8 of 33 had new flooring ensuring they were kept to an acceptable standard for the people living there. What the care home could do better To check out all the risks that each person may have and how to reduce these risks. Care plans need to say more about what people want to do and how staff will support them to achieve their goals. Managers need to ensure there are enough staff available so people can do the activities they want. Complaints records should show that issues have been investigated thoroughly and resolved to the satisfaction of the complainant. Staff should write down what and how much each person has eaten. This will make sure they are getting the food they need to be well. Dangerous substances must be locked away and the keys to cupboards kept safe. Care Homes for Adults (18-65 years) Page 9 of 33 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 Brenda ONeill 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 10 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 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place so that people have the information they need and they can be confident that their needs will be met on admission. Evidence: The service user guide for each of the properties and the supported living flat had been updated. They provided people who may be thinking of moving into the home or their representatives with appropriate information to help them decide if the home could meet their needs. The guides were all available in an easy read format making them easier to understand for people who may be considering moving into the home. There was no information in the guides about the fees charged at the home or how these would be paid. This is important so that people know how much it costs to live at the home. The AQAA says the home has a robust admission process that takes into account the views of people living in the home, those wishing to live there and their families. As no new people had been admitted to the home since the last inspection the information above could not be tested. However at the last inspection the assessment and admission procedures at the home were found to be appropriate and that people were moved into the home only after information had been gathered from a range of sources, in order to Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: build up a picture of their complex support requirements. During this inspection one of the managers was able to tell us about how important it was for any new admission to the home to be done very gradually so that people are helped to settle in and so that other people living in the home were not upset. Care Homes for Adults (18-65 years) Page 13 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. Each person has a care plan, so that staff have information about how to support them according to their assessed needs. Risk management plans should be in place for all identified risks to ensure people are fully safeguarded. Evidence: The care for two people living at the home was tracked. The abilities of the two people varied considerable and one of the individuals was totally dependent on staff for support in meeting her needs. The other person had some degree of independence. The care files for the people living in the home included care plans which gave a considerable amount of information about the individuals, what they liked and what they needed support with. Some of the detail included in the care plans for things such as personal care were very well detailed. They showed how people wanted to be supported and were very clear about how staff were to deliver their care. In this respect care plans were quite person centred. The people living in the home that were able to state their views were happy with the support they were receiving. One person was able to show us his sleeping arrangements whcih were in line with what was detailed in his care plan. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: The care plans did not include any specific plans for people saying what they wanted to acheive, for example, to develop their independence apart from some health action plans but these did not include how the action plans were to be carried out or their success measured. It was particularly important that peoples care plans included clear deatils of what they wanted to achieve, and that these had outcomes that could be clearly measured. These should be evaluated when plans are reviewed, and adjustments made or new aims set, as appropriate. This would show people were being supported to do the things they wanted to do wherever possible. Some areas of the care files were not up to date despite them stating they had been reviewed recently. For example, one file commented about a person having weekly exercise classes and going to college. We were told these activities were not actually happening at this time. This would bring into the question the quality of the reviews that were taking place if information that was not current was left in care files. This could also be very confusing for newer staff in particular and lead to them trying to do something with people that was no longer current and this may cause some distress. The information on the care files in respect of how people communicated and how staff were to communicate with them had improved. Staff were seen to communicate effectively with people and in line with what was written in their guidance. There was some good detail of how staff would know if people were happy or unhappy. For example, if I am happy I will smile and make eye contact with you. If I am unhappy or uncomfortable I may become vocal and scream. There were numerous risk assessments on the files of the people being case tracked. These included assessments and management plans for such things as manual handling, use of vehicles, use of kitchen equipment and managing aggression. These were generally well detailed and included good details of how staff were to reduce the risks people were exposed to and ensure they were kept safe. It was noted that on one file the individual had been deemed at high risk of developing pressure sores. We were told the person had never had a pressure sore and that staff used creams and adjusted the individuals position as necessary. As the persons skin remained intact it can be assumed that staff knew how to care for the persons skin. However it was necessary to ensure there was a written management plan for this to ensure all staff had a point of reference they could refer to if they were unsure. This was also necessary as the home had had several new staff who would not be able to retain all the information about everyone in the home and would need to refer to the written guidance. As with the care plans it was noted that not all the information on the risk assessments was current despite them having been reviewed. For example, one person had a management plan in place for conflict with another person living in the home. This person had moved out and there was no longer an issue. This information needed to be removed to avoid any confusion. