Inspection on 15/12/08 for 73 Beech Road

This inspection was carried out on 15th December 2008.

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

73 Beech Road 16/08/06

73 Beech Road 27/01/06

73 Beech Road 22/08/05

73 Beech Road 02/03/05

73 Beech Road 29/09/04

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 73 Beech Road 73 Beech Road Wednesbury West Midlands WS10 9NR     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: Sally Seel     Date: 1 5 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 38 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: 73 Beech Road 73 Beech Road Wednesbury West Midlands WS10 9NR 01215021418 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Pioneer Care Limited care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 73 Beech Road is a small care home in the heart of a residential area near to Wednesbury town centre. The home is close to shops and local amenities, and close to a public transport route. The home is registered to provide care for three people with learning disabilities and the registered provider is Pioneer Care Limited who rent the premises from the Local Authority. The home is set out on two floors providing single bedrooms, toilet facilities and an office on the first floor: one lounge, a shower room and toilet, and a dining/kitchen on the ground floor. There is car parking on street, and a front and rear garden. The home has installed a stair lift to enable people with physical disabilities to access bedrooms. Services on offer include a key worker system, accessing community based healthcare and social resources, and a range of in house events with other Pioneer Care homes. A statement of purpose and service user guide are available to inform residents of their entitlements. The charges for accommodation varies but this is confirmed once the local authority have completed their assessment of the individuals needs. The fees charged, normally includes, accomodation, meals and laundry services. There are additional charges for hairdressing, toiletries and transport. Care Homes for Adults (18-65 years) Page 4 of 38 Over 65 0 3 Care Homes for Adults (18-65 years) Page 5 of 38 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: One inspector undertook this fieldwork visit to the home, over an eight hour period. The registered manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were three people living at the home on the day of the visit and the inspector arrived before people living in the home had left for the day. Information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the Care Homes for Adults (18-65 years) Page 6 of 38 experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. The people who live at this home have communication needs that meant discussions with them could not take place and/or some people chose not to speak with the inspector. In view of this we spoke to the registered manager and staff on duty in order to find out about the support individuals receive. The atmosphere within the home is inviting and warm and we would like to thank everyone for their assistance and co-operation. What the care home does well: What has improved since the last inspection? The home has worked towards meeting the majority of previous requirements, which suggests that the providers and managers are keen to ensure that people live in a home that complies with regulations. Statement of purpose and service user guide have now been reviewed and updated so that individuals have the correct information to hand when making their decisions about living at the home. Detailed care plans, risk assessments and documentation for the monitoring and management of behaviours has now been expanded and reviewed so that staff have sufficient information to support residents, whilst reducing where possible the risk of harm and/or injury. The home have now developed activity planners for people living at the home reflecting the variety of activities individuals are enabled to participate in so that their lives have quality and meaning to them. The storage of medication has now improved in relation to the home ensuring that its drug cabinet is fixed to the wall appropriately. Care Homes for Adults (18-65 years) Page 8 of 38 The administering of medication has improved and separate records has been developed by the registered manager to promote safeguards within staff giving medication to people living in the home. The registered manager is striving to ensure that all staff have been trained in abuse awareness so that people are protected by staff who are competant in this area. The home has implemented its own surveys to obtain the views of people living at the home, relatives, visitors and stakeholders, as to how they think the home is performing. This demonstrates the homes committment in ensuring that it is run in the best interests of the people who live there. What they could do better: The home must ensure that all new people coming to live at the home have a statement of terms and conditions that is signed and dated with help sought from individuals representatives and or advocates where required. This will provide evidence that individuals rights and responsibilities are acknowledged. To record all the fruit and vegetables that are offered to individuals throughout their day so that this can be monitored and maintained ensuring people are receiving a well balanced nutritional diet. The registered manager must ensure that the pharmacy provider undertakes quarterly medication audit checks as per the homes contract with them ensuring that medications are managed safely on behalf of the people who live in the home. To ensure that individuals are provided with the opportunity of recording their last wishes with the help of individuals representatives and or advocates where needed so that people living in the home are reassured that