Inspection on 21/05/09 for Greenacres Cheshire Home

This inspection was carried out on 21st May 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenacres Cheshire Home 28/06/07

Greenacres Cheshire Home 14/11/06

Greenacres Cheshire Home 15/06/06

Greenacres Cheshire Home 23/01/06

Greenacres Cheshire Home 21/06/05

Greenacres Cheshire Home 25/11/04

Greenacres Cheshire Home 10/06/04

Greenacres Cheshire Home 13/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Greenacres Cheshire Home 39 Vesey Road Sutton Coldfield West Midlands B73 5NR     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: Amanda Lyndon     Date: 2 1 0 5 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 32 Information about the care home Name of care home: Address: Greenacres Cheshire Home 39 Vesey Road Sutton Coldfield West Midlands B73 5NR 01213547753 01213546065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.LCDisability.org Leonard Cheshire Disability care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 32 Date of last inspection Brief description of the care home Greenacres provides nursing and residential care and accommodation for up to thirty two younger adults who have a physical disability. The home is situated close to Sutton Coldfield Town Centre near to community facilities, leisure activities, and public transport links. There is off road car parking to the front of the building for several cars including reserved parking for vehicles belonging to people living at the home. There is a garden that is accessible to all people living at the home. Peoples bedrooms are spread over two floors and offer single accommodation. Seventeen of these have an en suite toilet facility. Upper floor rooms are accessed via a passenger lift. A bungalow that is accessed via an enclosed walkway from the main building provides accommodation for four people with lower dependency care needs. There are four Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 32 Brief description of the care home lounges, a dining room, bar area, cafe, and smaller seating areas around the home. Smoking is not permitted within the building. There are assisted bathing and toilet facilities which meet the assessed needs of the people who live at the home. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has specialist equipment to meet the assessed needs of individual people. Facilities provided include an art studio, computer suite and hair salon. In the reception area of the home there is a range of information which may be of interest along with details of forthcoming events. A copy of our last inspection report, statement of purpose and service user guide are displayed so that people can read them if they choose. In addition people told us that they obtain their own copies of our reports directly from us. The service user guide includes details of current fee rates. The weekly accommodation fee charged is between £800 for people receiving residential care and £1400 for people with complex nursing care needs. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on areas that need further development. The date of the last key visit at this home was 28th June 2007. Prior to the visit taking place, we looked at all the information that we had received or asked for. This included any complaints made or notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We received a comprehensive Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of people living there. It also gives us some numerical information about staff and people living at the home. Care Homes for Adults (18-65 years) Page 6 of 32 We sent out random questionnaires to ten people who live at the home, ten relatives and two health care professionals in order to obtain their views about the service provided. Shortly following the visit one person living at the home, their relative, and a health care professional returned surveys to us, and their comments are included in this report. The visit to the home was undertaken by two inspectors over one day, and We, the Care Quality Commission, were assisted throughout by the people living at the home, the general manager, care supervisor, and the staff team on duty that day. The home did not know that we were visiting. There were thirty people living at the home on the day of our visit. Four people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to staff about the care they provided to these people. In addition we spent time speaking with six other people living at the home, two relatives, and six staff. We sampled care, staffing, and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean, and comfortable for them. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: People living at the home do not always receive healthcare and personal support in a Care Homes for Adults (18-65 years) Page 8 of 32 timely fashion, and this has compromised their health, well being, and dignity. Wound care records should include details of any treatments and interventions, so that the effectiveness of these can be monitored. Systems in place for the recording of medication need to be improved in order to ensure that people are receiving medication as prescribed. Personal information relating to all people supporting people living at the home should be available for inspection. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. Admission processes are thorough, and people living there can be confident that their care needs will be met. Evidence: A statement of purpose and service user guide had been produced and these included information about the services and facilities provided at the home. These are produced in large print formats and are available in other languages and formats on request so that everyone can access the information. These included a copy of our last inspection report and a copy of the complaints procedure. Details of the arrangements in place for people who choose to smoke were not included, however we were told that the documents were in the process of being updated. We sampled the pre admission assessment of a person who had recently come to live at the home. We saw that senior staff undertake comprehensive pre admission assessments in order to determine whether their assessed care needs could be met whilst living there. In addition people are invited to spend time at the home in order to sample what life would be like to live there. This not always possible as Greenacres Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: provides a specialist service and people come to live there from all parts of the country. One person who had recently come to live at the home told us that his Wife came and viewed the home prior to him coming to live there. When people come to live at the home, they are introduced to other people there and are shown around the home. This helps them to settle in and to get a feel for the home from the people who live there. We met with a person who had recently come to live at the home. He said I like the atmosphere. The staff and people here are very friendly. I am happy with my room. Care Homes for Adults (18-65 years) Page 12 of 32 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 that live in the home receive good support to make choices and decisions about their day to day lives, so that they lead lifestyles that meet their needs and expectations. Evidence: On coming to live at the home, comprehensive assessments of peoples individual care needs are undertaken. These include details of their preferences so that their preferred routines can be maintained whilst living at the home. Care plans are devised from this information. These are individualised plans about what the person is able to do independently, and states what support is required from staff in order to meet the persons needs. Care plans were sampled for four people living at the home. It was evident from the records that people and their families are involved in the development and review of their care plans. In addition we were told that people living at the home were involved in introducing a new care planning system that would be more user friendly and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: accessible to them. A key worker system was in place so that a designated staff member works alongside each person living at the home, in order to understand their specific needs better. From discussions with staff it was evident that they had a good understanding of peoples specific care needs. One relative who completed a survey said that Greenacres provides all the care my Husband needs to live life to an acceptable standard despite his condition. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks, and promote their independence. From discussion with staff and people who live in the home, it was evident that people are encouraged to maintain and develop their independence. Care records identified that people living at the home and their representatives are invited to care reviews with the homes staff and social workers in order to discuss their care, and put forward any suggestions for improvements. One person said I have got my care review with my social worker next week and also the staff from here arrange reviews as well. From discussions with people living at the home, staff, and sampling of records, we evidenced that people have choices and make their own decisions about their daily lives. This includes the times they get up, the times they go to bed and what they spend their money on. Peoples preferred names were recorded within their care plans, and we heard staff greeting them by these names. People confirmed that they are supported to buy and wear clothing that is appropriate for their age, gender, culture and lifestyles. One person said I get up early at 6am as Id rather get up at that time to have my shower. I have my breakfast at 8am which suits me great as I dont like to eat when I first get up. Another person said I have lived here for nearly 12 years, so something has got to be right. People have a key to their bedrooms so that they have independence and privacy in this area. One person met during the visit however said that she was unable to manage the lock and this was brought to the attention of the general manager for action. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Regular group meetings are arranged for people living at the home and their relatives so that they have the opportunity to discuss the services provided at the home. The minutes of recent meetings and dates of forthcoming meetings were on display so that people could access this information. One person said We have a choice of if we want to go to the residents meeting. Sometimes they are boring as we discuss the same things each time. If you want to bring anything up its good. One of the residents is the chair person. I am happy that I state my views. Care Homes for Adults (18-65 years) Page 15 of 32 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 who live in the home experience a meaningful lifestyle that promotes their independence and is reflective of their individual needs and interests. Evidence: There are two part time activity co ordinators working at the home. From discussions with people living there, staff and our observations during the visit, it was evident that people are encouraged to pursue any interests that they had prior to coming to live at the home. People are consulted and staff including a team of volunteers, strive to arrange activities both within and outside of the home to meet the needs and interests of people living there. The activity co ordinator said We accommodate people at different times to suit them. People are informed about forthcoming events via noticeboards in the home, meetings, and newsletters. People are encouraged to pursue their talents, for example, one person living at the Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: home is very artistic and an art studio was available. People also have unlimited access to a computer suite. People told us that they are supported to develop new skills. One person said The activity lady is going to teach me how to use the computer. The latest edition of the homes newsletter was on display. This included information about life at the home and both local and national news, so that people were kept updated about current issues. The hairdresser visits each week, and there is a hair salon so that people can enjoy the experience of having their hair done. Arrangements are in place so people can follow their religious beliefs if they wish. People are supported to maintain links with the community thus lead fulfilling lifestyles. People attend local colleges and work shops and one person said I still use my car regularly and get the driver to drop me into Sutton to do my shopping. There are two minibuses available for people living at the home to use for trips out. People are encouraged to maintain relationships with the people