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Care files were not orgainised in a way that made them easy to follow. Any out of date information should be archived. Risk assessments needed to be cross referenced to the support plans and vice versa so that staff were clear of where to find information about people. Staff were directly observed engaging with people and encouraging them to make decisions wherever possible. For example asking them what they wanted to do and did they want to go out, what they wanted to eat and drink and if they were going to assist with food preparation. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels could at times restrict the activities people were able to pursue affecting their quality of lfe. People were well supported to keep in touch with families and friends. People had access to a varied and nutritious diet. Evidence: Care plans gave some information about what people enjoyed doing and of their daily and weekly routines. People had weekly diary sheets but the information on these varied considerably for some people they detailed everything they were doing during the week and were only filled in when the activity had been completed. For others these sheets only detailed structured day centre attendance from Monday to Friday. Daily records gave some detail of the activities people were taking part in both in the home and the community. For example, attending day centres, swimming, out for meals, to the cinema, reflexology in the home and DIY. Records also showed that holidays had been discussed and plans were ongoing for these. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: It was difficult to assess the the quality of activity opportunities that people currently enjoy. Recording in this area was quite variable. Daily records only included basic information about where people had been. There was little information about whether people had enjoyed their activities. There was little information on daily records about how people were spending their time when in the home. There was information about personal care needs being met and what people were eating but little else. The care plans for one person stated they would help with certain tasks around the house such as hoovering, putting laundry in the machine and generally putting things away. This person was seen helping in the kitchen during the day and told us he helped out around the house. These activities were rarely included in the daily records. Staff were also completing monthly summaries on each of the people living in the home. These should have given an overview of what people had done throughout the month. Again the information on these varied considerably. One that was seen stated taken part in activity with other service users there was no further information of what or whether activities were enjoyed. The importance of good record keeping was raised at the last inspection. There should be clear links between the activity opportunities provided and individuals goals in their care plans. It is important to recognise that the activities that people are enabled to take part in are a prime indicator of the quality of life that they enjoy. The AQAA indicated that the staffing levels across both properties had been reviewed and increased. This was confirmed to us by the managers on site. However staff told us that activity opportunities in one of the houses, particularly in the evenings, could be restricted by the numbers of staff available to support people outside the home. This was confirmed when checking the rotas and only two staff were on duty several evenings. We were told staffing had been better but as there was a vacancy in one of the houses this affected the amount of staff on duty. Managers need to ensure that having an empty bed in the houses does not infringe on the activity opportunities available to the other people living in the home. Discussions with the registered manager after the inspection indicated that the lack of staff in the evenings was more due to poorly organised rotas than low staffing numbers. This was seen on some of the rotas where on some days there may be four staff on duty during the day but only two in the evening. Records provided evidence of support to maintain contact with families and friends, including visits at the home, contact by telephone and, in some cases people going to stay with their relatives. One person was seen to go out with relatives on the day of the inspection. Menus varied considerably throughout the properties. We were told menus were done on a weekly basis with input from the people living in the home where they were able. There was some information about peoples likes, dislikes and preferences in the care files and these were taken into consideration when planning menus. However the manager needed to ensure staff were aware of all the foods people should and should not have. The Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: grumble book for the home stated one person could not have prune juice not all staff were aware of this. This could lead to someone having being given something they do not like or that could be detrimental to their health. Daily records included details of the meals people had eaten. These records should be further developed to include more information, for example, staff were writing veg and not detailing what vegetables were eaten. Where applicable diets were being catered for. One person was having a pureed diet and there were good details of this in the persons care plan. The management plan stated the person was at high risk of malnutrition and that if she refused food to leave for a while and then offer again. Although the records did not show this was happening we were told staff did follow this and according to other records the individual concerned had gained some weight. Staff were encouraging people to eat healthily and there was evidence of this