their needs and preferences will be met at this time in their lives. The homes garden now requires some repair and replacement to its patio area so that individuals are able to access this area of their home and are safeguarded from any potential health and safety hazards. Inidviduals within the home are limited in tending to the homes garden due to there being no raised flower beds where individuals can become more independent and follow their interests in gardening. The home must be able to demonstrate recruitment checks have been completed for anyone who works at the home specifically in respect of gaining two pieces of appropriate evidence that verifies a persons identity. This will ensure that the homes recruitment practices are robust together with reducing any potential risk of harm to people living at the home. A list of recommendations is located at the back of this report if people wish to view. Care Homes for Adults (18-65 years) Page 9 of 38 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 38 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 38 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 considering living at this home are provided with information regarding the services available. There is an holistic assessment process which includes spending time at the home so that people considering living at the home can be assured their individual needs will be measured and met. Evidence: The home have a statement of purpose and service user guide. The statement of purpose has been updated since the homes last inspection and has a wealth of information for people considering moving into the home. For example, aims and objectives of the service, principles of individuals choices and rights, qualifications of registered manager and staff, admission criteria, activities and social stimulation and compliants procedure. The service user guide provides people with accomodation details so that individuals know what rooms are like together with meal times and social activities. It also gives people an idea of how many other people live in the home and on the day we inspected there were three women living there which the service is registered for with the Commission for Social Care and Inspection (CSCI). Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: We found no details in relation to the fees charged by the home but an explanation is provided that confirms that the local authority normally agrees fees prior to the indivudal coming to live at the home and these include accomodation, meals and laundry. It is now recommended that the service user guide is also dated and regularly reviewed so that all the preadmission information that is provided to people is correct at any given time. This guide is in easy read format so that all individuals are able to access information about the home to enable people to make informed decisions about whether it is the right place for them. It is also good practice for the service user guide to give full details of any avaliable independent advocacy services so that individuals without appropriate representatives are able to be supported by this resource in order to express their wishes, feelings and values. One new person has come to live at the home since our last inspection visit. In the homes service user guide it is stated, Prospective service users visit the home before admission, which is only following a full assessment to make sure we can look after you properly. We found this to be the case, as assessments completed by the local authority together with the homes assessment and a letter sent by the home to confirm that it is able to meet the individuals needs, are in the care records we looked at. This means people can be confident that their individual needs will be met prior to living at the home. This is also reflected in the statement of purpose which details the experience and skills of the registered manager and staff. Individuals can visit the home and stay overnight which provides people with further reassurance that the home is able to meet their needs. This is also confirmed in the service user guide, You may spend a night with us to make sure we can look after you properly and within care records where it was documented the days and nights that individuals spent at the home prior to deciding to live there. It was recommended at the homes last inspection that the service user agreement and terms of conditions of residency is signed by either the service user and or representative. Where the individual is unable to sign and there is no immediate family, the use of an advocacy service must be sought. We found service user agreements in the three care records that we case tracked. It was postive to see that these are produced in easy read styles but in the care record of the person who moved into the home, in August of this year, there is a service user agreement, terms and conditions of residency but these are yet to be signed and dated appropriately. Therefore it is now recommended that these important documents are signed and dated upon the person moving into the home in a timely manner. This will ensure that individuals and the homes rights and responsiblities are known. It is positive to see that the service user agreement is provided in an easy read format to meet individuals Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: needs. Comments from questionnaires sent by the home to relatives told us: No complaints whatsoever. Warm and friendly home. Everyone so friendly and obliging. Care Homes for Adults (18-65 years) Page 14 of 38 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. People are supported to make choices and decisions about their daily lives. The home has developed care planning to ensure that this is person centred and guides staff in supporting peoples individual needs. The management of risk is positive, whilst keeping safety in mind, staff are mindful of improving the quality of life and independence of people living in the home. Evidence: We found individual care plans, some of which were designed in a easy read format, so that person centred planning can be undertaken with the individual taking part in drawing up plans that are specific to them. For example, how individuals like their personal hygeine needs met together with what the person can do for themselves and what assistance may be required in order for people to achieve their goals in this task. This means that individuals independence and choices are maintained in their own preferred way. In the main care plans reflected individuals daily activities such as, washing, dressing, mobility, healthcare, medications and eating. Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: Daily records are completed for each person living at the home. These give an insight into the persons routine each day, their state of wellbeing and any appointments they have attended. It was postive to see that essential lifestyle plans were produced in a format suited to the needs of the individual. For instance sections of the plan are in diagrams and pictorial formats. These plans tell a story and enable staff to gain a good insight into a persons history. For instance, their communication needs and preferred style of communication, what they like, what others admire about the person, what is important to the individual, people involved in their lives and what is important to them. In one essential lifestyle plan it told us that the person likes shopping trips, seeing family and going to church and in another the individual likes their clothes laid out, to look nice and some assistance with specific clothing items. This detail ensures the diverse needs of an individual are identified in a person centred way. This is particularly important where people cannot easily communicate their needs verbally and may require specific aids to support them to enhance their quality of life within the home and community. The home have adopted a keyworkers system which means that members of staff become familiar with peoples needs, likes and dislikes. This is important as individuals may have difficulty in communicating their needs so keyworkers are able to recognise the persons particular likes and dislikes and act on their behalf to lesson any frustrations. People living in the home are also able to have someone they can relate to if they have any concerns or worries. The home have developed a keyworker file which is used by all members of staff within these specific roles. People who live in the home have specific behaviour and or communication needs and guidelines have been created in these areas. The care records looked at had sections on communication in which information was stored to assist staff in communicating with individuals. For example, hand gestures, body language, using short sentences, Makaton (a method of signing) and pictures. We also found care plans to guide staff in relation to some behaviours that required to be managed appropriately and or patterns of behaviour that would prompt staff to an individual being unhappy. For instance, at the homes last inspection a recommendation was made for the home to gain advice from appropriate professionals in relation to providing suppport to individuals with their sexualised behaviour. We found that this has now been added to care plans and is reviewed accordingly. This would suggest that the home are promoting person centred care planning in respect of recognising individuals basic human needs. Within the care records that we sampled we found many examples of how people are Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: not limited in making their decisions but supported in a safe and managed way. This is further supported by the use of risk assessments, strategies to manage the risk are recorded, implemented and reviewed. This ensures that where possible risks can be minimised but choices not restricted unnecessarily. For example, individuals are encouraged to go shopping and to pay for their own items but staff will need to ensure that the correct monies are given. This shows that essential life skills are maintained with any identified risks managed appropriately so that people living in the home are not restricted in sampling all aspects of life. Also the home have now developed appropriate forms of consent which are recorded within individuals care records in respect of giving staff permission to open mail and the management of locked bedroom doors. This not only safeguards individuals rights but provides staff with protocols to follow. This was positive to note as it was made a requirement at the homes last inspection visit. At the homes last inspection two requirements were made in respect of reviewing and expanding care plans together with reviewing risk assessments around challenging behaviour and continence difficulties. We found examples that this work has now been progressed due to the hard work of the registered manager who has organised care records into separate files. This has meant that staff are able to easily retrieve information so that they can follow this and thereby ensuring people get the best possible care to meet their diverse needs in a timely manner. It is recommended that this process is now sustained as individuals grow older so that goals set are measurable and personal to the individual, these are regularly reviewed and new goals set. Comments from questionnaires sent to stakeholders confirmed: Place has shown improvement in planning and communication. Not always given feedback. Care Homes for Adults (18-65 years) Page 17 of 38 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 are supported to take part in valued activities, so that they get to do the things that they like that