Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 05/03/09 for 290 Newton Road

Also see our care home review for 290 Newton Road for more information

This inspection was carried out on 5th March 2009.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 290 Newton Road 290 Newton Road 290 Newton Road Great Barr Birmingham B43 6QU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 0 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: 290 Newton Road 290 Newton Road 290 Newton Road Great Barr Birmingham B43 6QU 01213577517 01213578417 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lonsdale Midlands Limited Name of registered manager (if applicable) Mrs Joanna Price Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 290 Newton Road is a large detached dwelling adapted to be a care home in 2003. The home caters for up to seven people with a Learning Disability, and additional emotional and psychological needs within the autistic spectrum disorder range. The home offers personal care and support to a group of individuals with a range of complex needs and strives to promote ordinary living principles and social inclusion. Staffing levels reflect the level of support required for the individuals accommodated. The home is situated on a very busy dual carriageway near to local shops, post office, and pubs etc. There is a pedestrian subway crossing. The home is accessible by public transport and offers limited off road parking, which is shared with the adjacent supported living project. The premises offer a small yard and recreational space at the rear of the property. The accommodation is spread over three levels. Bedrooms are located on the ground and first floor. There is a passenger lift. The games room, sleep in room and medication Care Homes for Adults (18-65 years) Page 4 of 35 care home 7 Over 65 0 7 Brief description of the care home room are on the second floor. The unit has seven single bedrooms, all of which offer ensuite toilet and handbasin, with one ground floor room also providing an ensuite shower. Communal space on the ground floor include a lounge and dining area. Kitchen facilities are domestic in size and there is a separate laundry, which offers commercial equipment. Social and recreational pursuits are provided for the occupants and the home also has its own people carrier vehicle, which is used to transport people to appointments and for outings etc. The home should be contacted for information the fees charged for this service. Care Homes for Adults (18-65 years) Page 5 of 35 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: This inspection was carried out over two days during March 2009. The home did not know we were going to visit. The last key inspection to this home was carried out in February 2008. The focus of inspections is upon outcomes for people who live inthe home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we received, or asked for, since the last key inspection. This inluded notifications received from the Care Homes for Adults (18-65 years) Page 6 of 35 home. These are reports about things that have happened in the home that they have to let us know about by law. An annual Quality Assurance Assessment (AQAA) had been sent to the home. The AQAA is a document that provides information about the home and how they think that it meets the needs of the people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files and focussing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around the home. A sample of care and health and safety records were looked at to see if the home was being managed safely. We looked at the files of two staff to make sure that the people living in the home were being supported by people who had been checked and trained appropriately. Where people who use the service were able to comment on the care they receive their views have been included in this report. We had not received any complaints about the service since the last key inspection. One complaint had been received directly by the home. One adult protection issue had been referred too the social workers but nothing had been substantiated and the matter had been closed. What the care home does well: What has improved since the last inspection? What they could do better: The redecoration and refurbishment programme for the home should be progressed to ensure that all areas of the home are comfortable, homely and safe. The remaining support plans for the people living in the home must be updated and made more person centred to ensure that the staff and the people living in the home know how individuals are to be supported. Systems must be put in place to ensure that where challenging behaviours occur that they are reviewed and monitored to ensure any required actions are undetaken to prevent them happening again wherever possible. Staff must respect the fact that bedrooms are the private space of the occupants and they must not use them for their rest breaks. Mandatory training for all staff shoud be completed as agreed by the end of April 2009. Care Homes for Adults (18-65 years) Page 8 of 35 Induction training should be catered to meet the individual needs of new staff. This will ensure that the people living in the home are safely supported by appropriately skilled and knowledgeable people. The manager should look at the reasons and need to limit the access to areas of the home by the people living in the home on an individual basis and not penalise all of them due to the needs of a particular person. Where there is no other option but to limit access the process leading to this decision must be clearly recorded. The recording of the use of as and when required medicines must be accurate and daily records and medicine administration charts must tally. The manager must ensure that the personal records of the people living in the home are stored securely and accessible on a need to know basis only. 