Inspection on 29/04/09 for 68 Bescot Road

This inspection was carried out on 29th April 2009.

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

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

Other inspections for this house

68 Bescot Road 30/04/08

68 Bescot Road 10/10/07

68 Bescot Road 02/10/06

68 Bescot Road 28/11/05

68 Bescot Road 05/08/05

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: 68 Bescot Road 68 Bescot Road Walsall West Midlands WS2 9AE     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: Peter Dawson     Date: 2 9 0 4 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 33 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 33 Information about the care home Name of care home: Address: 68 Bescot Road 68 Bescot Road Walsall West Midlands WS2 9AE 01922648758 01215258492 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lonsdale (Midlands) Limited care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 68 Bescot Road is a care home with nursing that is owned and managed by Caretech following the takeover of Lonsdale Midlands Ltd in 2006. The home offers nursing care and personal support to up to eight individuals with a learning disability with health and/or complex social care needs, plus degrees of behavioural challenge. The home has two floors which are identical and are staffed separately. A passenger lift is available. The two units have the same layout and comprise four single occupancy rooms, (some with en suite shower facilities). There is a shared bathroom and two separate toilets, lounge, dining room, and kitchen. The two units operate independently of each other although staff work between both. The external area of the home comprises a car park at the front and small rear garden. Entrances and exits are ramped providing good access for people with mobility needs. The home aims to provide its residents with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. This is stated to be achieved through a programme of activities designed to encourage Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home stimulation, self-esteem, and social interaction with other residents and with recognition of core values that are fundamental to the philosophy of the home. The core values being Privacy, Dignity, Rights, Independence, choice, and fulfilment. The stated range of fees is 1400 - 1850 pounds per week depending upon the level of dependency needs and service required to support people. People who use the service and their representatives are able to gain information about this home from the Statement of Purpose, Service User Guide and inspection reports produced by Care Quality Commission. Inspection reports can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This service was last inspected on 30th April 2008, when a Key Inspection was carried out. Improvements had been made to the service and the quality rating changed from Zero star - Poor to 1 Star - Adequate. This inspection was unannounced and was carried out by one inspector on one day from 08:45 am - 5:30 pm. The National Minimum Standards for Younger Adults were used as the basis for the assessment of the service. Prior to the inspection the Acting Manager completed an AQAA (Annual Quality Assurance Assessment) and was returned to us prior to the inspection. The AQAA is a self- assessment of the service and is a legal requirement. This was completed Care Homes for Adults (18-65 years) Page 6 of 33 accurately and in detail. Some of the information in this report is taken from the AQAA. Two questionnaires from people using the service were also returned to us prior to the inspection. These were completed with assistance from staff who recorded the information as given. When asked the question Is there anything else that you would like to tell us? one person replied No, its alright here. There were 4 permanent and 3 people receiving respite care at the time of the inspection. Two had completed a pre-arranged 1 night stay and were returning home on the day of the inspection. All were seen and spoken with together and separately, although one did not have any verbal communication but communication was with staff assistance. Seven members of staff were on duty throughout the time of the inspection. All were spoken with and keen to be part of the inspection process. Communication between staff and people using the service was observed to be good. People were supported in a very positive way. Some instances of changed behaviours were seen to be dealt with skilfully by means of diversionary tactics, sensitively and appropriately applied. All staff members were positive about their work at Bescott Road and had good working knowledge of the people they were supporting. All the communal areas were seen and also a sample of bedrooms, with consent and assistance from people using the service where possible. A range of records were inspected including care and support plans, risk assessments, medication records, staff files, complaints records, policies and procedures and other documents required to inform the inspection. Since the last inspection the Registered Manager left the service in September 2008, an Acting Manager was then recruited who left in February 2009. The former Deputy Manager was then appointed as Acting Manager. She was present during this inspection and provided knowledgeable, helpful and open information throughout the day. The Area Manager who provides good support to the service was also present during the inspection. There was a good and open dialogue about all aspects of the service. What the care home does well: What has improved since the last inspection? The quality and quantity of daily recording and generally in relation to support records has improved since the last inspection, the service is reviewing the systems of information recording to meet good professional standards. There has been positive movement towards person centered plans and records with details of individual needs and preferences. Training available to staff has