Inspection on 10/03/09 for 5 Trinity Street

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Good 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

5 Trinity Street 18/01/07

5 Trinity Street 12/12/05

5 Trinity Street 16/03/05

5 Trinity Street 08/01/05

5 Trinity Street 15/03/04

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 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Trinity Street 5 Trinity Street Old Hill Cradley Heath West Midlands B64 6HT     The quality rating for this care home is:   two star good 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: Jonathan Potts     Date: 1 0 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 31 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 31 Information about the care home Name of care home: Address: 5 Trinity Street 5 Trinity Street Old Hill Cradley Heath West Midlands B64 6HT 01384823048 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Inshore Support Limited Name of registered manager (if applicable) Christine Bridgwater Tracey Lake Type of registration: Number of places registered: 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: 3 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Date of last inspection Brief description of the care home 5 Trinity Street provides long term care to 3 adults with a learning disability who are of mixed gender. The house is sited near the centre of Old Hill in an established residential area that affords easy access by foot to a range of local facilities, including public transport. Staff also have access to a car for transporting the residents between venues. The house is a terraced property that has been adapted for its current use and consists of two living rooms, a kitchen/diner and three single bedrooms as well as Care Homes for Adults (18-65 years) Page 4 of 31 care home 3 Over 65 0 3 Brief description of the care home bathroom and toilets. The main stated aim of the home is to provide a service that reflects the expectations of the residents: identifying and fulfilling their individual needs by means that are valued by society; this in order to develop and support individual and personal experiences and characteristics which are culturally valued and maintained. There is a staff group that consists of a manager, deputy, senior support and support workers. There are waking staff available 24 hours per day. The manager is responsible to a service manager and directors of Inshore support who have a number of homes of similar size and purpose. The current charges for living at the home are not detailed in the homes statement of purpose (as should be the case) and the home should be contacted for information as to what these are. Care Homes for Adults (18-65 years) Page 5 of 31 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: two star good 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: We carried out this unannounced inspection over one day looking at the homes performance against the key national minimum standards for younger adults. Evidence was drawn from a number of sources including sampling records related to the care for individuals living at the home and comparing this to their experiences. We did this by talking to them and staff as well as observing what was happening during our visit to the home. We also reviewed other records and looked around the home. We considered all the information we had received about the home since the time of the last key inspection, this including their annual quality assurance assessment, senior mangers monthly visit reports, notifications the home has sent us and such like. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There is a need to ensure that directions for staff in the administration of as required Care Homes for Adults (18-65 years) Page 8 of 31 medication are in place for all individuals; this so that staff are in no doubt as when it is appropriate to administer these. Care needs to be taken to ensure that staffing levels do not compromise the good quality of community activity and stimulation that individuals receive, and most critically are maintained at safe levels. There are areas where staff need training to improve their skills and knowledge in keeping up to date with expected and current ways of working such as training in nutritional assessment. Some records need to be improved such as clarity to show exactly which staff are administering medication, and development of quality assurance records so that a clear record of monitoring of standards is available to reflect the homes quality monitoring. First aid training is should be in accordance with a risk assessment that clarifies what level of training is needed to meet the specific needs of individuals. 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 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 10 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. People who may wish to use the service have access to information about the home, this with the possible exception of the range of fees that may apply. The homes phased admission procedures are however appropriate in assisting people to find out about the home in a more direct way. Evidence: 5 Trinity Street was set up to accommodate three individuals on a long term basis and as such admissions to the home are infrequent, none having occurred since before the last key inspection. The manager was knowledgeable as to how to ensure admissions are carried out on a phased, planned basis this so as to ensure any prospective resident has the opportunity to sample the service prior to moving in (through a gradual introduction to the home including day visits and overnight stays). This would also ensure that the management have time to assess the homes ability to meet an individuals assessed needs. This approach is supported by the homes procedures which draw from practices outlined in the National Minimum Standards for younger adults. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We saw that there is an individualized Statement of Purpose and Service users guide that we noted has been subject to some review since the last inspection of the home. The afore mentioned documents we saw contain information about the homes aims and objectives and philosophy as well as procedural information (such as how to complain) in accordance with legal expectations. We saw that some of the documentation (such as terms and conditions of residency) has also been adapted to include pictorial cues and the manager stated that she intends to extend the use of pictorial information for such as the service users guide. We saw that there is clear information in the individuals contracts, this showing the range of fees for the service, although this information is not currently detailed in the service users guide of statement of purpose as should be the case. The lifestyle agreements that we saw had been signed by the individuals to whom they related. We noted that a copy of the statement of purpose/service users guide is included in each case file. We saw documentary evidence of the home providing copies of CSCI inspection reports to relatives, with other copies available in case files for individuals living at the home. From previous inspections we have seen that admissions are not made to the home until a full needs assessment has been undertaken. All the individuals living at the home are funded through care management arrangements. We saw that staff have reassessed the needs of individuals at the home through use of inshore assessments formats, with the assessments seen detailed, confirming the information that individuals living at the home and staff told us. We saw that there is usually been input from social services where they have reviewed individuals placements, although there is one individual who has not been involved in a review with the funding authority for an extended period. We saw that the home has requested a review with no success to date. Care Homes for Adults (18-65 years) Page 12 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. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive, this with support from the staff. Evidence: The individuals living at 5 Trinity Street are able to express their views clearly this meaning that staff are able to ascertain their preferences and choices. We looked at some of the care plans at the home and discussion with individuals indicated that the information within these reflected their likes, dislikes, needs and goals. Based on the the accuracy of the plans, as we found when sampling (including discussion with the people they related to) it was evident that individuals have been involved in their formulation. They have also signed to agree the plans. The plans we saw set out important information in respect of how staff should interact with individuals and the staff we spoke to are aware of this information and the reasons why. There is also use of lifestyle assessments, pictorial information (such as Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: questionnaires, activity plans), and detailed behaviour monitoring records. Whilst detailed these plans are written so as to be easily understood by the staff so that they can provide consistent care to individuals. We did however note that whilst it is the homes policy to have staff sign to say they have read and understand these plans many of the staff have not signed, although in discussion with us were aware of the plans detail. Individual plans we saw had clearly identified goals and there was evidence in reviews and supporting documentation of how the staff worked towards achieving these with the individual. We also saw that the individual plans reflect the homes assessments of individuals needs. Some staff did tell us that care plans provide them with up to date information in regard to individuals needs, and that they are reviewed on a regular basis, this monthly based on the ones we looked at. Tracking of areas of one individuals plan showed us evidence that this is followed into practice as we saw within supporting records, observation and discussion with staff and the manager. Observation of individuals also supported the information that the manager and staff gave us on the day. We saw that care plans are supplemented by comprehensive risk assessments with these taking into account the individual needs of the service users, although we did note that some of these are not up to date and would benefit from review, one specific example of this in respect of an individuals possible weight loss and nutrition. We did note that much of the information is still relevant however. We saw that there is clear detail of limitations within case files although the home does need to consider the possible impact of the mental capacity act and deprivation of liberty in reviewing these limitations. The manager was aware of the changes in the mental capacity act and some staff have received training. From records we saw that individuals are consulted as to whether they are happy with personal information about them been shared with other professionals, and consent was documented and signed by them. Care Homes for Adults (18-65 years) Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals that use the service are able to make choices about their lifestyle within agreed limitations and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: We saw during the course of our visits to the home that staff do encourage individuals to have involvement in daytime activities that they enjoy and choose with the support of staff. At the time of our arrival at the home two of the residents were out, one visiting the health centre and the other at daycentre. We saw that the one individual who was getting up at the time of our arrival went out later in the day and the one who returned then chose to visit the cinema later in the day. The activities the individuals are involved in reflect their choices and incorporate community integration. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: One individual told us that they had a bus pass and traveled on the bus with staff quite often, and also attended college at least twice a week. The choices in assessments reflected activity plans with one exception for the one individual, this an activity the staff said they were trying to source in accordance with their wishes. Domestic routines are built into the activity plans and individuals are expected and encouraged to have involvement in household tasks such as cleaning and food preparation (we saw one individual help themselves to their breakfast and make frequent drinks during our visit). One person we spoke to told us about a planned holiday this year at a venue they had chosen with assistance from staff. We noted that there is some restriction in respect of daily routines this due to the need (as highlighted in assessments) for the individuals to have a planned routine that ensures individuals are stimulated. There is much flexibility within this however and we saw staff offer individuals choices on a number of occasions. We saw that where there are restrictions in place these are usually