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 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 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 was available to help people make an informed decision about whether the home was suitable for their needs. Evidence: A copy of the statement of purpose and service user guide were seen in the home. The statment of purpose of purpose was in the process of having the appropriate pictures put in place to make it easier for the people living in the home to understand. The statement of purpose stated that the fees would be discussed with the individuals and the service user guide would include the amounts to be paid. The files were in the process of being updated to ensure that they had up to date information on them. The file that had been updated included a copy of the service user guide. This stated the fee that was to be paid and what the fees included and did not include. This meant that the people living in the home or their representatives knew how much they were paying and the services they would receive.There had been no new admissions since 2006 however, we were told that the acting manager had Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: been to assess some referrals but it had been decided that they would not be compatible with the people already living in the home. This showed that people were being assessed for their needs and that they would fit into the home and not have an adverse effect on the people already living there. Care Homes for Adults (18-65 years) Page 12 of 35 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. Care files were being updated to ensure that the people living in the home received care in an individualised way. People living in the home were not always supported in the choices they made and this sometimes led to incidents of challenging behaviour. Storage of information did not ensure peoples confidentiality. Evidence: We were told that the acting manager was in the process of updating the care plans and risk assessment. As part of the case tracking process we looked at one file in detail and another file in less detail.The files had been organised by colour. Each person living in the home knew what colour their files were. There were five folders for each individual that included a variety of information. The daily record folder included a list of birthdays that the individual would need to be reminded about ensuring that they could send cards to people who were important to them and help them maintain good relationships. The support file included a brief history and information that gave a good overview of the individuals abilities and what support they needed. Together Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: with the individual support plans there was good information available to the staff to know how to support the individuals to enable them to make choices and remain as independent as possible. The support plans covered issues such as personal hygiene, communication, eating and drinking, sleeping and morning routines, laundry and domestic skills, oral hygiene, social interaction and management of challenging behaviours. This means that the people living in the can be assured that the staff know how to support them to be cared for in the way that they want. Along with the support plans were risk assessments. This told the staff the issues they needed to be aware of in order to keep the people living in the home safe. There were management plans in place where these were needed for example for the management of challenging behaviours. One of the files that we looked at had been updated by the acting manager however the other had not yet been updated with the changes in the individuals needs. It was important that any changes in needs were made to existing files until they had all been updated to the new format so that the staff were kept up to date with the changes. The people living in the home were enabled to make choices on a daily basis by being able to choose which staff helped them with some tasks such as support with personal hygiene, the food they ate, the clothes they wore and the activities they did. For example, on the day of the inspection one individual had been to college but on the way asked to be taken on a bus ride which the support staff facilitated. During the day and the evening the people living in the home were encouraged to make their choices about the meal that they were to eat. Since the last key inspection of February 2008 there had been a decrease in the number of incidents of aggressive behaviour occuring in the home. We were told that the charts indicating what happened before, during and immediately following the incident were no longer being completed as no triggers had been identified. Incident reports were being completed and these included some information about what happened before and immediately after the incident. There was no evidence that these incidents were being monitored to look for any patterns or learning that could prevent similar incidents occuring. This could mean that the people living in the home were left at risk of incidents re occuring because trends had not been indentified. One of the incident reports looked at indicated that an incident had been triggered due to night staff being on duty during the day. Although there may be occasions when this is unavoidable the manager needed to ensure that any changes in routine were Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: managed closely due to the possible repurcussions. On another occasion an incident was triggered because a member of staff refused to give the individual a drink. This would indicate that peoples choices were not always being facilitated. The people living in the home told us that they went shopping with the staff to buy food for the home. They were involved in cleaning their bedrooms and helping with the laundry. One person liked baking and made cakes and helped with preparation of the meals. They were supported to make drinks for themselves and prepare snacks such as cheese on toast and salad. Since October 2008 the office had been relocated to what used to be the small lounge on the ground floor. It was noted that there was no lock on the office door and information relating to the people living in the home was stored on open shelves. This meant that information regarding the people living in the home was accessible to anyone having access to the office and confidentiality could not be assurred. There were two lockable filing cabinets in the office that had been recently purchased, however other documents including staff files were stored in these. Care Homes for Adults (18-65 years) Page 15 of 35 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. The people living in the home lived individualised lives that met their needs. Contact with people important to them was encouraged and they were supported to eat a healthy and varied diet. Staff did not always respect the fact that bedrooms were the private space of the people living there. Evidence: The people living in the home could retire to bed and get up in the morning at times that suited their needs except where they attended college when they were encouraged to get up so that they could get to college at the right time. Individual activity plans were available in bedrooms for the individuals and on their files. The people living in the home were seen to refer to these when asked what they were doing during the day. Activity plans could be presented in a way that