been increased, although there are still some shortfalls. All support plans for both people receiving permanent and respite care were previously reviewed and updated. Since the last inspection the home have introduced a system for recording the outcomes of respite care in a mini-book that is returned home with the person. Family carers then input any changes in need and the book returned to the home for the next period of respite care. This provides a necessary written two-way process of communication, improving the service to respite care users and their family. Care Homes for Adults (18-65 years) Page 8 of 33 Weekly menus have been changed in relation to input and demands from people. Food is provided to suit the individual choices of people rather than have planned menus for all mealtimes as previously. For example English breakfast and Sunday Roast are still available but most people having other dishes they ask for. There is a now a monthly care review with the person and key worker. There are 6 monthly or annual reviews with social worker and GP. A member of staff has recently been nominated to be the lead on activities both inside and outside the home. This will enable more community presence and activity in the local and wider community. Talk time is established on a 1:1 basis with a persons key worker. This is weekly and is recorded. This ensures the views and choices of people are sought, recorded and acted upon. All people have a health care action plan, that record planned and actual visits and interventions with all professional health care staff. Improved medication procedures have been developed for those on respite care. Medication is logged in and out and checked. Discrepancies are immediately checked with the family and/or GP practice for clarification prior to medication being administered. What they could do better: The complaints procedure should be more accessible to both people using the service and visitors. Shortfalls in some areas of training should be addressed swiftly. The training needs of the service are identified and planned. Some shortfalls exist and some planned training needs to be brought forward. Protocols should be obtained from prescribers for all PRN medication. When administered the outcomes (effects/success) of the medication given should also be recorded. Safeguarding of Vulnerable Adults Training is needed for all staff and also training in the Management of Violence and Aggression. These are particularly important areas for this service where all staff must have the appropriate training. When falls or other incidents occur this should always be followed by a risk assessment review. This is important to ensure the continued safety of people using the service. Documentation prior to recruitment of staff must include photographs of staff and proof of qualification. The statement of purpose must include the range of weekly fees charged for the service and a copy of the statement of purpose and service users guide kept in the home for people using the service, their families and other visitors. Care Homes for Adults (18-65 years) Page 9 of 33 A Registered Manager should be appointed as soon as possible to ensure maintenance of standards and review and continuity of the service. The complaints procedure must be available in the home for people using the service and visitors. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the level of service provided could be improved and more readily available to inform people and their carers using the service. Evidence: The Statement of Purpose/Service Users Guide was updated in March 2009. This is a generic form adapted to Bescott Road. The document is in pictorial form to facilitate communication for people in the home. The document was not available in the home at the time of the inspection, although a copy was obtained from the Caretech regional office. Some information areas had not been completed, including the weekly fees for living at Bescott Road. It is important that these documents are completed for individuals and copies readily available in the home for visitors/enquirers. Copies should also be given to all people using the service including relatives, carers and advocates. People are assessed prior to being offered a permanent or respite placement, usually Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: completed by the homes Manager and referring social worker completing a multidisciplinary assessment. One person permanently resident has left since the last inspection another person admitted who had spent periods of respite care at Bescott Road, making the transition easily and smoothly involving family and other professionals. Most people admitted on a permanent basis have prior knowledge and experience of the home through respite stays. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in care and support plans and general information formats have involved both people and their carers using the service in a more meaningful way. Evidence: Care and support plans for the 4 permanent and 19 respite people using the service had been reviewed and updated at the time of the last inspection. Plans have continued to be regularly reviewed since the last inspection. The AQAA refers to improvements over the past year and states Risk assessment and support plans have been revisited incorporating person centred planning. The sample of care plans seen support this view. There has been a move away from generic, nursing based plans to individual person centred formats. Risk assessments are in more detail and have support plans to address the assessed risks, although in relation to a person who had a fall, the support plan did not give details of the support needed to reduce the risks and ensure safety, although action had been taken in providing a Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: pressure pad on the bed to alert night staff when he moved from the bed. This information was not in the risk assessment or support plan. Support plans seen contained adequate