on their medical action plans. We had quite lengthy discussions with the managers about healthy eating and that this should not unduly restrict the choices people have. For example, the grumble book said one person should not have mashed potato due to the way it was prepared as would be too calorie laden. Staff needed to be aware there were other ways of preparing food to ensure peoples choice was not restricted unnecessarily. Care Homes for Adults (18-65 years) Page 19 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 using the service get good personal care. Health action plans were not always followed which could affect the well being of the people living in the home. Medication was well managed ensuring people received their medication as prescribed. Evidence: The personal care needs of the people living in the home were well detailed in their care plans. Peoples needs varied considerably and this was reflected in their care plans. Where people were able to help meet their own needs this was detailed. Direct observations of the grooming and dress of people using the service provided evidence that the standard of basic personal care they received was very good. Interactions between the people living in the home and staff showed that both were comfortable in each others company, and support was given with friendliness and respect. Sampled files included an O.K. Health Check which was a health assessment and included details of any ongoing health issues and how these were managed. The assessments resulted in an action plan. One action plan that was seen included actions that were or had taken place, for example, going to weighing clinic and best interest meeting. Another action plan included actions that were not happening and there was no indication as to whether any progress had been made on these. For example, attend regular exercise classes, these had stopped and although the persons file included some Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: details of exercises that could be undertaken in the home there was no evidence these were being carried out and a staff member spoken with was not aware of any exercises for this person. These action plans needed to be regularly reviewed and updated to ensure people were being enabled to lead a healthy life style. There was ample evidence on peoples files that they had access to health care professionals as necessary. Records showed that people had access to G.P.s, chiropodists, opticians, nurses and attended hospital appointments. One persons file showed that he had refused some medical treatment and as he had capacity to make his own decisions this had been respected. For another person who was not able to make their own decisions there had been a best interest meeting as the person needed to have some surgical treatment to improve her quality of life. The treatment went ahead and we were told how much better the persons eye sight was and how this had improved their life. Care files included some very good information about the manual handling needs of the people living in the home which included which hoists were to be used and sling sizes. There were also some very good management plans in place for such things as epilepsy. these management plans ensured people were cared for safely. We were told no one was self administering their medication. Peoples medication was kept in a lockable drug cabinet in their bedrooms and administered from there. Medication was generally acknowledged when it was received into the home and signed for administered. One lot of boxed medication had not had an additional supply added to the numbers and this was difficult to audit. There were PRN protocols in place for as and when required medication. This was pain relief for one person and it was stated on the protocol what it was for however how staff would know the person was in pain was not included. This information was detailed on the care plan. It was recommended that this information be included with the PRN protocol so that it is at hand for staff when administering medication. It was pleasing to note that on the files sampled there were comprehensive details of how people liked their medication to be administered. Care Homes for Adults (18-65 years) Page 21 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. Complaints and concerns were not always managed in the best interests of the people living in the home. Arrangements were in place so that people were safeguarded from harm. Evidence: There was a complaints procedure for the home and this was available in a pictorial format to try and make it more understandable for the people living in the home. The address and telephone number for the Commission needed to be updated so that people had the correct information should they want to contact us. It has to be recognised that a formal complaints procedures will have little relevance for some of the people using this service. Their levels of learning disability and communication support needs mean that they are dependent on the vigilance of the staff team to interpret changes in mood, behaviour or body language as indicators that something may be causing concern. There were very good details on care plans sampled of how staff would recognise if people were unhappy. For example, I may at times get quite cross and start to shout and lash out. and If I am unhappy or uncomfortable, I may be very vocal and scream. There was also information about how people would recognise when people were happy. One individual was seen to display both behaviours and they were as described. Staff were also able to tell us how they would know if this person was unhappy. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: A grumbles books had recently started to be used at the home. These did not include any grumbles directly from the people living in the home but appeared to be staff making comments based on their understanding of what people would want. One staff member spoken with did not know about the grumbles book. As stated earlier in the report some of the entries were about food and not all staff knew about these meaning they would not be able to follow the guidance in it. Other entries were about people putting clothing away with holes in and someone needing a new lady shave. We were told these had all been followed up but there was no evidence of this in the books. It was important to ensure that any issues raised on behalf of the people living in the home are followed up and a record of this made. This will show that staff are acting in the best interests of the people living in the home at all times. The complaints log for the home indicated two complaints had been lodged with the home since the last key inspection. The most recent complaint was not dated we were told the this had been the week before the inspection. There was no details of any investigation. We were told this was ongoing and that a meeting had been arranged with the complainant for the same week. One of the managers updated this on the day of the inspection. Another complaint did not include any details of the investigation or the outcome of the complaint. We were told this had been managed by Social Services and that there would be information about this on site but it could not be found on the day of the inspection. No adult protection issues had been raised in relation to the home since the last inspection. Staff told us they had undertaken training in adult protection issues and they were able to demonstrate they had an understanding of what abuse was and what should be reported. The training matrix for the home showed that the majority of the staff had received training in the protection of vulnerable adults. For some staff this training was over three years old and the matrix did not indicate when this was due to be updated. There were systems in place for managing money on behalf of the people living in the home. The records for were sampled. For some people their family managed the financial affairs of the individuals and took only small amounts of cash into the home for every day use. Receipts were kept for all expenditure and there were also two staff signatures. Other people had their own bank accounts. Three senior staff were able to sign for withdrawals from these accounts. Records were kept of all income and expenditure and two staff signatures were obtained. bank statements were cross referenced to the income and expenditure detailed in the home. The system was regularly audited by a senior a manger in the organisation. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the benefit of living in flats that provide them with a comfortable and clean home environment, which is well equipped to meet their needs. Evidence: A tour of all the flats was undertaken. There had been no changes to the layout of the flats since the last inspection. All were well maintained and provided people with very comfortable accommodation. Staff have worked hard to support people to have their rooms as they like. These are very personal to the occupant and reflect personal tastes, age and gender. One person showed me their room which he used more as a work shop and did not like to sleep in. He told me he slept in the lounge in a new recliner chair as he was more comfortable in there. Communal areas were well furnished and decorated. Some areas had been redecorated and had new flooring ensuring they were kept to an acceptable standard for the people living there. Both houses had safe outside areas that could be used by the people living in the home during better weather. One garden included a wooden outbuilding housing a snoezelan facility that could be used by all the people living in the home. Each bathroom offers adapted bathing facilities and showers, for the benefit of residents Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: with restricted mobility. One bathroom had had a ceiling track fitted so that hoists could be used more effectively. One issue that was raised was that the communal facilities had cotton towels in place not disposable towels. These should be removed as they are not conducive to good infection control. A previous requirement to provide a weighing chair had been met so that peoples weight could be monitored effectively. There were several aids and adaptations around the home to enable the needs of the people living there to be met. These included assorted bathing facilities, shaft lift, hoists, ceiling tracks and so on. The home was kept clean and tidy throughout. It was noted that in one of the flats the keys to the COSHH cupboard were accessible. Staff needed to be more vigilant with these to ensure people were fully safeguarded. Care Homes for Adults (18-65 years) Page 25 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. People were cared for by a well trained staff team that was able to meet their needs. Staff communication systems could be improved to ensure staff have all the information they need to undertake their roles fully. Recruitment procedures were generally robust and ensured people were safeguarded. Evidence: Staff turnover at the home over the last year had been relatively low. Several new staff had been appointed to enhance staffing levels and fill existing vacancies but the home retained a core group of staff who had worked there for some time which was good for the continuity of care of the people living in the home. As mentioned earlier in this report there were some indications that staff availability was having an impact on the opportunities for people to undertake activities particularly in one of the houses. Observations throughout the day showed that staff knew how to communicate with the people living in the home and that relationships were good. This ensured people were comfortable in the presence of the staff. Staff spoken with said the staff team got on well together but some thought communication could be better to ensure staff had all the information they needed to Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: fulfill their roles effectively. For example, some staff had no knowledge of the grumbles books and what was written in them about peoples diet and such like. New staff confirmed they had undertaken a full induction training programme when they started working at the home. Induction training took place both on and off site and covered topics such as, manual handling, confidentiality, protection of vulnerable adults, health and safety, epilepsy and challenging behaviour. This ensured new staff had the skills and knowledge necessary to care for people safely and efficiently. There was a training matrix for the home that was updated on a monthly basis by the organisation. A copy of the most recent one was sent to us after the inspection by the registered manager. This showed there had been a marked improvement in training for all staff ensuring peoples skills and knowledge were regularly updated. the information on the AQAA indicated that nineteen of the thirty three staff employed