would be Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: easier for the people living in the home to understand by incorporating pictures. Some of the people living in the home attended college courses inluding use of computers, pottery and DIY. All the peole living in the home required at least one to one support. When attending college they had someone with them to support them. Although there was a vehicle that could be used individuals were being supported to use the bus service to encourage and develop their skills. Whilst in the home people were involved in daily living tasks such as cleaning, laundry and food preparation. This helped them to develop these skills and remain as independent as possible. Individuals were able to spend time in their bedrooms watching television, listening to music and using the computer. One person proudly showed us their skills on the computer. There was a communal television in the main lounge that people could watch together socially. The old office on the second floor was being used as a games rooms for the people living in the home. We were told that people were looking at where to go on holiday. Each individual went on a different holiday that met their needs. For one person they had to remain close enough to home to enable the individual to come home if they became unsettled. The people living in the home were encouraged and supported to maintain contact with people who were important to them. One person told us that a parent was coming to collect them so that they could go shopping, another told us that he went to visit his brother regularly and another person told us about someone who came to visit them on a regular basis. Birthdays and special events were recorded on peoples files and staff reminded them of forthcoming celebrations and there was evidence of people being helped to make or choose cards to send. People living in the home had the keys to their bedrooms and their individual cabinets in the bathroom. This information was available on the file that had been updatedas recommended at the last inspection. One member of staff was seen to be taking a break sitting in the bedroom of one of Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: the people living in the home. It was acknowledged that the individual had been carrying out some domestic tasks in the home prior to this however, the manager must ensure that there is appropriate space for staff to take their breaks and that staff are encouraged to use it. The AQAA told that us that weekly menus were planned in advance however during the inspection we were told that there were no set menus in the home and the individuals were encouraged to choose on a daily basis what they wanted to eat. The daily records confirmed that individuals did have a variety of food and they were observed to choose what to eat during the day. There was a picture menu on one of the files. It would be appropriate to have this accessible to the people living in the home to encourage them to make more varied choices. The home had purchased new dining room furniture so that there was enough space for all the people living in the home to sit together for meals if they wanted to. The AQAA stated that the people living in the home had full access to the kitchen however, because there was a coded lock on the door access was only with the supervision of staff. We were told that this was due to the risk of people injuring themselves with knives and on equipment. Knives were generally kept locked in a drawer. Although all the bedrooms had an en suite facility the toiletries of individuals were all locked away in metal cabinets in one of the locked bathrooms meaning that everyone had to go to ask one of the staff to unlock the bathroom to get them. We were told that this was because one person would go into other peoples bedrooms and take the toiletries and that one person would fill the bath with cold water and sit in it whilst another person would drink excessive amounts of water. At the time of this inspection there were five cabinets in the bathroom, another two would be needed if the home was fully occupied and this would make the bathroom look even more institutionalised. This also meant that whilst one person was in the bathroom the other people living in the home had to wait for their toiletries. The plug for the bath could be removed to prevent it being filled up without supervision and the person who could drink too much water could also drink this from his en suite facility and regular checks from his one to one support could monitor this. The acting manager needed to ensure that this did not become an institutionalised practice for everyone living in the home because it was easier to manage by locking things up. Care Homes for Adults (18-65 years) Page 18 of 35 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 living in the home were supported to have their personal needs met in an individualised way. Some practices in the home were restrictive and needed to be reviewed. People were supported to have their medical needs met to remain healthy. Some aspects of the management of medicines needed to be improved to ensure that people received their medicines as prescribed. Evidence: At the time of this inspection four young men were using the service. They all needed some support with personal care and attending health care appointments. The care files showed what support was needed and what the individuals could do for themselves when attending to personal care for example, for one person it stated staff to rinse shampoo out, assist with wet shave. Will do most tasks with verbal prompts. Although all the bedrooms had an en suite facility the toiletries of individuals were all locked away in metal cabinets in one of the locked bathrooms meaning that everyone had to go to ask one of the staff to unlock the bathroom to get them. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: The people living in the home were supported to have their medical needs met. They were escorted to appointments by their keyworkers. One person told us that they had been to the dentist. The records showed that the people living in the home attended appointments with the dentist, chiropodist, GP and specialist appointments where needed. Weights were monitored on a monthly basis. No one living in the home was able to look after their own medicines. It was pleasing to see that the people living in the home were on very little medication and the majority of medicines were dispensed through a monitored dosage system. There was a protocol in place for medicines that may need to be given at particular times that is as and when required. When comparing the daily records with the medicines administration record (MAR) it was noted that the MAR chart was not completed to support the daily records to indicate when as and when required medicine had been given. On one occasion it was noted that this medicine had been given twice within 8 hours when the protocol stated it was to be given only once in 24 hours following agreement from the manager. There was no record to show that this had been discussed with the manager or person on call. The medicines were stored in a metal cabinet however, the cabinet was not secured to the wall. This was not in accordance with the regulations for the storage of medicines in care homes. Care Homes for Adults (18-65 years) Page 20 of 35 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. The people living in the home could be assured that their views would be listened to and the policies and practices in the home would safeguard them from harm. Monitoring and reviewing of incidents occuring in the home needed to be evidenced. Evidence: Since the last inspection we have not received any complaints directly about the service. One complaint had been recorded in the homes complaint log. The complaint was from a relative of one of the people living in the home who was unhappy at the physical state of the decor and furnishings in the home. There was evidence to show that this issue was being dealt with appropriately. The people living in the home and their representatives could be assured that their views would be listened to. There was a complaints procedure on the files of the people living in the home which was in an easy read format enabling them to know how they could raise issues they were unhappy about. Minutes of house meetings evidenced that staff had been reminded to discuss the complaints procedure and the service user guide with the people living in the home. One adult protection issue had been raised since the last inspection however the issues were not substantiated. Risk assessments had been updated. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Staff had either been on adult protection training or will have completed it by the end of April 2009. At the last inspection we were told that arrangements had been made for all staff to attend adult protection training by April 2008 however, there had been a significant number of staff changes recently. This will ensure that the staff in the home are up to date with current procedures and good practice issues in respect of the protection of vulnerable adults.The people living in the home were being supported to manage some of their monies. There were procedures in place that safeguarded them from abuse and adequate records were maintained. Staff spoken to showed a good understanding of their role in protecting the people living in the home. The number of incidents of challenging behaviours occuring in the home appeared to have reduced. There was no evidence to show that incidents were being monitored or reviewed. This issue was raised at the last inspection. The recruitment procedure was robust safeguarding the people who live in the home but the paperwork was not always in place in the home before the individuals started work. Therefore it could not be evidenced that the process was consistently applied. Care Homes for Adults (18-65 years) Page 22 of 35 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. Improvements had been made to the home to make it more homely for the people living there but further progress was needed. Evidence: At the time of the last inspection in February 2008 we had been assured that a budget for the redecoration and refurbishment of the home had been approved. At the time of this inspection it was noted that the home had received attention to its decor and furniture. However, there were still issues that had not been addressed. These included: replacing of the carpets, the overhead shower in one of the bathrooms, the heating system and the ground floor toilet door that did not close properly. On the second floor of the home the office was being used as a games room. There were some games available for the use of the people living in the home however, it did not present as a very inviting environment. The fax machine was still in this room and was waiting to be relocated elsewhere in the home. Games included a dart board, connect four and a small pool table. The sleeping in room was not being used as a sleeping in room at the time of the inspection and some documents ready to be archived were stored there however, the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: door was not locked. Also on the second floor was the medication room which was kept locked. On the first floor there were some bedrooms all of which had an en suite facility including a toilet and small wash hand basin. There were two bathrooms fitted with coded locks meaning that the people living in the home were unable to go in them without asking the staff to unlock them. The over the bath shower in this bathroom had still not be fixed to the wall and one of the tiles had been broken. On testing the temperature of the water in the bath it was found to be 52 degrees from the tap and 50 degrees in the bath. We were told on 10.3.09 that the hot water temperatures were being attended to. This would ensure that the people living in the home were not exposed to a risk of accidental scalding in the bath. There was no soap available in one of the bathrooms for washing hands. We were told that it was available but had not been replaced when it had finished. There were paper towels available in both bathrooms to promote good hygiene practices. It was noted that the fire escape door on the first floor had a coded lock on it. This was not an appropriate lock for use on emergency doors. We were told that work to replace the lock had been arranged for the 9.3.09 however on 11.3.09 we told that this had not happened as other tasks had taken precedence. Three bedrooms were seen on the first floor. The first two were comfortable and appeared to meet the needs of the occupants. They appeared to be personalised to their liking and needs. Keys to the bedrooms and bathroom lockers were available in the bedrooms. The extractor fan in one of the en suite facilities was not working and the wardrobe door closures were not working properly. There were no curtains up at the window of the third bedroom although net curtains were in place. The windows had a mirror finish on the outside so that privacy had not been compromised but the presence of curtains would make the room more homely. One of the bedrooms seen on the ground floor was found to have no door to the ensuite facility and this could compromise the occupants dignity. The wardrobe doors had been removed at some time and had been replaced by curtains. The drawers in the chest of drawers had fallen off their runners and this looked as if the drawers were broken. The carpet was very dirty. The overall impression of the bedroom was not one of a homely environment. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: Some of the bedroom window restrictors had been removed on the second day of the inspection resulting in the windows opening widely and this could be a potential risk if any of the people living in the home started throwing things out of the window. On the ground floor there is a large kitchen that was well equipped and people living in the home were seen to be able to go into the kitchen under supervision only as the door to the kitchen was locked. The knives and other sharp objects were locked away in a drawer. The kitchen linked directly to the combined lounge and dining room. There were two dining tables with 8 chairs for the people living in the home to be able to sit socially at meal times. The lounge contained comfortable seating for seven people. The television in the lounge was encased in a box high up on one of the walls. This could be uncomfortable for people having to look up for a long period of time. The construction of the casing for the television and its positioning on the wall made it look very unhomely. Otherwise the lounge and dining room had been made much more homely with the new decor and furnishings. What used to be the quiet lounge was now an office on the ground floor. The people living in the home freely went in and out of the office and they were well aware of which files were about them. Also on the ground floor were the laundry and the yard where the people living in the home could play ball games. The first and second floors were accessed via the stairs although a passenger lift was in place. Initially the inspector was told that the lift was stuck between floors but later we were told that the power to the lift had been shut off as it was not needed as everyone could access the upper floors via the stairs. The lift continued to be regularly serviced. The emergency call system had also been disconnected so that it was difficult to know how staff would summon help in an emergency situation. On the ground floor there were two communal toilets. One of these had been out of order for three weeks awaiting for a part to be obtained and fitted. The door of the other toilet did not close properly if it was not locked from the inside and managing odours could be a problem. The fact that the door did not close had been identified during the last inspection. At the time of the last inspection there were baffle locks fitted to the doors to the Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: kitchen and bathrooms. These had been replaced by coded locks. The impact of this was that it detracted from providing a homely environment and could potentially restrict access to people who could safely access these areas because of the potential risks to others. Apart from some of the carpets the home was clean and odour free. Soap for washing hands was not available in one of the bathrooms and foods that had been removed from their packaging had not been dated with the date they had been put in the freezer or when they had to be used by. The home was centrally heated throughout and the windows could be opened for ventilation. The staff needed to ensure that the window opening restrictors were not removed to ensure that people living in the home were safe. The front door bell was not working properly at the time of the inspection and this meant that visitors could be left waiting to be let into the home for long periods of time. At the time of writing this report we were informed that the bell and hot water temperatures had been addressed. Care Homes for Adults (18-65 years) Page 26 of 35 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. There were adequate numbers of staff on duty to meet the needs of the people living in the home. The recruitment process was robust and ensured that only suitable people were recruited to work with vulnerable people. Staff training needed to improved to ensure that the people living in the home were supported by people with the appropriate skills and knowlede. Evidence: The people living in the home at the time of this inspection all needed one to one support and one person needed two to one support when in the community. This meant that there was a minimum of four support staff on duty during the day and five when the individual attended college. Day staff tended to work from 8am to 8pm and two waking night staff worked from 8pm to 8am. At the time of this inspection there was no sleep in person due to the low numbers of people living in the home. The staffing rota showed that as the events were becoming lighter there were occasions when there was a third member of staff on duty until 10pm. It also showed that attempts were made to ensure that there was a mixture of male and female staff on duty on all shifts. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: There had been a number of staff changes since the last inspection however, the use of agency staff had been reduced by the staff taking on additional shifts. This was an advantage for the people living in the home as they knew the staff. Two staff files were sampled to monitor the recruitment process. One of the files included all the information needed to show that good recruitment practices had been followed to ensure the safety of people living in the home. A proforma completed at the companies head quarters showed that references and the required checks had been undertaken before the individual started work however, the other file did not include this information. We were told that the information was awaited from the head office. Both of the files showed, and staff confirmed, that the individuals had undertaken induction training. The induction undertaken was suitable for people who had previously worked in a care setting. However, for people new to this field a more indepth training package was needed to ensure that they understood all the underpinning theories of care including privacy, dignity, respect and the need to promote independence as well as issues of health and safety and so on. We were shown a new package that could be used and this would be a good improvement on the current training. It was important that the documentation evidenced that the individual was sufficiently skilled to work alone. There were training records on each staff file but no overall training matrix to show what training gaps there were and when refresher courses were needed. An overall training matrix would assist the manager in managing training requirements and ensure