information in relation to needs such as night care, nutrition, activities, diagnosed conditions and general health care needs. There was information about communication needs and the several people with behavioral management needs, including the management of violent and aggression. Known triggers for difficult behaviour were recorded and any incidents of restraint recorded. There have been no incidents of restraint since the last inspection. The home have managed to balance the need for adequate information to meet the care needs of people, against the possible over-load of information for staff to know what actions are needed to support people. People living permanently at the home have 3 records of information: A large file with all completed, assessments, care plans, risk assessments and historical information. A smaller file with current risk assessments, care plans and health care needs. A small monthly file contains a brief summary of needs with a record of daily recording including activities and events which are reviewed and a new document completed each month. A recommendation of the last report to improve the standard and quality of reporting has been actioned. The changed daily and monthly recording mentioned has vastly improved the record of daily events and the levels of support given to people. In relation to the 19 people having respite care at Bescott Road a mini book has been established for each person. Entries are made by family prior to the respite period, the book accompanies the person and the home then record a summary of events and support given whilst in respite care, the book is then returned to the carer upon discharge. This facilitates good information and dialogue between the home and carers and and changes or significant events recorded. This has replaced the previous discharge letters sent to carers and establishes a good two-way dialogue and record. It was noted in relation to a person having respited care during this inspection there was a missing entry by the home when he returned to carers after a recent respite stay. People are consulted about their needs, wishes and preferences. Specific 1:1 time is spent with each person - key workers ascertaining each persons views about the service, what they wish to do or to change. Some people have restricted or no verbal communication, some people use BSL (British Sign Language) or at least parts of it. Staff have not had training in BSL although they have picked up some aspects of sign-language. Staff spoken with said that they would welcome training opportunities for BSL. This would certainly improve aspects of commmunication with some people they support. Care Homes for Adults (18-65 years) Page 15 of 33 Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that their chosen activities and lifestyle needs are known and met. Evidence: Some people use day service provision as part of their weekly activities. This applies to people who are permanent or those having respite care, for whom continuity is vitally important. Some permanent people use the service having established relationships over time with people in the day centres. Four people attended day centres on the day of this inspection - two permanent and two on respite care. There is a close working relationship between the home and day centre staff, important information relayed between the two. At the time of this inspection two of the 3 people receiving respite care were accommodated for one night only, attended day centre the following day and returned home from there. The service is very flexible and adaptable in providing respite care which can be for one night, one week or longer. This can be in response to Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: immediate needs of the person, carers or family. On the day of this inspection three people did not attend a day centre, one was later returned home by staff the other two were taken out by staff. one was taken shopping another to the cinema to see a Bollywood film that he had asked to see. This person also has a collection of his favourite Asian DVDs that he plays in his bedroom. He also attends an Asian Day Centre 2 days each week that he enjoys. The centre deal well with some of the challenges he presents. Another example of cultural needs being met was a person having a steak (halal) breakfast. Activity preferences are discussed in time allocated specifically for each person with a key worker. Activity plans are established from these contacts, although depending upon the mental health or psychological status of the person on the day are changed/adapted to their particular needs and preferences at that time. People enjoy trips out with staff usually individually and sometimes in small groups. These vary from local shopping trips to a recent holiday in Skegness referred to by some people spoken with. Cinema, pubs, discos, church and other social events are accessed on an ongoing and mostly individual basis. Staffing levels are geared to meet the social and recreational needs as stated. - when people are in day care staffing reduces, when people return or at home weekends staffing increases. Transport is readily available with 3 vehicles being located at the home. These include an adapted vehicle for wheelchair users. Activity programmes were seen and were tailored to meet individual needs. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home can feel that their health and personal care needs are known and met and their medication administered in the interests of safety and their well-being. Evidence: We saw a sample of care and support plans to assess the input and actions taken to meet the personal and health care needs of people. Recording was generally good and attention to detail ensures that people have the care they need. There has been improvement in this area over the past year. Routine screening and health checks were in place in the records seen. All have annual health checks with the GP and some have ongoing outpatient appointments with Consultant Psychiatrists and other health care professionals. There were support plans for people with epilepsy and daily monitoring for someone needing daily insulin. A person admitted permanently some months ago has been referred due to concerns to the SALT (Speech and Language Therapists) due to concerns about swallowing. They have visited and daily food intake was being closely monitored and recorded and Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: records forwarded to the SALT team. People have not always been weighed regularly in the past. This has improved although in relation to a person in respite care, there was a nutritional assessment but no weight recorded. Another person permanently resident had, at the request of the family and agreement with the person, been put on a healthy eating weight reduction diet and lost 1 stone in weight over a period of time. She is monitored by the GP practice nurse monthly. We saw health action plans in place for people we monitored as part of the inspection. The AQAA stated We have good working relationships with the community health team ensuing service users to have the best possible health care. This was evidenced in the records seen and from discussions with staff. In one record it was stated in a report at the point of admission that the person had a mental illnes. Staff were unaware of this and there were no other records, observations or medication to support the statement. It is important that this is clarified and the care plan corrected if this is not the case. We looked at the medication system in place and the records relating to this. A medication error was reported to us as required under Regulation 37. It was found that a bank (stand-in) nurse had not administered medication as prescribed on one occasion. When discovered this error was reported to us immediately, the home spoke to NHS direct (out of hours) and later the GP - it was confirmed that there was no effect to the person for the missed medication. The home had insisted the bank nurse should have updated medication training before working further in the home. The AQAA stated that All PRN (as required) medication has a PRN protocol. In a record seen there was no protocol from the prescriber. This should state under what circumstances the PRN medication should be given. At the time of the last report the Manager had stated that ongoing reviews of PRN protocols would be monitored. This should be done. A recommendation of the last report was to record the reasons for PRN medication being administered and the outcome (whether effective) - records of the person showed that no record of the outcomes following administration of the medication had been recorded. Apart from the matters outlined above, other aspects of medication recording were good and accurate. The importance of the attitude of the home in relation to the safety of medication is reflected in the positive action taken following the medication error reported. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: The medication for people on respite care was seen and discussed with staff. This is sent usually in bottles and tablet packs, by carers when the person is admitted for the respite period. This is checked very carefully and recorded on MAR sheets (Medication Administration Records), shortfalls or changes are questioned with carers and/or the GP practice. There are further potential complications in medication also being sent to the Day Centre when the person attends whilst at Bescott Road. The home has good records and policies and procedures to ensure this area, which has potential for confusion, is absolutely clear and procedures are followed. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and protection issues are appropriately actioned and people can be assured that they are listened to and protected. Evidence: There is a pictorial complaints procedure in easy read format but unfortunately this was not available in the home at the time of this inspection. A copy was requested and faxed from the Companys regional office. Unfortunately this is a generic form and was for another home in the group. We were assured that they are generally readily available in the home and also that there had been discussions during 1:1 talk time with all people in the home. In written feedback directly to us prior to the inspection two people had said that they did not know how to make a complaint. Discussion with staff and observations showed that in fact both people had verbal communication and in fact had raised issues when they were dissatisfied with matters in the home. One related, for instance to DVDs being taken from the persons bedroom. This had been fully investigated and discussed with the person. Complaints are recorded and there had been one since the last inspection which related to scratch marks on a persons neck after returning from respite care. This was fully investigated by the social worker, there was poor skin integrity and no evidence of any injury. There was no complaints procedure in the home for visitors and this should be posted prominently in the reception area with other information. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Three matters have been referred to the Safeguarding (Protection of Vulnerable Adults) Team since the last report. All relate to body marks seen when the person returned home from respite care. All have been investigated under the Safeguarding procedures, one finalised the other two about to finalised at a Strategy Meeting on 7th May 2009. There is no evidence to indicate that the injuries or marks were nonaccidental. The home have referred and cooperated fully with these investigations and followed procedures correctly. As a result of this the home have established body maps for all to record any marks or injury upon admission or discharge. Additionally the mini notes mentioned previously have been established to inform carers of any events or accidents when receiving respite care. The staff training matrix showed that 4 members of staff had not had training in Safeguarding and others needed updated training. This should be arranged. Many people present behaviours that challenge the service. These are well documented with triggers that may precede this behaviour. Staff have had training in the management of violence and aggression and also in physical restraint which is always only used as a last resort. The usual de-escalation techniques are first deployed and usually successful in calming the situation and ensuring the safety of others. No physical restraint has been used or necessary in the past year. The staff training matrix showed that 5 members of staff have not had training in the management of violence and aggression, this is arranged for May/June 2009 and must be completed. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, homely, safe environment that meets their individual needs. Evidence: The home is situated in an area that is easily accessible to local shops and other community facilities. The building is generally well presented, all areas are well furnished and provide a pleasant, comfortable homely atmosphere. All bedrooms are for single occupancy and have en-suite facilities. Redecoration is needed in some areas but is part of the planned ongoing maintenance of the building. Since the last inspection lack of allocation of funding and poor responses from an otherwise responsive maintenance team have led to difficulties with delays in some maintenance to important matters such as waste blockages. This has improved recently although at the time of this inspection an en-suite room did not have lighting and one of the other two lights in the bedroom area was not working, although these have been reported to maintenance staff. The importance of this to maintenance staff may not be clear but the occupant of the bedroom usually has the light left on in the Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: en-suite room to access it during the night, this has meant the one remaining light in the bedroom has to be left on. This needs to be addressed swiftly and checks made on any outstanding maintenance requests. The building is essentially divided into 2 areas, one on each floor that are replicated. Each areas has 4 single bedrooms, all en suite, some with showers, a shared bathroom, lounge, dining kitchen and toilet areas. There is shaft lift access to the first floor. The two units, (generally one for permanent care the other for respite care) operate and are staffed independently, although staff do work between the two. There is a small parking area at the front for the homes 3 vehicles and a small garden/patio area at the rear. Access to the building is good with ramped access for wheelchairs. There is level access to the rear garden from the lounge area. Staff are keen to make some space available for people to grow plants taking some ownership of the small garden area. High standards of cleanliness and hygiene were noted throughout the home. Cleaning is the responsibility of staff with input from people living there, where possible/appropriate. There is a laundry on each floor, people encouraged to bring their laundry, that is washed and ironed by staff. A sample of bedrooms were seen. People said they like and enjoy their bedrooms and several use them throughout the day. All were personlised to reflect individual interests and preferences and had the usual visual/audio facilities. Bedrooms for people receiving respite care were inevitably less personalised, but had good space and facilities. A bedroom has facilities for wheelchair users with wide-width doors and space to maneuver in both the bedroom and en suite area. An adjustable height bed is in place. There is an assisted bathing facility (manual bath-hoist) and there is an over bath shower. The unit would benefit from a walk-in shower/wet-room facility. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels give good support to people using the service but staff training would further ensure people are safe and fully protected. Evidence: At the time of this inspection there were 4 people in permanent care and 3 in respite care. Of the 3 in respite care, two had been accommodated for 1 night only, the other for 5 days. Four left in the morning to attend day centres, two people on respite would be returned home later from day care to their own homes. There were 6 people on duty. Staffing levels are good and meet the needs of people using the service and take account of the varying respite periods. The home have developed flexible working routines to ensure adequate staffing at all times. Clearly less staff are needed if 4 people attend day centres, but this is then increased to provide good levels of support to people in the evenings and at weekends, when individual activities are provided both inside and outside the home. There are 3 waking night staff providing the necessary cover and safety for people with varying needs. This is a nursing home and there is always a registered nurse on duty throughout the 24 hour period. Past staffing shortages have long been resolved and the home no-longer uses agency staff, gaps Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: being covered by the homes own bank staff. The AQAA stated We have full compliment of staff with access to regular bank cover for additional shifts. There were shortfalls in staff training at the time of the last inspection and a requirement made to ensure training needs were met. Progress has been made in this area but there were still some shortfalls in statutory training at the time of this inspection. This related to mainly to more recently appointed staff and others requiring updated training. Training is required in Safeguarding and the Management of violence and aggression, including restraint, as mentioned previously in this report. Additionally training is also required for some staff in Moving & Handling, Health & Safety and infection control. Some training is already planned other requests to the Companys training unit have not been