are important to them. Inidviduals are able to make use of local facilities, ensuring that they have a real presence in their local community. Also individuals get the support they need to make sure that they can stay in touch with people who mean a lot to them. All people living in the home are able to make positive choices about the food they eat, so that they enjoy their meals and have a balanced diet. Evidence: On the day of our visit two people attended day care. Another person went with a staff member to Walsall to do some shopping and when they came back to the home we observed staff assisting them to thread some beads to make jewellery. The registered manager has now developed activity planners which show that people experienced a Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: wide range of activities both in the home, community and when they attend day care. For example, hair done, discos, nails painted, pop music, gardening, art and craft sensory sessions, relaxation to music and hand massage. This was positive to see as it was a recommendation from the homes last inspection visit and shows that people are being provided with more meaningful lifestyles. In the care records we sampled individuals are encouraged to observe staff tidying and cleaning their bedroom together with changing their bed clothes. In others it is confirmed that the individual is able to make sandwiches with some support. This shows the homes committment to promoting peoples essential life skills whenever possible and in the Annual Quality Assurance Assessment (AQAA) the homes ethos around individuals gaining life skills is further echoed, Encourage daily living skills as part of plan of care. Whilst this was positive we did note that some people living in the home enjoyed gardening but having seen the homes garden there would be very limited options for people to undertake appropriate gardening tasks. For example, there are no raised beds, the patio area needs replacing as it poses risks to individuals in respect of a tripping and or falling hazard. This is discussed further in the environment section of this report. When the inspector arrived at the home they were introduced to the people who lived there by the registered manager acknowledging the importance of individuals being included in all aspects of their home life. We observed the registered manager and staff talking with people in a polite and friendly manner. We found examples within peoples care records that showed that individuals were positively encouraged to remain in touch with the important people in their lives, such as, family members and friends. Peoples care plans stated their religion and culture which shows that these aspects of a persons identity are respected. There were examples where inidviduals wanted to maintain their attendance at church and the home ensured that they were able to do this. It was also positive to see that the home had asked a family member about Roman Catholic practises in relation to the rosiary and associated prayers so that the person living in the home would be supported in continuing to follow their beliefs. It was evident people are supported to make choices about what and when they eat, when to go out, how to spend their time. Activities are planned and some are spontaneous, these are based on the things the person enjoys, and are monitored to show whether the activity had been carried out. This is an effective way to monitor the goals in the care plan to ensure they are suited to the needs of the individual. Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: At the homes last inspection it was recommended that the home include food taster sessions to identify whether individuals would like different meals and food types included in their diet. Care records showed that an Indian food taster session was organised but on speaking with the registered manager and noting the outcome of the event in the daily records it would appear that individuals did not like this food. This practice demonstrates that the home are open to ideas and suggestions and are willing to follow these through so that people living in the home are provided with opportunities of trying new food. Care records that we looked at showed that people are receiving appropriate nutritional assessments and staff are daily recording the meals, food and drink that people have. It is recorded what people like to eat and drink together with peoples dislikes. It is now recommended that the home should clearly state the amount of fruit and vegetables that people are being offered so that people are being provided with a healthy diet and there are records to verify this. Comments from questionnaires completed by staff told us: Very good choice of menu. Healthy food offered. I feel staff should not do gardening. I feel that service users are restricted in what activities they can do due to their personal finances. Menu is tailored to individual choice. Care Homes for Adults (18-65 years) Page 20 of 38 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 are well cared for by a staff team who knows them well. Individuals are assisted to get help from specialist and other health professionals to help keep them healthy and well. In the main arrangements are in place to make sure that people get their medicines at the right time and in the correct amounts but there needs to be some work undertaken to ensure that the pharmacist completes regular medication audit checks. Evidence: We observed that staff had paid attention to each persons personal care; people were wearing clothes in good condition suitable to their age and gender. Everyone who lives in the home has access to the health care they need. Peoples care plans show that people are seen by their doctors when they are ill and by other health care professionals when needed. It was positive to see that within individual medication records we sampled there were various examples of guidance for staff to follow in relation to preventing bowel cancer, breast awareness , healthy woman guide to prevent cancer, cervical screening, asthma, healthy heart and weight management. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: This means that staff will be able to identify peoples changing healthcare needs and health risks for the people living in the home. Some improvements have been noted since the last inspection to include weight records being maintained, and safer medication practices ensuring the health care needs of people are more closely monitored and acted upon with out delay. It was encouraging to see that the registered manager has now reviewed the risk assessment for people who live in the home in relation to the frequent nightly checks that were being completed. This is a good example whereby the registered manager focused upon peoples individual risks through the night, such as, incontinence difficulites, erratic sleep patterns, poor short term memory and individuals requiring support when walking. We found that one persons nightly check is now reduced to once, another person has twice nightly checks and another person is now monitored only. This demonstrates that the home are actively practising person centred planning and risk assessing so that individuals sleep is not unduly distrubed by staff checking on them through the night but idenitified risks are still being managed appropriately. The home uses a monitored dosage system, (tablets are in individual blister packs indicating day of week and time of day), for giving medication which appears to be robust. The medication administration records (MAR) were well maintained and the system for ordering medication was good. Staff have received training in safe medicine handling and this means that people who live in the home are protected from unsafe medication practices by staff who have the necessary understanding. At present none of the people who live in the home take their own medication independently. The pharmacist that supplies medication to the home has not undertaken their contractual arrangement with the home in respect of quarterly audit checks of medicines to see that they are managed safely on behalf of the people who live in the home. This issue continues to be outstanding from the homes last inspection. We understand that the registered manager has contacted the pharmacist but still no medication audit checks have been made. Therefore we now strongly recommend the registered manager contacts the pharmacy where medication is dispensed to request the audit of medications is urgently completed as per the homes contract with the pharmacy. As at the previous inspection medication checks are undertaken regularly by the home in order to make sure people receive their medication as prescribed and that stock balances. It was positive to see that the drugs cupboard is now securely fixed to the wall as this was a requirement made at the homes last inspection visit. Also the homes protocol in relation to as and when required, (PRNs), medication has now been added into individuals medication care plans. Therefore this practice has now improved since the homes last inspection when this was made a requirement. The registered manager told Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: us that the home do not use any homely remedies. We found in one care record that we sampled a letter to be opened at the time of the persons death. This ensures thst individuals needs and choices are maintained at this important event in their lives. It is now recommended that the home focuses on all the people who live there having this opportunity of recording their last wishes with the support of representatives and or advocates. Comments received from staff questionnaires told us: We have regular discussions. More support with challenging behaviour. Care Homes for Adults (18-65 years) Page 23 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have continued to welcome views, complaints and suggestions about the service, and has used these positively in developing creative ways to support people who are vulnerable. There are systems in place to ensure people are safeguarded and protected. Evidence: We were told that the home have received no complaints since its last inspection. There is a complaints procedure, which has been given to all people who live in the home. The procedure is well documented and is contained in the service user guide, and statement of purpose. It was positive to note that the compliants procedure has been produced in an easy read format ensuring that all individuals living in the home are able to acesss this important information as they choose. The levels of learning disability of people living in this home indicate that they would require a great deal of support or advocacy to ensure their rights are protected. In the AQAA completed by the registered manager it is confirmed that there have been no incidents of alleged or actual abuse reported and states, Encourage service users with the ability to do so to speak out if unhappy or have any concerns and or issues. It was encouraging to see that all staff have received training in abuse awareness. This shows that management and staff are being proactive within this area as a recommendation to ensure staff are trained was made at the homes last inspection Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: visit. This means staff will demonstrate that they are able to be confident when protecting people from risk of harm. Individual records are maintained for people where the home holds personal monies. Receipts were available to confirm all expenditure on the accounts. The balance of monies was found to be correct and this should ensure that peoples money is held safely. The