Inspection on 27/05/09 for 23 Barncroft Street

This inspection was carried out on 27th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

23 Barncroft Street 19/06/07

23 Barncroft Street 06/07/06

23 Barncroft Street 16/12/05

23 Barncroft Street 05/08/05

23 Barncroft Street 09/02/05

23 Barncroft Street 14/10/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

Key inspection report Care homes for adults (18-65 years) Name: Address: 23 Barncroft Street 23 Barncroft Street Hill Top West Bromwich West Midlands B70 0QJ     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: Linda Elsaleh     Date: 2 7 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 23 Barncroft Street 23 Barncroft Street Hill Top West Bromwich West Midlands B70 0QJ 01215568809 01215568807 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.milburycare.com Milbury Care Services Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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) 4 Date of last inspection Brief description of the care home 23 Barncroft Street is an adapted bungalow property, which is owned and managed by the Milbury Organisation. The home is situated in the Hilltop area of West Bromwich, which is easily accessible and is close to nearby public transport routes. Local shops and amenities are also available. The accommodation consists of four single occupancy bedrooms, kitchen, lounge/dining area, and bathroom and toilet facilities. There is a small enclosed rear garden/patio and off road parking to the front of the property. People who use the service are offered 24-hour personal care and support. The service should be contacted for information about the current fees. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 4 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 quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. We looked at the information that we had received about the service since our last inspection. We sent out sixteen comment cards for people living in the home, their relatives/representatives and staff from the home to complete and eight were returned to us. The views expressed about the service in the surveys have been included in this report. We sent the service a form to complete to bring us up to date with what is happening in the home. This is called an Annual Quality Assurance Assessment (AQAA). This was completed by the Operations Manager for the service. We visited the home without notice during the afternoon on 27th May 2009. The Care Homes for Adults (18-65 years) Page 5 of 31 service has not had a registered manager for two years and staff reported to us this has had an unsettling affect on the service. During this inspection we spoke to the registered manager for another service within the company who has recently been redeployed to manager the service on a temporary basis. We also spoke to three staff and two people living in the home and observed the interaction between the staff and people who use the service. We looked at the files for two residents, following the care and support being provided to one in detail, and looked at other documents and records kept by the home. We used the information provided to us about the service and the information gathered during the visit to assess the homes performance against the national minimum standards and outcomes for people. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 7 of 31 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 8 of 31 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 9 of 31 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. Information is provided in easy to read formats to enable people who do not read to make informed choice about where to live. Peoples needs are assessed before they move in and the service provides them with a statement confirming it is able to meet their needs. Evidence: The service provides some information about the home, such as the Statement of Purpose and Service User Guide, in pictorial formats. This makes the information accessible to people who do not read. A pictorial copy of both documents is kept on the persons file we looked at in detail. Since we last visited the service has reviewed these documents to ensure the information is up to date. Four people live at the home and each person has been resident for more than two years. The registered manager at the time completed a needs assessment for the most recently admitted person before s/he moved in. We saw the assessment on the persons file and a copy of the letter sent to them stating the home is able to meet Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: their needs. The service reviewed its referral and admission procedures in 2008 to ensure it remains up to date with any new guidance for assessing peoples needs. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service produces clear and detailed plans for the care and support individuals need. Risk assessments are produced to keep them safe and support them to take risks as part of an independent lifestyle. Evidence: Information on the persons file we looked at in detail is organised. It contains good information about her/his personal, social and healthcare needs in the form of individual support plans and risk assessments. However, on closer examination we found an individual risk assessment for managing epilepsy. There was no reference to this in her/his plan. Staff we spoke to told us this person does not have epileptic episodes. This suggests care plans and risk assessments are not used as working tools within the home. It is advisable all files are checked to ensure the care plans and risks assessments produced are relevant to the individuals needs. There are records to show regular meetings are held to review the persons care needs and who attended the meetings. The care plans, where applicable, have been Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: amended to reflect any changes and how their needs are to be met. Staff we spoke to told us best interest meetings are held to ensure peoples wishes are respected. Records of these meetings are held on the persons file whose care we were following. However, the acting manager told us a recent meeting to discuss how the service supports this person to act on the decisions s/he makes had not been recorded. It is advisable for any discussions about a persons right to make their own decisions to be recorded. This is to ensure their wishes are fully understood and respected. Staff