responded to. These training needs need to be planned, agreed and carried out as soon as possible. A sample of 2 staff files were seen. A requirement was made at the last inspection to provide for each person recruited, the documents listed in Schedule 2 of the Regulations. We have agreed that Caretech may hold these documents centrally providing a pro-forma on each persons file as evidence that documents have been obtained. Checks of the files indicated that photographs had not been obtained and in relation to a qualification stated by an applicant, the Companys Human Resources team could not produce a copy of the qualification certificate, although this had been recorded as present in the pro-forma. It is important that all checks and documents are obtained as required under Schedule 2 to protect people using the service. CRB (Criminal Records Bureau) checks had been obtained prior to employment of the two members of staff whose records were seen. It was positive to see that regular supervision for all staff was now in place, established by the Acting Manager following the departure of the last manager. Throughout the inspection observations of interactions between staff and people in the home were very relaxed and positive. Communication skills were evident, particularly in relation to people with little or no verbal communication. Some people using the service use Makaton and BSL. Staff were keen to have the opportunity for learning BSL as a means of improving communication. Most staff on duty were spoken with and demonstrated that they had a detailed knowledge of the needs of the people they support and were clearly positive and committed to continued improvement of quality of life for them. Care Homes for Adults (18-65 years) Page 27 of 33 Care Homes for Adults (18-65 years) Page 28 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Interim management arrangements maintain standards of the service but the appointment of a Registered Manager is a legal requirement and will ensure accountability for the quality of the service. Evidence: This home was rated Poor in 2007 at a time when the Registered Manager was on maternity leave and a vacant post of Area Manager meant that there was no management support to the home in that interim period. Many areas of service suffered as a result. At the time of the last Key Inspection on 30/04/08 the Registered Manager had returned to duty and a new Area Manager appointed just prior to that. Many aspects of care had improved and the quality rating of the home increased to 1 Star. Positive progress was being made. Following that inspection, in September 2008 the Registered Manager left, to take up Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: another post and an Acting Manager appointed from outside the Company with a view to becoming the Registered Manager. That person left in February this year during which time standards were not maintained. In February the Deputy Manager was appointed as the Acting Manager and also an Acting Deputy Manager appointed. The Acting Manager has sought to address the shortfalls in the service and made positive progress in doing so. She has detailed knowledge of the needs of people using the service and there were examples of her addressing difficult and complex situations with carers, staff and other professionals in a very positive way. She says that she is fully supported by the Area Manager who is also involved in review meetings, safeguarding strategy meetings and other management responsibilities. This inspection was carried out with the Acting Manager who provided an open and helpful dialogue throughout the inspection process. The Area Manager was also present. The Acting Manager summed up the recent difficulties in the AQAA when she stated It has been recognised and acknowledged that there have been changes in management twice in the past year, resulting interruptions to the preferred management operation The current interim management arrangements are far more positive than those existing in 2007 and the standard of service remains adequate. It is important for the providers to put forward an application for a new Registered Manager to us as soon as possible to ensure the standards and quality of service are not compromised. Quality assurance is by means of individual 1:1 talk time with all people using the service. Their comments are sought and recorded. This ensures they have a say in their individual care and in the daily running of the home. The Company also carries out quality assurance assessments of the service by means of reports to the Companys Regional Office and a Quality Manager from the region visits and reports on the running of the home. The Company does not seek the views of relatives or external professionals in written or other form. This would be helpful in providing independent views of the service. Care Homes for Adults (18-65 years) Page 30 of 33 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 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 9 A risk assessment and support plan must be established for a person following a fall. The support plan should record in detail the actions taken to reduce/avoid risks. This will ensure people remain safe in the service. Protocols must be in place for all PRN medication administered and outcomes recorded when this medication is given. The complaints procedure must be readily available in the home for people using the service and for visitors. Ensure all staff have training in Safeguarding adults and in the management of violence and aggression. Shortfalls in statutory training for all staff must be provided swiftly. Recruitment procedures and all documents listed in Schedule 2 must be evidenced in staffing records. Application for approval of the Registered Manager must be forwarded to us as soon as possible. 2 20 3 4 5 6 7 22 23 32 34 37 Care Homes for Adults (18-65 years) Page 32 of 33 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 33 of 33 - 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!