agreed with the individual, with evidence of their signature on this agreement. We saw in the individual plans that there is detail as to how the home will maintain contact between individuals and their relatives. This involves where necessary, taking an individual in their or the homes car to their relatives home. We saw from records that this was clearly recorded and reflected the individuals activity plan. There is scope for relatives to visit the home as we saw was the case. Discussion with a relative confirmed that the home had supplied an answering machine so that messages could be left for people at the home, this as they were said to be out much of the time. The staff have ascertained residents likes and dislikes based on the foods they chose to eat and the records of foods provided to residents showed that the menu is varied with a number of choices including healthy options. Meals are balanced, nutritional and cater for the varying dietary needs of the individuals . We saw that the staff do involve individuals in discussion as to their choice of foods, this when we saw and heard staff offering individuals options. The meals we saw served during the time of our visit where appropriate and in keeping with individuals choices. As people are given a choice the homes menu is seen as a guide rather than a set menu, this appropriate in such as small home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that individuals received is based on their assessed needs and preferences. The principals of respect, dignity and privacy are considered in the way care is delivered. Individuals are encouraged to have involvement in management of their medication, but safeguards for as required medication needs to be more consistent. Evidence: We saw the home has suitable procedures in place in respect of the promoting of effective personal care. The homes policies and procedures set out how the service is to address these. We saw that the individual plans set out what peoples personal and health care needs are and detail how they are to be met by staff at the home. Individuals we spoke to said they were happy with the support that staff provided to them. From observation we saw that staff are aware of and we saw respect individuals preferences, allowing them to make choices. The home has a mixed gender staff group Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: which reflects the mixed gender of the residents and is important for assistance with personal care like bathing. The staff responses to the individuals living at the home that we saw at the time of our visits were appropriate and reflected what we saw in individual plans. A number of staff have achieved an vocational qualification in care (NVQ 2 or 3). Input in respect of training relating to such as nutrition would be beneficial this to assist staff to develop more robust nutritional assessment tools based on such as B.M.I. (body mass indicator), this to allow easier identification of ideal weights. This would assist where they maybe concerns in respect of weight loss. The care plans we saw set out how the staff are to encourage independence through encouraging individuals to be involved in their own care, this as we saw,and as was documented in monitoring records. Individuals have regular access to health services and when needed visited the GP in the community, with the staff pro-active in maintaining individuals access to health care as identified in their plans. The manager and staff in discussion showed a good awareness of what the individuals health care needs are although we did note that there was no joint health action plan completed with health service. In addition the one care plan we looked at in some depth did not have a specific section on health care, although we noted that issues related to this are documented in such as assessments and other parts of the plan. A more concise health care plan may assist clarity as to what staff currently do to promote an individuals health. The home has developed an efficient medication policy and procedure as well as practice guidance. Staff that administer medication have received training that allows them to understand their roles and responsibilities (this evidenced by certificates), and there is a range of information about medication available at the home for reference, with easy read versions for individuals. We saw that there are clear medication plans in place for each individual that build on good practice although we noted that there was no protocol in place for when as required medication should be given for one individual such as what behaviour triggered the need to administer it. These protocols we saw are in place for other individuals however. Staff that administrate medication have received accredited training and additional training has been given for administration of specific medicines needed for epilepsy. Whilst the individuals at the home do not self medicate the goals set out in plans promote work towards independence and self administration. To this end individuals do take part in taking their medication in so far as they are able, with support from staff. The individuals consent to the home managing their medication has been obtained. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: We looked at medication records and found these to be accurate and up to date although we did note that when medication is administered two staff sign to evidence this. The manager needs to ensure that it is clear which staff is signing to evidence administration and which is the witness. The home does regular checks on medication, with documented records of the same kept. The last audit of the homes systems for management of medication by the contracted pharmacist raised no area of concern. Care Homes for Adults (18-65 years) Page 19 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. Individuals living at the home have access to methods by which they can express dissatisfaction and the homes practices ensure that they are protected . Evidence: We saw that the home has a complaints procedure that is up to date and clearly written as well as been easy to understand. We saw that a simple pictorial format has been produced, this readily accessible within the home. We saw that the home has provided individuals and their relatives with copies of the homes complaints procedures, and we have been told that staff do listen to people using the service. Behaviour records did show what possible precedents to any behaviours may be, this another indicator for picking up on possible