told us they had not yet attended training on the Mental Capacity Act & Deprivation of Liberty Safeguarding and a programme for training is being arranged for them by the company. Staff told us they support people to make their own choices and express their views about the service. Key workers arrange regular meetings with the individual and their support workers. The records show issues discussed include her/his care plan, how their needs are met as well as the persons view about the service being provided. There are also records of additional meetings the person had requested with her/his key worker. House meetings are not arranged for people who use the service. Staff said individual meetings were more productive because of the diverse needs within this group. Care Homes for Adults (18-65 years) Page 13 of 31 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. People would benefit from more opportunities and support to access and experience a wider range of activities at home, in the local community and to enjoy holidays of interest to them at locations suitable to meet their needs. The service provides people with meals that are nutritious and meet their dietary needs and personal preferences. Evidence: When we arrived at the home we were greeted by a resident and a member of staff. She told us she was on her own at present and the two staff on duty were on an errand and would return shortly. All four people who live at the home were in. Two people were watching television in the lounge, one person was in their bedroom and the person who greeted us at the door was walking around the house. The member of staff told us one person was expecting a visit from their physiotherapists at any Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: moment. She told us lunch had not long been served and she was finishing tidying up. The two staff on duty with her returned and the physiotherapists arrived. Staff told us the physiotherapy session needed to be carried out in the lounge as there was not enough space in the persons bedroom. They asked the people watching television to spend time in their rooms while the session took place. Both people are wheelchair users and were assisted to their rooms by staff. We observed staff addressing people by their preferred name throughout this visit. The scene appeared somewhat chaotic as the people who had settled to watch television were disturbed. This showed us staff had not planned how best to complete the errands for house and arrange for the lounge to be used, in private, by one of the residents. This was raised with the acting manager and is reported on further in the staffing section of this report. One person attends an external day care provision. We looked at her/his support plan. There were details of when s/he attends and the transport arrangements. Records are kept of the contact made by the service to the day centre to monitor the persons progress. The file of the person whose care we were following shows a weekly activity is no longer being produced. Staff told us this was because the person prefers to choose activities on a daily basis and the person confirmed with us this was correct. Their record of activities shows us most of the activities are mainly home-based. However, the person makes regular arrangements to go on outings with a family member. Staff we spoke to told us, that at present, the provision of external activities is limited for all people living in the home because so few staff drive and the vehicle only allows for one person in a wheelchair and a staff member to be carried. On some occasions people are being supported to make use of the local Ring & Ride service. We discussed this with the acting manager who told us arrangements were being made to improve the provision of activities. These staff supporting people to make more use of local facilities that are within walking distance, providing the home with the use of a more suitable transport when it is not being used by the service it is based at. Also, the service has recently completed recruiting for new staff and the people offered posts are also experienced drivers. The records kept by the service show arrangements are made for people to spend time on holiday. One person showed us her/his photograph album of a trip to Disney World in Paris. Staff told us a recent holiday in Wales was not as successful because of Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: the location and the lack of transport. The records seen and the discussions held show the staff team needs to be more proactive in identifying suitable venues and appropriate travel arrangements to ensure people are fully supported to participate in a range of activities and enjoy holidays that are suitable to their individual needs and interests. A board displaying the days menu is situated on the wall in the corner of the dining room. It cannot be viewed easily and as most of the people living at the home were identified to us as non readers could not be understood by them. Staff told us the previous picture menus had been discarded and photographs were in the process of being taken of meals to produce new ones. In the meantime, staff told us people are offered presented with a choice of two meals. Alternative meals are provided for people who indicate they do not want a meal from the days menu. Information about peoples dietary needs, likes and dislikes are kept in the kitchen with a record of the meals taken by individuals. These records we looked at tell us people are provided with a choice of meals and, where applicable, their dietary needs are being met. A selection of fresh fruit was displayed in a bowl in the kitchen. The daily records kept by staff tell us the person, whose care we were following, likes to spend a lot of time in her/his bedroom with their own possessions around them, listening to music or watching DVDs. Staff said concerns had been raised about the amount of time s/he chose to spend sitting on their bed, although an armchair is available, as it was not good for their posture. However, the person has recently been spending more time in the communal areas and at times has shown some interest in cooking and, on occasions, made sandwiches for the other people who live here. The kitchen is not designed for people who use wheelchairs. Staff said to address this ingredients and equipment are brought to the table in the dining room. Care Homes for Adults (18-65 years) Page 16 of 31 