important to them. There is an open visiting policy and people can choose where they meet with their visitors. The home has a pub staffed by volunteers that people can go to with their friends and families if they wish. We met with the parents of a person living at the home on their return from taking him out to the dentist. They told us We are happy with everything here and are volunteers here ourselves. People have a choice of where they are served their meals, and menus identified a variety of nutritious meals. A choice of meals is always available and in addition people have the option of choosing snacks at other times. Special diets are prepared for reasons of health, culture, and religion, and catering staff met during the visit had a good understanding of this. During the visit people told us that they were enjoying their meal. Dining tables were laid attractively drinks were served and seating was arranged to promote social interactions between people living there. One person told us We get a choice of food and I have snacks in my room for other times. An environmental health inspection had recently been undertaken, and the home was awarded five stars. This means that food is prepared in a hygienic manner. Care Homes for Adults (18-65 years) Page 17 of 32 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. Systems in place do not always meet peoples personal and health care needs, and this places them at risk of harm. Evidence: The personal and health care plans of four people living at the home were sampled at this visit. Information was available about the health conditions of people living at the home, and any associated risks involved with these. These included information about peoples preferences and we saw that people and their families were involved in the planning of these. One person said I have a shower every morning. This is my choice. Care plans had been written about care to be provided for short term conditions, however the information in these often contradicted that included in the current care plan file. This may result in confusion about the actual care to be provided. In addition staff had on occasions failed to record the care provided within the care plans but had recorded this on separate documentation. Staff had failed to start a wound chart to describe the the treatment. We discussed this with the care supervisor who confirmed that this should have been done. We saw that skin inspection charts had not been Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: completed at the times that they should have been, and this means that people may be at risk of developing sore skin. In other instances staff had failed to record on the care plan the actual care to be provided, and had on one occasion identified that a turn chart was in place when in fact this was not the case. This means that permanent or agency staff may not know what specific support is required. From discussions with staff during the visit, however, we evidenced that they had a good understanding of the care needs of people case tracked. People can retain their own doctor on admission to the home, if the doctor is in agreement. Advice can be sought as needed from a range of other health and social care professionals. A number of people are supported by external specialists to obtain equipment in order to improve the quality of their lives, for example to assist with communication and mobility needs. Information obtained from a survey completed by a health care professional who visits the home said that The home respects people, maintains dignity, and always ensures clients are forefront of decision making. We did, however, evidence that on one occasion, there had been an unnecessary delay in staff seeking medical advice for a person who was unwell. This in turn resulted in a three day delay in the person starting antibiotics for an infection. This was brought to the attention of the general manager for further investigation. A physiotherapist is employed at the home four days a week, and positive feedback was obtained about the service provided by this person. One person living at the home who completed a survey said I really value the physiotherapy sessions. Safe handling plans gave detailed and clear instructions for staff about how peoples needs can be met in this area. The training matrix identified that staff had undertaken moving and handling training, however it also identified that the majority of staff had not received refresher training. We saw however that forthcoming training dates in this area had been planned, and we did not observe any poor practices during our visit. From previous complaints made, discussions with people living at the home, records held at the home, and our observations on the day of the visit, we identified that people were waiting for long periods of time for staff to respond to call bells. This has led to people not being assisted with their toileting needs at the times they require, and as a result of this their dignity has been compromised. We were told that this was due to staff members assisting other people in their bedrooms, however during our visit we saw that on occasions staff had failed to respond to calls, despite being in earshot of the call system. We looked at the system in place for the management of medication, and saw that Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: staff had recently undertaken training about this. Stock balances of medication sampled during the visit were correct and refrigerated items are now stored at the correct temperature. Medication administration charts were well maintained, however where a variable dose of medication is prescribed the number of tablets given have not been recorded. This means that there is not an accurate record of the dose administered. In the event of staff requesting that medication is discontinued details of medical consent regarding this was not always available. This should be recorded in order to protect both the person living at the home and the staff team. Care Homes for Adults (18-65 years) Page 20 of 32 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 people living at the home are listened to, and they are safeguarded from harm. Evidence: The complaints procedure was included within the service user guide, and leaflets were available in the home. It was produced in a large print colour format making it easy to read, and included easy to understand information. People living at