Inspection on 30/06/09 for Ferndale Crescent, 10

This inspection was carried out on 30th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ferndale Crescent, 10 03/07/08

Ferndale Crescent, 10 14/02/07

Ferndale Crescent, 10 10/11/05

Ferndale Crescent, 10 04/05/05

Ferndale Crescent, 10 23/09/04

Ferndale Crescent, 10 26/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Ferndale Crescent, 10 Ferndale Crescent, 10 Moseley Birmingham West Midlands B12 0HF The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter Date: 3 0 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 39 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Ferndale Crescent, 10 Ferndale Crescent, 10 Moseley Birmingham West Midlands B12 0HF 01217721885 01217666856 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) : joannesp@trident-ha.org.uk Trident Housing Association care home 8 Number of places (if applicable): Under 65 Over 65 8 8 0 0 learning disability physical disability Additional conditions: Residents must be aged under 65 years Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 39 A bit about the care home 10 Ferndale Crescent is located in a small road near to the centre of Birmingham. The home is close to local bus routes. The home has some parking spaces for cars to the front of the home. The home is allowed to provide support to eight adults who have a physical and/ or learning disability. When we visited there were six people living in the home. The home caters for adults, both male and female. Care Homes for Adults (18-65 years) Page 5 of 39 All bedrooms are single and have an ensuite facility. There is an open plan lounge and dining room, kitchen and sensory room on the ground floor. The laundry is situated on the first floor. The home has a small rear garden. A copy of the service user guide is available in the home, this tells people about the home. The actual range of fees was not stated in the current service users guide so people would need to contact the home for fee information. Copies of previous inspection reports are available in the home for people to read if they want to. Care Homes for Adults (18-65 years) Page 6 of 39 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 Care Homes for Adults (18-65 years) Page 7 of 39 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home to carry out the homes main inspection. We visited the home over one day, the home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We talked to two people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at parts of the home, staff and health and safety records. Care Homes for Adults (18-65 years) Page 8 of 39 We were not able to meet with everyone who lives at the home as some people were on holiday when we visited. Some of the people who live at the home were not able to tell us their views because of their communication needs. Surveys were sent to six people who live at the home and two completed surveys were returned, surveys were also sent to six staff, four were returned. Surveys were provided for people to distribute to their relative or representative and we sent four surveys to health professionals, none of these were returned to us. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 39 Staff spend time sitting talking to the people living in the home so that they feel valued. Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals. The people living there go out and do things they enjoy with staff that know them well. Care Homes for Adults (18-65 years) Page 10 of 39 Staff help the people living there to keep in contact with their families and the people that are important to them. There is a choice of healthy food so that people are supported in their diet to keep well. Each person has a Health Action Plan. This is a personal plan about what a person can do and what health care services they need to use to stay healthy. This helps staff to know how to support each person to meet their heath needs. Care Homes for Adults (18-65 years) Page 11 of 39 Each person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there. There is equipment that is in good order to help people be moved safely. What has got better from the last inspection Staff have training to help them understand how to protect the people living there from harm. Care Homes for Adults (18-65 years) Page 12 of 39 Some rooms had been decorated and new furniture bought so it was more homely and comfortable for people to live in. More staff have been employed to work there so that staff that know the people who live there well. Staff recruitment records have got better and most of them show that suitable people had been employed to work with the people living there. The home now has a new manager to help the home improve and get better for people. Care Homes for Adults (18-65 years) Page 13 of 39 What the care home could do better People should have the information they need about the home so they can make a choice about whether or not they want to live there. The systems for administering medication need some improvement to ensure people get the medication they need safely. The frequency of staff supervision should be increased to make sure that staff get the support they need to do their job well. Care Homes for Adults (18-65 years) Page 14 of 39 Health and safety needs to improve to ensure that people are safe. The complaints procedure on display in the home should have our new address so that people are able to contact us if they need to. Staff should have the training they need so they know how to help people to meet their individual needs. Reports about how the home is being run should be available in the home to help ensure the home is being well run. Care Homes for Adults (18-65 years) Page 15 of 39 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kerry Coulter 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 16 of 39 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 17 of 39 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. Prospective new people have most of the information they need so they can make a choice about whether or not they want to live there. Before people move into the home their needs would be assessed to ensure they can be met. Evidence: The home has a service user guide that tells people about the home to help them decide if they would like to live there. At our last inspection we found that the guide had most of the information but needed to be updated to reflect the current management arrangements for the home. Information about the range of fees was not clear, the guide said fees are dependent upon the level of care required based on assessment of need. The guide