had NVQ level 2 or the equivalent giving the home more than the required 50 . The recruitment files for two staff were sampled. Files showed that all the required checks had been undertaken prior to staff starting work at the home including two written references being obtained, medical checks being undertaken and CRB checks obtained. Although the files stated CRBs had been sent for and obtained only one file included the letter from the organisation to evidence this. This evidence should be available for all new employees so that we can be assured people are safe to work with the people living in the home. Care Homes for Adults (18-65 years) Page 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run however the management of information needs to be improved so that people can be confident that their needs will be met. There were systems in place to ensure the service was continually improved for the benefit of the people living there. General practice promotes the health safety and welfare of everyone in the home. Evidence: At the time of the inspection the registered manager had been off for some time. She was due back at work just after the inspection. The assistant managers in each of the houses were acting in the managers role. Both of the assistant managers were present throughout the inspection and were very helpful. Both showed a good understanding of the needs of the people living in the home. The staff and managers had been working hard to review the care files and risk assessments. Some of the care plans included some very good detail about the needs of individuals. However there was information on some of the files that was no applicable and needed to be removed to avoid any confusion, files were quite disorganised and quite Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: difficult to track and there were no real clear goals about what people wanted to achieve. We spoke to soem staff who did not know about all the information that was available in the home about the people living there, for example, information in the grumbles book and in health acation plans. This could lead to peole not having their needs met. The organisation has adopted the REACH standards as a tool for measuring the quality of all the services it provides. These standards are designed specifically to relate to the supported living model of care provision, rather than to a registered care home. The standards include statements such as I choose who supports me and I choose what happens in my own home. The system was discussed with the registered manager after the inspection. The manager stated it can be difficult to measure the service against the standards when the people who live in the home have such complex and diverse needs as some of them are not able to communicate their views. However the manager stated she audited one standard every month and looked for evidence to support the statements. This included information from such things as in house health and safety checks and involving other professionals, staff, families and friends in the process. Any shortfalls then resulted in an action being drawn up. Over the year the whole service was reviewed which resulted in a development plan to improve the service for the people living there. The health and safety of the people living in the home and the staff was well managed. the home was well maintained and the staff received training in safe working practices. The information on the AQAA indicated that the equipment in the home was regularly serviced. The in house checks on the fire system were sampled and found to be up to date. Fire drills were being undertaken regularly in each house. Accident and incident recording and reporting were appropriate showing us occurrences were well managed. Care Homes for Adults (18-65 years) Page 29 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 Care Homes for Adults (18-65 years) Page 30 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 24 13 COSHH substances must be kept secure at all times. 14/07/2009 This will ensure people are fully safeguarded. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should include some information about the fees charged at the home so that people know what is being charged for the service. Care plans should be developed to include peoples agreed aims and how these are to be acheived. This will ensure are getting the support they need to do what they want. There must be risk management plans in place for all identifed risks. This will ensure people are not exposed to any unnecessary risks. Files should be reorganised so that essential information can be located quickly and easily. 2 6 3 9 4 9 Care Homes for Adults (18-65 years) Page 31 of 33 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 5 12 Managers need to ensure that staff availability does not infringe on the activity opportunities available to the people living in the home. Staff should improve the quality of daily activity recording so that detailed information is kept about what activity opportunities are offered and taken part in each day. Managers should ensure that peoples activity opportunities are clearly linked to their agreed aims, so that people get to do the things they want. Staff should ensure they record as necessary to evidence nutritional management plans are being followed. This will show peoples nutritional needs are being met. Food records should be kept in enough detail to show people are receiving a varied and nutritious diet with choices available. Health action plans should be regularly reviewed and updated to ensure people are enabled to lead healthy life styles. PRN protocols should include details of how staff will know when people are in pain so that they know when to administer pain relief. Complaints records should show that issues have been investigated thoroughly and resolved to the satisfaction of the complainant. It is recommended that where staff had adult protection training some years ago this is updated to ensure they have all the current information. Cotton towels should be removed from communal facilities to ensure good infection control. There should be evidence from the organisation on all staff files that a clear CRB check has been obtained. This will show people are suitable to work in the home. 6 12 7 12 8 17 9 17 10 19 11 20 12 22 13 23 14 15 30 34 Care Homes for Adults (18-65 years) Page 32 of 33 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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