that the people living in the home were supported by staff who were up to date with current practices. Although some training was being provided to staff not all the staff had completed training appropriate to their roles. This was discussed with the manager and we were assured that the training would be completed by the end of April 2009. Staff were being supervised on a regular basis ensuring that they were kept up to date with current good practice issues. Care Homes for Adults (18-65 years) Page 28 of 35 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 staff at the home were being supported by a knowledgeable person who could lead and advise them on supporting the people living in the home. Records in the home were not always stored appropriately and accessible. Evidence: Since the last key inspection a new acting manager had been appointed. This person was in the process of being registered with the commission. This would mean that the home was being led by someone who had day to day responsibility and was accountable for the way in which the home was managed and for meeting the needs of the people living there. It was evident from discussions with the acting manager that she had a good knowledge about person centred care and had spent some time in developing the care planning system. There had been a significant change in the staff group and although some issues still Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: remained to be addressed good progress had been made towards addressing these. Staff commented that the acting manager was accessible and approachable. There was evidence that the manager was using staff meetings to assist in developing the staff team to ensure that they supported the people living in the home appropriately and raise practice issues. The manager needed to ensure that systems were put in place to ensure that monitoring of practices in the home was undertaken to identify issues that needed to be discussed. For example, the occurence of incidents in the home, daily records where they did not reflect what had taken place but were rather statements of intent eg All support and assistance with aim to promote independence, empowerment and well being has been offered and completed as and when required. The acting manager was receiving ongoing regular support from the area manager who visited the home on a regular basis and completed the required reports from the owners representative. This meant that the people living in the home were assured that people from outside the home were available for them to raise any issues with. The home was being managed externally to ensure that standards and improvements were being maintained. We were told that there was regular monitoring of standards within the home and that this was formulated into a development plan for the home. This was not available in the home at the time of the inspection. The manager needed to ensure that the improvements needed to the home were pursued and that information about the people living in the home were stored in compliance with the data protection act. The record of weekly fire alarm checks and emergency lighting were not found on the day of the inspection. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The people living in the home must be given as and when needed medication only as prescribed. This will ensure that people are not given too much or too little medication. 06/04/2009 2 32 18 All the staff must have undertaken training suited to their roles. This will ensure that the people working in the home have the skills and knowledge needed to support the people living in the home safely. 01/05/2009 3 42 23 Evidence must be available 06/04/2009 to ensure that the required fire safety checks have been undertaken and records kept. This will ensure that the equipment is kept in working order and people in the home are safe. Care Homes for Adults (18-65 years) Page 32 of 35 4 42 13 Windows openings must remain restricted to 4 inches. This will ensure the safety of the people living in the home. 06/04/2009 5 42 23 The lock on fire exit doors 13/04/2009 must be easily opened in the event of an emergency. This will ensure that the people who live in the home and those that work there are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Incidents of challenging behaviour should be reveiwed and monitored to identify any triggers or practices that could be managed to reduce the behaviours occuring. Files should evidence that the support plans have been discussed and agreed with the individuals. Individuals rights and choices must be observed unless it can be identified that allowing them would put them at risk. This will ensure that the needs of the people living in the home are met appropriately. Records relating to the people living in the home must be stored securely in line with the Date Protection Act 1998. This will ensure their confidentiality. Records relating to the people living in the home must be stored appropriately. This will ensure that that information is available on a need basis only. Activity plans should be in a format that would be easy for the people living in the home to understand. This will mean that they can refer to them and easily identify their activities. The reasons for denying access to particular areas of the home should be recorded with evidence that alternative Page 33 of 35 2 3 7 7 4 10 5 10 6 14 7 16 Care Homes for Adults (18-65 years) actions have been considered. This will ensure that access is denied only on the basis of risk to each person living in the home. 8 9 20 20 The medicine cabinet should be secured to the wall to ensure that medicines are safely stored. Evidence shouldbe kept that the protocol for the administration of as and when required medicine has been followed. This will ensure that the medication is used in a consistent manner. More indepth induction training should be provided for people who are new to the caring role. This will ensure that the people living in the home are supported by individuals who hav ehte appropriate skills and knowledge. Evidence that the appropriate employment checks have been undertaken should be in the home before people take up their employment to show that the checks have been completed. A report on the quality monitoring of the home should be made available to all stakeholders. This will ensure that the service continues to improve and take the views of stakeholders into consideration when developing the service. A system should be put in place to ensure that staff could summon assistance in an emergency. This will ensure that the staff and the people living in the home are kept safe. 10 32 11 34 12 39 13 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!