procedure for reporting concerns to the Commission For Social Care and Inspection (CSCI) is understood and we have received no notifications in relation to incidents that may affect the welfare of people who live in the home. However, we are satisfied through evidence and discussions with the registered manager that the home would be proactive in relation to reporting concerns with competence in this area further safeguarding individuals from potential harm. Care Homes for Adults (18-65 years) Page 25 of 38 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 registered manager has a good understanding of the areas in which the home needs to improve and considerable planning is in place indicating these are to be resourced and managed. There continues to be significant and positive changes to the decor and furnishings. The improvements made contribute to creating a pleasing and pleasant environment for individuals to live in. Landscaping, repairing and replacing work now needs to take place in the garden area of the home so that it promotes individual independence and health and safety. Evidence: We toured the environment with the registered manager. The home is domesticated in style and blends in with the other homes in the nieghbourhood. The home has a stairlift for individuals who experience difficulties in climbing stairs. We looked at individuals bedrooms and found these were decorated to a good standard and rooms looked bright and cheery. In one bedroom the curtain pole had come away from the wall and we were assured by the registered manager that this would be repaired to enable the individual to have their curtains put back up. Each bedroom have hand washbasins as no rooms have ensuite facilities. All bedrooms were personalised to reflect individuals personalities and tastes. For example, photographs of family members, pictures and ornaments. Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: Access to the home is via a gate with a level pathway that leads to the front door. The lounge area of the home has laminated flooring and has comfy settees. When we visited the home was decorated for Christmas with various decorations and a Christmas tree. The lounge looked clean and there were no offensive smells anywhere in the home. It was positive to find that the fire guard is now secured to the wall in the lounge area as this was a requirement made at the homes last inspection visit. The lounge area leads into the homes kitchen which has a small table and chairs so that individuals are able to eat in the kitchen if they wish. The kitchen looked clean and well organised. It is fitted with a separate hand wash basin but there are no paper towel dispensers in the kitchen to ensure that good hygeine and infection control standards are maintained. We discussed this issue with the registered manager as this was made a requirement at the homes last inspection. The registered manager will now ensure that there is a paper towels dispenser placed in the kitchen area of the home but it was noted that staff normally wipe their hands on kitchen towel which the inspector witnessed. The kitchen also has laminated flooring and this was positive to see as the state of the flooring was a requirement at the last inspection visit. The home does have a wet shower room as there is no bath in the home and there is also a toilet downstairs as well as one upstairs. The registered manager confirmed with us that refurbishment work is scheduled in January 2009 where the homes central heating system will be replaced and this will mean that the shower room will be redecorated. This will be a big improvement ensuring that the home is well maintained for the people that live there and all radiators will have thermostatic controls that are accessible which was a requirement made at the homes last inspection. The home has a good sized rear garden which is laid to lawn with a patio area. However, the garden looked rather neglected. It was evident that some landscaping work now needed to be undertaken so that people living in the home are able to use the garden as at the present time it would be difficult for individuals to access all parts of the garden. At the homes last inspection a requirement was made in respect to the patio area which has broken paving slabs and cracked concrete. It is now strongly recommended that this is now replaced and repaired ensuring that it is made level or fitted with ramps where necessary. This is a health and safety issue and prevents the people living in the home from safely accessing the garden area of their home. It is also recommended that there are some areas of the garden where individuals living in the home are able to tend such as raised flower beds as it was noted that some people living in the home enjoy gardening. The state of the garden prevents individuals from participating in their pastimes and does not account for individuals varying physical abilities. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: In the completed AQAA it is confirmed that the home have replaced all flooring in hallway, lounge and kitchen areas. Also comments gained from one relative who completed a questionnaire told us, Decor and furnishings are modern, clean and comfortable, home to be proud of. Care Homes for Adults (18-65 years) Page 28 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally staff are trained and have the skills and knowledge to meet peoples individual requirements but there needs to be further work acheived around staff gaining their NVQ Level 2 qualification. The homes recruitment procedure needs to be improved to ensure the safety of vulnerable people. Evidence: Staff interaction with people who live in the home on the day of our visit clearly showed that they have formed friendly and respectful relationships with people. The registered manager and one care staff were on duty caring