concerns that may exist. The incident of challenging behaviours in comparison to previous years it was stated by the manager has decreased, written ABC records looked at for the last 2 months supporting this contention. The policies and procedures regarding protection of individuals we saw are of satisfactory quality and are readily available to staff. These are supported by copies of the local authorities procedures that are also available to staff in the home. The manager is clearly aware of when incidents require external input this evidenced by Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: the safeguarding referrals that have been made by the home over the past year, with it clear that the necessary steps will be taken to protect the people living at the home. Any allegations are investigated following involvement of social services. The manager did tell us that she has identified a need for the staff to receive safeguarding training. We noted that the staff record any injuries in individuals records, these on body maps. The incident of challenging behaviours we also saw is well documented with detail as to the exact behaviours and possible precedents to the occurrence to help with understanding as to any specific trigger or cause. There are behaviour plans in place that follow low arousal techniques meaning that physical restraint would be a last resort, with the preferred method of tackling behavior verbal redirection. Records of incidents we saw evidenced this. Staff are given input in adult protection as a part of their induction although we saw that only a small number of staff have received formal adult protection training based on the homes training plan. All staff have however received MAPA (training in management of aggression). Management did tell us that the company is looking to use consultants to develop the homes behaviour management training, this to fit in with individual assessments for individuals living at the home. Discussion with some staff indicated that a better awareness of the implications of the mental capacity act would be beneficial and building on this training in deprivation of liberty safeguards. This was an area in which the manager stated training input was to be continued. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home presents a comfortable and homely environment that is appropriate for community living. The building, overall, is well maintained and spacious allowing individuals living there ample privacy. Evidence: 5 Trinity Street is a traditional terraced property adapted for use from a domestic dwelling and as such blends in well with the local community and fits in with the principals of normal home living. There is no indication from outside to indicate that the house is anything other than a domestic dwelling. We saw that the physical environment is generally well maintained and is pleasantly decorated inside and out. We saw that there are monthly building audits by the companys general manager as well as the responsible individuals visits and the former highlights any general issues in respect of building maintenance and repair. We did note that the downstairs toilet did not flush very well and there was a cracked tile in this same room. The shower curtain in the bathroom next door was also not properly attached. These relatively minor issues do not detract from the pleasant and overall well maintained homely environment that we saw however. The layout of the building allows for individuals to have ample space and privacy, all Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: having their own bedrooms and as well as two lounges and a dining area. We saw that bedrooms contained numerous personal possessions, these consistent with those we found recorded on inventories when sampled. We saw from servicing records that equipment used at the home was maintained and the certificates for maintenance of the building are up to date. We saw that staff document water temperatures on a regular basis. We saw that the home has reference in some of its risk assessments to infection control practices that cover food cross contamination and laundry and has completed an essential steps assessment in respect of general infection control practices. The information in this is basic but does show that the management have considered infection control as an issue. Development of this, as part of the homes wider quality control system, with reference to where evidence is of the homes compliance would be useful. We saw that the staff complete checklists to evidence that they have carried out cleaning tasks, although we noted that whilst staff had recorded the downstairs bathroom had been cleaned on the morning of our visit there were areas that had not (brick dust on shelves for example). We suggested to the manager that staff could initial these forms when complete to assist tracking who had completed the task. We saw no issues in respect of cleanliness anywhere else in the building, which was clean and fresh with no unpleasant odours. We saw that personal protective equipment (such as overalls) are readily available. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are generally trained, skilled and usually in sufficient numbers to support individuals chosen lifestyles. Evidence: From sight of staff rotas and comparison of these with the staff on duty at the time of our visit we saw that there is sufficient staff to cater for the assessed needs of the individuals living at the home. At the time of the visit there was 3 staff on duty and the deputy manager/manager arrived later in the day. Discussion with the manager in respect of staffing indicated that the use of staff at another of the companies homes of similar size and purpose that the manager has responsibility for has the potential to allow for staff to be interchangeable in times of staff shortage this avoiding the need for agency staff. The manager did inform us that there have been some staffing difficulties over the past year due to staff turnover and she was looking at ways in which this could be stabilized to assist with the consistency of the service. Staff turnover was raised as a possible issue by one of the people we spoke to as well this indicating that his has possibly had some impact on service provision (for example getting to know new staff employed at the home). Comment we received from staff also indicated that staff turnover had been an issue. Whilst there is the concern that Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: staffing levels may impact on the homes