was in a written format with symbols called widget. The temporary manager said that it was intended to update the guide soon so that it was in a more suitable format for people to understand. At this visit we found that a new version of the guide was near to completion. Two people who live at the home returned a survey to us, they told us that they had received enough information about the home. Page 18 of 39 Care Homes for Adults (18-65 years) Evidence: No new people have moved into the home for several years. At the time of the visit the home had two vacancies but the manager said that due to planned refurbishment of the home it was planned that these would not be filled. The annual quality assurance assessment completed by the manager indicates that a comprehensive assessment would be completed of any potential new person to make sure the home would be able to meet their needs. Care Homes for Adults (18-65 years) Page 19 of 39 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. Staff have most of the information they need so they know how to support people to meet their needs. People make decisions about their lives with assistance from staff where needed and are consulted on all aspects of life in the home. Evidence: We looked at the care provided to two people, this included looking at their care records. Each person had an individual care plan that detailed how staff are to support them to meet their needs. The format of the plans has changed since we last visited the home. We found the new format to be person centred and detailed regarding peoples needs. Care plans reflected the cultural background of the individual and how staff are to support the person to continue to practice their religious and cultural background. Plans covered areas of needs such as health, communication, mobility, eating and drinking, personal care, finances, activities, relationships and likes and dislikes. People had a care plan about the support they needed at night. This said they needed to be checked regularly. We recommended to the manager that the plan should detail what the frequency of checking should be as staff may have different ideas of what regularly Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: means. It is good that monthly reviews take place with the persons keyworker. This helps to make sure peoples plans are up to date and people are getting the care they need. Staff were observed throughout the visit giving people choices about what they wanted to do, eat, drink, what they wanted to watch on television or where they wanted to spend their time. People told us that they either usually or always make decisions about what they want to do. Discussion with the service manager and a member of staff shows that one person at the home is involved in the process of selecting new staff for the home. Meetings are held regularly with people at the home to help seek their views on the running of the home. Topics discussed include meals, activities, things people are not happy about, holidays and decor of the home. Recently people had been consulted about rearranging the furniture in the lounge. Where changes are being made, for example the frequency of reviewing peoples risk assessments, minutes show the reason for the changes is explained to people. A representative of people who live at the home also has the opportunity to attend service sector meetings with people from other Trident homes where wider issues can be discussed. Peoples records included individual risk assessments. These generally stated what action staff need to take to ensure that the risks to the individual are minimised as much as possible. Areas that had been assessed included manual handling, night support, responding to fire alarms, falls, finances and pressure care. Most of the assessments were detailed but a minority were overdue for review. However the homes annual quality assurance assessment told us that the home is working towards a system of reviewing risk assessments on a monthly basis. This should help to ensure that in future all of the assessments are up to date. Care Homes for Adults (18-65 years) Page 21 of 39 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. Arrangements are in place so that the people living in the home experience a meaningful lifestyle. People are offered a varied and nutritious diet to help them stay healthy. Evidence: Most of the people at the home go to day centres and some attend college courses during the week. Records and discussions with people and staff show that activities on offer include food shopping, pub visits, walks, gardening, Irish club, church, cinema, meals out, parks and going to concerts. The homes annual quality assurance assessment told us that one person has recently been supported to get a voluntary administrative job at the headquarters of Trident. Since our last visit to the home they have introduced aspects of Eden Alternatives into the home. This is where peoples well being is promoted through contacts that include animals and plants. Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: Each person has their own activity plan and records show that people are consulted about what they would like to do. It is good that plans include some activity that involves light activity and this helps people to have a healthy lifestyle. Surveys received from people told us that they can do what they want to. One person told us that they like going to the pub for a drink and that staff support them to do this. Information about contact with family and friends was available in peoples care plans, this included how contact needs to be promoted. People said they were supported to maintain contact with their relatives. The manager of the home has had a meeting with peoples family to keep them informed about future plans for the home. A summer barbecue is planned where people can invite their friends and family if they want to. The annual quality assurance assessment indicates that the home promotes peoples social networks and that in the last twelve months three people have been supported to make new friendships in the community. Menus show that meals at the home are nutritious and varied. There is a menu board in the kitchen, this shows what meals are planned in a picture format. Records and discussions with staff show that people get a choice and help with planning the menus in advance. Lots of fruit and fruit juice was available in the kitchen. The fridge was well stocked with food. It was good that there was lots of choice, for example skimmed, semi skimmed or full fat milk. We saw one person being supported with their breakfast and support given by staff