and supporting three people, it was a relaxed atmosphere, with staff assisting people well with preparations for the start of their day. For example, two people were going to day care and when their transport arrived they were assisted to this. Staff used various methods of communication to guide and prompt people providing good cues as to what was happening next. Staff rotas were sampled and showed that there are usually a manager and one care staff during the day to support people in their activities, this ensures that staffing ratios provide for peoples support needs in following their interests. At night there is one waking night member of staff with sleep in support. It was positive to see that Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: the registered manager has included herself on the duty rota which now reflects a true picture of the hours staff work in the home. Information taken on the day of our inspection indicates that the recruitment procedures are in the main robust. For example, in two staff records that were sampled there was evidence of completed application forms, CRB, (Criminal Record Bureau), checks, two references and previous employment details. However, we only found one piece of appropriate evidence that proves a persons identity for the two staff records that we looked at. We discussed this with the registered manager and were assured that another form of proof will be gained from each staff member. This will mean that people who live in the home are safeguarded and the home has carried out appropriate checks to make sure staff employed by them are suitable to work with vulnerable adults. From discussions with the registered manager, sampling of records and observation of care practices within the home it is evident that people are supported by a well trained and competent team of established staff that have a good understanding of their individual needs. Also the home have improved their practices in relation to recording staff training and this is confirmed in the AQAA, A matrix book is now used to log all staff training, thereby ensuring that all training is monitored and renewed appropriately. We found that staff have received training in manual handling, medication, health and safety, infection control, fire safety and food hygeine. There now needs to be some improvement with staff achieving their National Vocational Qualification Level 2 (NVQ) as the level who have acheived this qualification still stands at under 50 and provides no guarantees in ensuring that people living in the home are in safe hands at all times. It is now strongly recommended that the home strive to ensure that it meets the expectation in relation to 50 of its staff team are supported in achieving their NVQ Level 2 so that people can be confident that they are cared for and supported by a competant and skilled staff team. It was encouraging to see that staff are receiving regular supervision with care practices discussed, aims and goals for staff to work to. This ensures that people living in the home can be confident that staff are receiving the support they need to make sure their standards in doing their job do not decline and any concerns/issues staff have are looked at. The registered manager now needs to focus upon staff receiving appraisals which was a requirement made at the homes last inspection visit. This will then ensure that staff are provided with the opportunity of reviewing their performance with their manager against their job descriptions and agreed career develelopment plan is drawn up. We were told by the registered manager that the home have now improved their Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: practices since their last inspection visit in relation to ensuring that staff meetings take place on a regular basis with a minimum of six per year. This means that improvements have taken place, which have had significant outcomes for the service users. These include consistent staff levels, good communication systems and clear targets for further improvements. Care Homes for Adults (18-65 years) Page 31 of 38 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 well run for the benefit of the people who live there. There have been significant improvements in the efforts to find out what people feel about the quality of the service they receive so as to meet their needs and wishes. Important safety checks are carried out regularly to make sure that people living and working in the home can stay safe. Evidence: Sandra Horsley has been the registered manager of Beech Road for a number of years and it was evident at this inspection visit that the manager has made a number of improvements to the home. The main improvements are around quality montioring, to gain the views of the people living in the home, family members and or representatives together with staff and stakeholders. Also we found that all care plans had been reviewed and were now person centred to ensure that individuals receive the care in a way that is preferred. The registered manager is clear about further changes she would like to implement in order to ensure that the home is run in the best interests of the people who live there. Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: The registered manager has achieved her Registered Managers Award (RMA) and is still working to ensure that she completes the National Vocational Qualification Level 4 (NVQ), with only two units left to do. The registered manager recognises that she must complete this qualifiication as it remains outstanding from the homes last inspection in 2006 and confirms the same in the AQAA, As a person to see through my Registered Managers Award 4, to sign on to less hands on care, to make way to see paperwork etc. Delegate to others. Residents and staff meetings are held so that people have the opportunity to voice their concerns and suggestions for improvement. It was positive to see that meetings known as Happy Gatherings still occur so that residents from different services within the organisation meet to discuss forthcoming events and service delivery. We were told that senior managers visit the home and complete Regulation 26 visit reports which focus upon the quality of service being offered at the home. However, on the day we visited we could not access these reports. Therefore we cannot be confident that there is a systematic system in place to review and improve outcomes for people living in the home. It is required that all Regulation 26 visit reports are kept within the home so that these can be viewed. The organisation has a number of audits in place to monitor the service provided and it was positive to see that the registered manager has developed the quality assurance system since the homes last inspection. We found that customer satisfaction questionnaires are provided to people living in the home, relatives, staff members and stakeholders and the information is then collated into a report. The report was very detailed and an analysis is provided where graphs are produced. A traffic light system is used to ensure that priorities for improvements are maintained so that people living in the home are provided with services that meet their needs. Throughout this report we have used statements from the questionnaires that had been completed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. As detailed in the staffing section of this report the registered manager must now ensure that all staff acheive their NVQ Level 2 so that people living in the home can be confident that they are supported by staff who have the right skills and knowledge. Also there needs to be two pieces of appropriate evidence that verifies a prospective employees identification within staffing files so that people living in the home are safeguarded from any potential harm by the homes recruitment practices. Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks are completed on the fire system and equipment so that people should be safe in the event of a fire occurring. It was positive to see that staff no longer wear slippers to work in the home. We observed that staff had appropriate footwear as this was a requirement made at the last inspection visit and ensures that the home are conforming to health and safety guidelines to protect staff from any potential injuries whilst at work. We were told that the home have no accidents reported in their records and CSCI have not received any notifications from the home in the last year. Stakeholders comments from completed questionnaires told us: Staff will make contact at times of concern. Excellent levels of communication between LD (Learning Diabilities) team and Pioneer Care. Care Homes for Adults (18-65 years) Page 34 of 38 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 35 of 38 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 5 To ensure that relevant paperwork subject to an individuals admission to the home in relation to service user agreement and statement of terms and conditions, these need to be signed and dated appropriately. If the individual is unable to do this then an advocate should be sought. To record the amount of fruit and vegetables that are offered to individuals throughout the day so that this can be monitored ensuring that people living in the home are being provided with a healthy nutritional diet. The registered manager must ensure that the homes pharmacy provider completes regular quarterly medication audit checks as per their contract with the service. This will ensure medicines are managed safely on behalf of the people who live in the home. To ensure that the last wishes of all the people living in the home are now sought with the help of individuals representatives and or advocates where needed so that people living in the home are reassured that their needs and preferences will be met at this time in their lives. To focus upon landscaping parts of the garden so that it promotes peoples independence in being able to tend to the garden thereby fulfilling their interest in this area which will enhance individuals quality of life. Page 36 of 38 2 17 3 20 4 21 5 28 Care Homes for Adults (18-65 years) 6 28 To ensure that the patio area of the home is repaired and replaced as needed so that individuals safety is maintained when they access the garden. A hand paper towel dispenser should be placed in the kitchen area of the home so that good infection control practices are reinforced for all staff to follow. To ensure that suitable numbers of staff hold NVQ Level 2 qualification so that they can demonstrate they are suitably qualified to support people who live in the home and individuals know they are in safe hands at all times. The registered manager must gain two pieces of appropriate evidence of a prospective employees identity so that recruitment checks are completed in a robust manner in order to safeguard the people who live in the home from any potential harm. A system is developed in relation to implementing staff appraisals so that staff have the opportunity of reviewing their performance in respect of both their care practices and the care delivered to people living in the home. The registered manager must now complete the last two units of the NVQ Level 4 in care and management. This will ensure the registered manager has the required qualifications to manage the home and its staff adequately. All Regulation 26 reports must be held at the home to be viewed when necessary. This will promote confidence that there are systematic systems in place to review and improve outcomes for people living in the home. 7 30 8 34 9 34 10 36 11 37 12 43 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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