ability to ensure individuals carry on with their preferred community activities we did not judge that any individual is unsafe as a result. The management are fully aware of the issues raised above and are looking to address through recruitment. It was pleasing to hear from the manager that all the staff have taken part in recent team building so as to strengthen a team approach. We saw the homes training plan although discussion with the manager indicated that this needed some review and she said that there was to be a meeting with the companys training officer to review it. Comment received from staff indicated that they did receive alot of training but did need updates to mandatory training. The manager was open as to the areas of training that she felt staff needed, this including Adult Protection, Deprivation of Liberty safeguards awareness. it was also stated that some input in respect of autism awareness would be useful. We did see that vocational training for staff has been maintained, with over the expected number qualified. This has been assisted by the company now registered as accredited training assessment center. Staff told us that when employed they have received good induction training that has helped them understand the work they do and that support has been available from the manager when needed. The home we have seen has a satisfactory recruitment procedure and from sight of the files for two staff we saw that these evidenced that these procedures are followed in practice. We discussed with the manager the need to ensure that there is verification of why the potential employee left their last social care employer. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a competent and qualified manager who promotes the quality of the service in line with individual service users expectations. Whilst there is scope for improvement the management recognize this and are working to maintain and improve outcomes for individuals living at the home. Evidence: The home currently has a registered manager that has experience from working within another of the providers homes for a number of years at a senior level and is currently managing 5 Trinity Street and another small home in the immediate locality. The manager completed her registration with CQC shortly after our visit and is now the registered manager of both homes. We have checked the managers competence through this registration process and found her to be competent to manage the two units. Discussion with the manager at the time of our visit evidenced that she has a good understanding of the strengths and weaknesses of the service, as well as the individual needs of the individuals living at the home. The responsible individual for the company provides supervision for the manager and we saw regular monthly reports Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: relating to her statutory monthly visits to the home, this to check the quality of the service. The manager was aware of the need to ensure continued training of staff in mandatory areas related to safe working practice. The outcomes in respect of the service to individuals we have seen is positive however and standards have been maintained by staff. We have seen evidence that Inshore support has achieved accreditation to the quality standard ISO 9002, although the evidence of quality monitoring we saw at 5 Trinity street could be better, as the homes Quality assurance checklist, that bench marks its performance against a range of standards (based on National Minimum Standards), did not carry an audit trail, such as dates when standards were assessed, what evidence was used etc. The manager did tell us that the way the company is looking to assess quality standards is under review and this will involve the introduction of different quality monitoring system; this in part due to the company wishing to improve the way it monitors the quality of the service. We saw that individuals views are obtained through such as questionnaires (these available in pictorial format), meetings and day to day communication. The home has a health and safety policy that meets health and safety legislation and requirements. Checks show that health and safety records are generally up to date this including accident reporting. We saw a number of environmental risk assessments that are satisfactory and it was pleasing to see that the home has been achieved a Gold award from Environmental Health for good food hygiene practices. There is a need to carry out a risk assessment to establish what level of first aid training the home requires however, this to assess the risks present at the home, the needs of the residents, situational factors (i.e response times to 999) and such like so that the staff have training that is appropriate to potential risk. We saw that the homes records overall are in good order and maintained as such. Input from the responsible individual in respect of such as safekeeping records is seen as a worthwhile safeguard in terms of protecting individuals living at the home. Records relating to the safekeeping of individuals valuables and money was seen to be well documented with weekly checks on valuables. 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 1 To included the possible range of fees for the service in the homes statement of purpose so that this is available to any people looking to access services To develop specific health action plans for all individuals living at the home. To provide staff with input into nutritional training in conjunction with the introduction of more robust nutritional assessment tools. To ensure that protcols to identify when as required medication is to be given are in place for all indivdiuals as needed To clarify in medication administration records which member of staff is administering and which member of staff is witnessing the administration of medication. To ensure that all staff have formal training in adult protection, preferably sourced from the local social services department if possible. To ensure that the home verifies the reason any potential employees left their last social care employer. 2 19 3 19 4 20 5 20 6 23 7 34 Care Homes for Adults (18-65 years) Page 29 of 31 8 42 To ensure that first aid training is provided in accordance with a risk assessment that is to be carried out to decide what level of training is needed to meet the needs of individuals. Care Homes for Adults (18-65 years) Page 30 of 31 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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