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 receive personal support in the way they prefer and require. The service supports people to access healthcare facilities, however there are some shortfalls in the services management of medication that should be addressed to ensure peoples healthcare needs are being appropriately met. Evidence: Information provided to us by the service tells us all people living in the home require support with their personal care. We looked at the plans for the person whose care we were following. These identified their personal care needs and the support to be provided such as morning and night time routines for bathing and dressing. Two staff we spoke to were able to describe the persons needs and how they prefer to be supported, as is detailed in their plans. We looked at the persons healthcare plans which included regular healthcare checkups, routine and specialist appointments. Staff showed us the records of concerns expressed about the persons sleeping patterns and the doctors instructions to change the time of the persons medication. This tells us the service has made suitable arrangements to promote the persons well being. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Information provided to us by the service shows its policy and procedures for the control, storage, disposal, recording and administration of medication was reviewed in 2008. The records show training is provided to staff in the management and administering of medication. The medication cupboard is tidy and well organised. We looked at the audit report from the visit made by the local pharmacist in January this year. No issues of concern were identified. We looked at the medication records for three people. In the majority of cases the service has produced protocols for administering medication and monitoring reactions. This provides accurate information for the healthcare service when reviewing a persons medication. The records for the person whose care we followed show they have recently been prescribed as required medication for pain relief. We spoke to a member of staff who said this medication is offered to the person throughout the day. The medication administration record sheet has been completed for different times of the day with the code not needed by the person. The manager said the arrangement was for the person to request this medication when needed and not be routinely offered it by staff. She told us this is to reduce the risk of the person taking pain relief medication when it is not needed. This tells us there is inconsistencies in practice and the staff team would benefit from clearer guidance. The records for another person living at the home shows a thickening compound has been prescribed. The manager told us this is to be added to all meals and drinks. A member of staff said they add the compound to all meals and some drinks. We saw the records kept for when this has been added to meals. However, no record is kept of when it is added to drinks. Two staff we spoke to were unable to explain clearly to us when the compound is/is not added to the persons drinks. This tells us clearer instructions for adding the thickening compound to food and drinks should be obtained from the prescribing healthcare professional and a more appropriate recording system should be implemented. Care Homes for Adults (18-65 years) Page 18 of 31 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. People are protected from harm by the services policy and procedures and staff that have been trained to promote their well being. Evidence: We have received no complaints about the service since the last inspection. Information provided to us by the service show no complaints have been received by them. Easy read copies of the complaints procedure are included in the Service User Guide and leaflets were seen in bedrooms. The providers Let us Know What You Think cards are on display in the hall and can be posted directly to the services head office. Relatives/representatives of people living in the home reported they are aware of the complaints procedure. One person told us they had not used the procedure, but the service had addressed some minor practical concerns they have raised with staff. Since the last inspection the service has notified us of a safeguarding issue and the action it has taken. This shows us the service takes appropriate action to keep people who live in the home safe from harm. Two staff we spoke told us key workers meet regularly with individuals and this enables them to monitor any areas of dissatisfaction or concern. Staff who responded to our survey stated they know how to deal with any complaints received by them and Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: how to report any concerns about the well being and safety of people living in the home. The service reviewed its Safeguarding Adults and Protection from Abuse policy and procedures in 2008. Records kept by the service show two staff have not yet received training and arrangements are being made for this to be provided. Peoples finances are not managed by the service. Arrangements are made to look after/support people with their personal allowances. Two staff told us how they support the person whose care we were following to manage her/his personal allowance. This shows they are aware of the contents in the support plan we saw on the persons file. The service manages the personal allowances on behalf of other people living in the home. Records and receipts are kept of transactions made by staff. Regular in-house and company audits are carried out and any errors are rectified appropriately. However, some recording systems used by staff do not comply with the companys procedures. The acting manager agreed to address this. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is accessible, clean and tidy. However, the service should deal with minor repairs promptly and make suitable arrangements for the general upkeep of the premises in order to ensure people are provided with a comfortable environment in which to live. Evidence: The house is on one level providing easy access to all rooms. The service told us some communal areas have been re-decorated since the last inspection and the bath has been replaced. We observed a number of door handles throughout the home that are loose and need to be addressed. Information about the service and photographs of people living in the home are displayed in the hall. The lounge is suitably furnished with the television positioned for all to see. However, the curtains were not fitted properly and made the room look untidy. A new floor covering has been fitted in the dining room. The new dining table is narrow and does not appear suitable to accommodate the four people who live here, three of whom are wheelchair users. The clock situated in on the wall in the corner of the room is difficult to see. We observed one person and a member of staff discussing Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: what time the clock was showing. Each person has their own bedroom which is furnished and equipped to meet their needs. Peoples individual character and interests are reflected in their rooms by the display of personal possessions and equipment. One person has her/his own sensory equipment. The person whose care we were following told us of plans for her/his room to be re-decorated and said s/he had chosen the same colour scheme. This shows us people are consulted about their personal environment. The bathroom has a shower facility which is the preferred choice of two people who live in the home. Staff we spoke to said it took time for people to get use to the new assisted bath but were now pleased with it. However, the acting manager told us she had received mixed comments from staff. The front of the premises and rear garden is unkempt. The garden beds have not been tended for some time and weeds are growing between the paving slabs. Staff told us they were planning to make this part of the rear garden more pleasant for people to use. This should be addressed as soon as possible to enable people to enjoy the sitting out during the summer months. One area of the rear garden is fenced off to prevent accidents while a building issue is being addressed. The acting manager told us a budget had been allocated for this work and arrangements are being for the work to commence. There are suitable arrangements for the safe storage of cleaning fluids and information is available for the control of substances hazardous to health (COSHH). The service has procedures for preventing and managing infection control. The record we saw shows training has been attended by most staff and arrangements are being made for three staff to update and/or receive training. Comments in response to our surveys tell us the home is always kept clean and tidy, however they felt repairs and replacements could be addressed more promptly. The service has identified the need to devise a schedule for addressing maintenance issues. Care Homes for Adults (18-65 years) Page 22 of 31 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 services recruitment procedures and practice ensure people are protected. People are supported by trained and qualified staff. However, for people to be confident their needs will be met at all times staff on shift should ensure they carry out any other duties in a more appropriate manner. Evidence: One member of staff was at the home with the four residents when we arrived. She was tidying up after lunch and told us two more staff were on duty with her but had gone on an errand for the home and would be back shortly. Information provided by the service states two members of staff are required to support two people with their personal care and was confirmed to us by the staff member. The deployment of staff was raised with the acting manager. She told us the shift plan had been discussed with staff earlier in the day and she would be speaking to them as this had clearly not been followed. She explained that the recent changes in management have meant good leadership and support has not been consistently provided for the staff team. She told us the company is aware of this and taking action to deal with it. We looked at the rotas which show three staff (including a senior) is on duty during the morning and early afternoon. The late afternoon and evening shifts are covered by Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: a senior member of staff and a support worker (care assistant). A member of staff and the acting manager told us following the current recruitment drive an additional member of staff will be included on both shifts. This will allow people to receive more 1 to 1 care and support to participate in a wider range of activities. The staffing arrangement for the night time hours is currently one waking staff member who is supported by an on call system. The acting manager stated she had identified this as unsuitable and had raised the need for two staff to be on duty during the night time hours with senior managers. She expects this to be addressed in the near future. There is a mix of gender, ages and experience within the staff team. There is a core team of staff who have worked at the home for a number of years. On the day of our visit a newly appointed member of staff told us he had worked at other homes within the company. Information provided to us by the service show 96 of the staff team hold a National Vocational Qualification (NVQ) Level 2 or above. Staff we spoke told us the company supported them to achieve their NVQ Level 2 certificate. However, they would like to be offered opportunities to achieve further qualifications, such as NVQ Level 3. We looked at the recruitment file for a member of staff who commenced employment after our last inspection visit. The file is in good order and includes a completed application form and receipt of satisfactory safety checks from the Protection of Vulnerable Adults (PoVA First) and Criminal Record Bureau (CRB) before the applicant commenced work. This tells us satisfactory recruitment procedures have been followed. As part of the induction process the worker has received regular formal supervision sessions and an appraisal of his performance at the end of his probationary period. The minutes of these meetings are well detailed and held on the persons file. The service keeps at team record of training undertaken by staff with dates and when refresher courses need to be attended. The service has not produced a planned training programme and there are no individual training plans on the two staff files we looked at. Staff told us training is arranged for newly appointed staff as part of their induction. However, for future training, staff said they arrange their own training from the companys training programme that is periodically sent to the home. Staff training should be based on the needs of people living in the home and the personal development needs of individual staff members. It is advisable that an annual development programme is produced for the staff team. This will ensure training is delivered in an organised and timely manner with due consideration given to the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: needs to the people living in the home. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is currently being run on a temporary basis by a qualified and experienced manager. However, for people to be confident their best interests and needs are being met on a long term basis a suitably qualified and experienced manager should be appointed by the company and registered by us, the Care Quality Commission (CQC). Evidence: Since the last inspection visit the registered manager has left the service. The home has been run by two managers since, neither of whom has been registered by us, the Care Quality Commission (CQC). It is a breach of the Care Standards Act 2000, section 11 for a person to carry on managing a care home without being registered by the Care Quality Commission. The home must tell us in their improvement plan how they will address this. At the present the home is being run on a temporary basis by a qualified and experienced manager who is the registered manager for another service within the company. The acting manager told us she is being supported in her role by the Operations Manager. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The Annual Quality Assurance Assessment, information about the service requested by us, was completed on this occasion by the Operations Manager. She visits the home on a regular basis, produces a written report on her findings and identifies any action the service needs to take. A more in-depth review of the service is carried out periodically by a representative of the company. This was last carried out in February this year. This review and the reports produced by the Operations Manager were made available to us at the home. The service periodically uses surveys to seek the views of people who live in the home and their relatives/representatives. The surveys from relatives/epresentatives were dated 2008 and contained positive comments such as X has always had excellent care and Staff try hard with the difficult challenges Z presents. No surveys were available from the people living at the home since our last inspection. Responses to surveys sent out by us are not as positive as they have been. Comments included I do not think staff have the right skills and experience and the home could communicate more effectively. Staff we spoke said having three managers over two a two year period had been unsettling for the people who live in the home and the staff team. Staff who responded to our surveys told us the service would benefit from a stable manager and more staff. We were informed by the acting manager that both these issues were being addressed by the company. We saw some evidence to show the service is monitoring some aspects of its own performance such as how it meets the dietary and social needs of people living at the home. However, a more comprehensive quality assurance system should be implemented and an annual development plan produced and made available to all interested parties. This should provide people with more confidence that their views are listened to and acted upon and the service is meeting its own aims and objectives. The West Midlands Fire Service visited the premises in 2008 and reported that the fire precautions inspected at the time were satisfactory. We looked at a random selection of information held in respect of appliances and equipment, such as the portable electrical appliances, gas appliances and fire detection and equipment. These show us appropriate systems are in place to ensure regular servicing and safety checks are carried out to ensure the safety of everyone at the home. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 9 13 14 16 Risk assessments produced should be clearly based on the risk to the individual concerned. People should be provided with better opportunities and support to access facilities in the local community. People should be provided with better opportunities and support to participate in a wider range of activities. The service should ensure suitable arrangements are made to minimise the disruption caused to people living in the home by visits from healthcare professionals. The service should obtained clear instructions for adding prescribed thickening compound to a persons meals and drinks. A suitable recording system should be implemented for monitoring the persons reaction and to ensure the instructions are being followed. Clear guidance should be provided to staff about how to support a person prescribed as required pain relief medication to take it only when needed. The service should review its recording systems for managing peoples personal allowances to ensure company Page 29 of 31 5 20 6 20 7 23 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations procedures are being followed to ensure people are more fully protected from the potential of financial abuse. 8 24 The service should give more consideration to the suitability and positioning of items, such as wall clocks, to ensure they are accessible to the people living in the home. The service should address general repairs and upkeep of the premises promptly to ensure people live in a well maintained environment. The service should ensure staff members on duty are available to meet peoples needs at all times. An annual training plan, based on the needs of people living in the home and the personal development needs of each staff member, should be produced to ensure training is delivered in an organised and timely manner with due consideration to people living in the home when arranging for staff to attend courses. The service needs to address its management arrangements and submit a managers registration application to the Care Quality Commission in order for people living at the home to be fully confident of the service is committed to meeting their and best interests. A comprehensive quality assurance system should be implemented by the home and an annual development plan produced for people to be fully confident their views are listened to and acted upon. 9 24 10 11 33 35 12 37 13 38 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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. 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