was appropriate to their needs. At lunchtime we saw that the person at home was given a choice of what they would like to eat. Care Homes for Adults (18-65 years) Page 23 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are usually sufficient to ensure that the health needs of the people living there are met so ensuring their well being. Minor improvement is needed to the medication system to make sure people get the medication they need safely. Evidence: Care plans included how staff are to support people to ensure their personal care and health needs are met. Attention had been paid to peoples appearance and they were well dressed in clothes that were appropriate to their age, culture and the hot weather. We saw that one persons feet were not positioned properly on the footplate of their wheelchair. It was good that staff also noticed this and took action to make them more comfortable. Records included individual health action plans. This is a personal plan about what a person needs to be healthy and what health care services they need to access. The homes annual quality assurance assessment told us that the home intends to make these documents easier for people at the home to understand. Health records showed that people have regular health checks, for example with the dentist and optician. People have previously had regular chiropody but there had been a couple of months where there had been no input. Discussion with staff indicates that this Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: happened when the chiropodist had been unwell but that the chiropodist is now back at work. Records show that where appropriate other health professionals were involved in their care to ensure their health needs were met. Some people have had assessments of their needs completed by a speech and language therapist or the continence nurse. One person has been referred recently to the physiotherapist due to an increase in them falling. They had a fall a few days prior to our visit. Records showed that the home had obtained medical support following the fall, medical advice was that the person had not obtained any serious injury. The manager and staff told us that they were still concerned about the person as they were not their usual selves and their mobility was greatly reduced. It is good that the manager had acted in the persons best interests arranged for them to have a further assessment on the day of our visit. Some people at the home use a wheelchair and this may put them at an increased risk of having pressure sores. Records and discussion with the manager show that a referral has been made to the district nurses to help in reassessing people regarding their risk of developing pressure sores. Discussions with staff indicate that no one at the home had a pressure sore when we visited the home. One person did have a small sore last year and records showed that the home had quickly sought assistance from the district nurse and that the sore had soon healed. We looked at medication procedures in the home. Medication is stored in a locked cabinet. The cabinet was clean and organised into sections for each person to help ensure that it is clear which medication belongs to whom. Each person has their own guidelines that inform staff how they like to take their medication. Staff who administer medication have been trained to do so. There is a photograph of the individual at the front of their Medication Administration Records (MARS) to ensure that it is clear who to give the medication to. Some MARs had handwritten amendments made to them, the person who had made the amendment had not signed these. These should be checked and signed by two staff to make sure any changes are accurate and in line with the prescription. This was something we also recommended at our last inspection of the home. Detailed guidance was in place for people who are prescribed medication as required for constipation so that staff know when they need to give this medication. One person is prescribed medication on a variable dose basis, this means that staff can give them either one or two tablets. When staff administer this medication they sign the MAR chart but do not indicate on it how many tablets have been given. This needs to be done to make sure it is possible to track that people are having the medication they need. We looked at the most recent MAR chart for one person, this showed us that one persons medication had been increased from one sachet a day to twice daily. However staff Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: administering medication had not read the MAR correctly and had continued to give only one sachet. Luckily this had only happened for two days until we brought this to the service managers attention. The home needs to make sure that medication is given in line with the prescription so that people get the medication they need to stay healthy. Care Homes for Adults (18-65 years) Page 26 of 39 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. Arrangements ensure that the views of the people living there are listened to and acted on and they are protected from abuse, neglect and self harm. Evidence: The complaint procedure was on display in the home. This is in a written and widget (symbols) format. We noticed that the procedure gives our old address as a contact point, this means that people may not know how to contact us if they need to. We brought this to the attention of the services manager who said that this procedure was due to be updated into a pictorial format that would be easier for people to understand. They told us our new address would be added to this. People who live at the home who returned our survey told us they knew how to make a complaint. Staff told us they knew what to do if someone had a concern about the home. We have not received any concerns or complaints about this home in the last twelve months. The home had received one complaint directly about staff comments about a visitor to the home. Records were available in the home to show this had been investigated and the outcome sent to the complainant. The home has polices and procedures on safeguarding people at the home, these are available to staff. It is good that there is also information available to people at the home in an easy read format about prevention of abuse. Staff at the home have received training on safeguarding people from abuse and staff Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: that we spoke to at this visit knew what to do to keep people safe. Records of staff meetings and supervisions show that safeguarding procedures are reinforced with staff during these meetings. Staff records sampled showed that before staff start working at the home a Criminal Records Bureau (CRB) check is completed to help ensure they are suitable to work with the people living there. The financial records for one person who lives at the home were sampled; receipts were available for all expenditure. Records had been signed by two members of staff, but some had been signed by only one. It is good practice that the service manager audits these records on a regular basis as part of their monthly visits to the home, this increases the financial safeguards in place for people. Care Homes for Adults (18-65 years) Page 28 of 39 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 homely, comfortable, safe and clean environment that meets most of their individual needs. Evidence: The home has an open plan lounge and dining room. Since the last key inspection these areas have been repainted and new settees purchased. People who live at the home have been involved in choosing the colours and new layout of furniture. Generally the environment is homely in style but the number of poster type information on the walls in the dining room has increased, for example about the prevention of abuse. Whilst the information is useful to people the home needs to limit the amount on display so that it does not detract from the homely style of the home. Peoples bedrooms contained many personal possessions. Bedrooms were at a comfortable temperature and were clean. One person who showed us their bedroom told us they were happy with it. They told us they liked the new flower pots outside their bedroom and got involved in watering them. Some people have mobility difficulties and so some bedrooms are fitted with overhead hoists so that staff can help them to transfer more easily. This home is intended to specifically meet the needs of people who have a physical disability however the laundry is located on the first floor and can only be accessed by Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: people who are able to use the stairs of the stair lift. The annual quality assurance assessment and discussion with the service manager indicates that Trident is looking to make alterations to the home so that the laundry can be located on the ground floor. The kitchen was clean and had satisfactory hand washing facilities. Kitchen cupboards were in good condition but we noticed some areas of minor damage to worktops. Discussion with the service manager indicates that the kitchen will be refurbished when alterations are made to the environment. Surveys from people told us that the home is always fresh and clean. Care Homes for Adults (18-65 years) Page 30 of 39 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. The arrangements for staffing the home, their recruitment, support and development are variable and may not ensure that the needs of people living in the home are met. Evidence: Support to people who live in the home is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Surveys from people at the home told us that staff treat them well. Members of staff demonstrate that they have a good knowledge of the individuals in their care. The annual quality assurance assessment stated that most the care staff have achieved a National Vocational Qualification in Care. This is excellent and means that people are supported by well qualified staff. Previously the home has had several staff vacancies and so had to use agency staff to cover these. Since our last visit the home has employed more staff so that they do not have to use agency staff regularly. This means that people are supported by staff they know well. One staff told us its much better for the people who live here as they know the staff. There were enough staff on duty at time of our visit to meet peoples needs. Surveys from staff indicate there are usually enough staff on duty, however one staff commented that it would be better if there were more staff in the evenings so that people could go out more. Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: It is good that people who live at the home are involved in the recruitment of staff and have had training to do this. The recruitment records for four members of staff were looked at. These showed that checks undertaken included references and a criminal record bureau check prior to staff working in the home to help make sure they were suitable. For one staff there was not a reference from their last employer. It was not clear from the records why there was no reference. The service manager told us this was because their last employer had been in another country and it had not been possible to contact them. However three references had been obtained for them instead of the usual two. It is recommended that any problems in obtaining references for staff are documented in their file so there is an audit trail to show that a robust procedure as possible has been followed. Staff told us that their induction to the home had mostly covered what it needed to and the training they get is relevant to their role. One staff who had worked at the home told us that previously they did not get any training but that this had now improved. The home does not have a training matrix that gives an overview of what training the staff team have completed. It would be beneficial to complete this as it would make it easier to establish any gaps in training. The manager told us that staff training records were not up to date but showed us evidence that in the last month staff had completed training in food hygiene, infection control, health and safety, safeguarding people from abuse and manual handling. The manager said that training was in the process of being arranged for first aid and fire. Some staff have previously had training in the Mental Capacity Act, the manager told us this would be refreshed to include the new Deprivation of Liberty Safeguards legislation. Minutes of staff meetings sampled showed that these were held regularly. These included discussions about how to meet the needs of the people living there and training issues. One meeting had been used for a team building exercise. The annual quality assurance assessment told us that staff have regular supervision. However surveys from staff, reports in the home from the service manager and our sampling of supervision records showed that not all staff have regular supervision. Staff should have supervision at least every other month so that they get the support they need to do their jobs. Care Homes for Adults (18-65 years) Page 32 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to have a registered manager to help ensure the home is well run. People can generally be confident that their views underpin all self-monitoring, review and development by the home. Arrangements in the home need to be improved to help make sure peoples health and safety is promoted and protected. Evidence: The home has been without a registered manager in post since September 2007 and during this time has had several different acting managers. The home has now recruited a new manager who started working in the home several months ago. However we have not yet received an application for registration from them. Discussion with the new manager indicates they have many years care experience. Discussion with two staff indicates they feel the home is improving now that it has a permanent manager. The manager sent us the annual quality assurance assessment when we asked for it, this was completed to a good standard and told us where the home thought they needed to improve and what they were going to do about it. The service manager told us they visit the home monthly to undertake an audit of the Care Homes for Adults (18-65 years) Page 33 of 39 Evidence: home. However there were not many reports of these visits available when we visited. Reports that were available were detailed and showed that people who live at the home and staff were consulted during the visit. Minutes of meetings held with people show that the home seeks and listens to their views. At our last inspection we were told that Trident is trying to improve peoples involvement in quality assurance process and were putting together new customer satisfaction surveys. We did not see any of these that had been completed at this visit but the service manager said the home is looking to involve people more in quality assurance. We were told that this year it is planned to do an annual assessment of how the home is performing. Health and safety in the home is adequately managed. Water temperatures are checked regularly, these were observed to be within safe levels so that people are not at risk of scalding. The fire procedure was on display, this is in an easy read format that includes pictures so that it is easier for people to understand. Fire records showed that staff test the fire equipment to make sure it is working. Tests of the emergency lighting for the last three months before our visit showed that one of the emergency lights was not working. Records showed that this had been reported by the home but had still not been repaired. The manager told us this was because the home had been changing contractors and that the light would be repaired in the next seven days. An engineer regularly services the fire alarms. A recent fire drill had been held to make sure staff know what to do if a fire occurs. Staff training records did not show that all staff have had regular updated training in fire safety so they know how to keep the people living there safe. It is good that one staff at the home has recently completed a four day in depth first aid course. However some staff need training in first aid so that they would know what to do in a medical emergency. The manager told us this training was in the process of being arranged. A fire risk assessment had been completed but this had not been reviewed for over a year and a half despite the service managers monthly reports identifying this needed to be done. An electrician had completed a test of portable electrical appliances to make sure they are safe to use. Certificates were available to show that the hoists had been serviced and were safe for people to use. Care Homes for Adults (18-65 years) Page 34 of 39 Are there any outstanding requirements from the last inspection? Yes  No  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 39 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 Description 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 Description Timescale for action 1 20 13 Medication must be given in line with the prescription. So that people get the medication they need to stay healthy. 07/08/2009 2 20 13 When staff administer medication prescribed as a variable dose they need to indicate on the MAR how many tablets have been given. 07/08/2009 This needs to be done to make sure it is possible to track that people are having the medication they need. 3 37 10 The person managing the home needs to make an application for registration with the Commission. 07/09/2009 Care Homes for Adults (18-65 years) Page 36 of 39 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 Description Timescale for action This is to make sure they are competent to manage the home. 4 42 13 Repairs to the emergency 31/07/2009 lights need to be carried out. To ensure that peoples health and safety is protected in the event of a fire occurring. 5 42 13 Following assessment of their 07/10/2009 needs staff should receive appropriate training in fire prevention and first aid. To help ensure staff know how to meet peoples health and safety needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The new version of the service user guide needs to be completed and made available to people so that they have all the information they need about the home in a format that is easier to understand. The homes intended policy of reviewing risk assessments on a monthly basis should be fully implemented so that all risk assessments are up to date. This will help ensure staff have the information they need to help keep people safe from harm. 2 9 Care Homes for Adults (18-65 years) Page 37 of 39 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 3 20 Where handwritten amendments to the directions on medication administration records, these should be signed by two staff to ensure the amendments are accurate. Update the complaints procedure on display in the home with our new address so that people are able to contact us if they need to. any problems in obtaining references for staff should documented in their file so there is an audit trail to show that a robust procedure as possible has been followed. A training matrix should be completed that gives an overview of what training the staff team have completed and make it easier to establish any gaps in training. The frequency of staff supervision should be increased to make sure that staff get the support they need to do their job well. Monthly reports of the service managers visits should be available in the home to make sure it is being well run. The fire risk assessment should be reviewed to make sure the fire precautions in the home are satisfactory. 4 22 5 34 6 35 7 36 8 9 39 42 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 39 of 39 - 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!