the home told us where these leaflets could be found and that they are aware of how to make a complaint. During the past twelve months we have been told about five complaints regarding the home including allegations of a safeguarding nature. Issues raised included two allegations about peoples personal belongings being either missing or stolen. There was evidence that actions had been taken in order to address issues raised for the benefit of people living at the home. We looked at the complaint register held at the home, and this included details of the complaints that we were already aware of, and an additional eight. Concerns raised included the general standard of care at the home, the length of time taken for staff to answer call bells, and lack of continuity of care when agency staff are on duty. In response to the safeguarding issues raised, a monitoring visit was undertaken at the home in May 2009 by Coventry City Council. From records held at the home, it was Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: evident that complaints are taken seriously, are investigated thoroughly, and the outcomes of these are feedback to all concerned. The training matrix identified that the vast majority of staff had undertaken recent training about the protection of vulnerable adults. The adult protection policy was in line with local multi agency guidelines and staff met during the visit had an understanding of safeguarding procedures. This should mean that people are protected from harm. The home do not manage the money of people living at the home, however there is a robust system in place for the safekeeping of small amounts of peoples money. Care Homes for Adults (18-65 years) Page 22 of 32 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 clean, safe and comfortable environment that meets their needs. Evidence: Greenacres is situated in a residential area of Sutton Coldfield. There are a range of shops, leisure activities, and public transport links nearby. This is important to the people who live there as they make regular use of these amenities. There was a rolling programme of redecoration and refurbishment in place, so that people were provided with a clean and homely place to live. One person living at the home met during the visit said Lots of money has been spent on the interior and exterior of the home. Bedrooms were located on both floors of the home, and these offer single accommodation. These had been personalised to reflect the age,gender, and interests of the people living at the home, and people were able to re decorate if they wished. Bedrooms were equipped with specialist equipment that met peoples assessed needs for example, ceiling hoists and profile beds. Staff told us that other equipment available at the home such as showering and bathing facilities, and pressure relieving equipment met the needs of the people living there. There is a bungalow that is accessed via an enclosed walkway from the main building, that provides accommodation for four people with lower dependency care needs. We Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: saw that some areas of the bungalow are in need of redecoration and the kitchen had been taken out of use. People living in the bungalow met during the visit said that they were happy to have their meals in the main building. Visitors now access all areas of Greenacres via the main entrance and report to the person on the reception desk. This promotes the safety of people living at the home. There are four lounges, a dining room, bar area, cafe, and smaller seating areas around the home, and people can choose which of these they use. Facilities provided include an art studio and computer suite. Corridors and doorways are wide and push buttons are provided at wheelchair height so that doors can be opened, and people can independently move around the home as they wish. There is a garden that is accessible to, and suitable for all people living at the home. Since our last visit, improvements had been made in this area and a sensory garden is near completion. Plans are in place to install a new pendant style call bell system, so that people using the garden can call for assistance from staff. There was an effective system for the cleaning of peoples personal clothing and bed linen. We saw that the home was clean and fresh throughout. We saw however, that medication pots had been turned face down to dry onto a radiator in one of the corridors, and this may result in the spread of infection. This was brought to the attention of the care supervisor for action. The general manager told us that the longstanding problems with the hot water and central heating system had been resolved. Hot water outlets sampled during our visit were satisfactory, however people told us that the temperature of water from shower outlets could be too cold, dependant on whether other people were using water at the same time. This was brought to the attention of the general manager. Care Homes for Adults (18-65 years) Page 24 of 32 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. People are cared for by staff that is deemed to be suitable to work with younger adults so that they should receive a good standard of care. Staff are not always available to provide support to people at the times they require and this places them at risk of harm. Evidence: From discussions with staff and sampling of staffing rotas, we identified that there are two nurses, and between seven and nine carers on duty during day time hours. There is one nurse, and three carers on duty overnight. One staff member said Its better now. There are enough staff. We have a floater which is a big help. Its an extra pair of hands. We were told that there is one full time nurse vacancy for night duty and one carer vacancy. Administration, activity, maintenance, cleaning, laundry and catering staff are also employed, so that people are supported in all areas of their lives. People living at the home and staff told us that the use of agency staff had reduced recently, and on the majority of occasions when agency staff are used, regular workers return. This promotes continuity of care for the people living at the home. One person living at the home said There is not a high use of agency staff. I am quite Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: pleased with the agency people we have. They come regular now and do a good job. There was one agency worker at the home on the morning of our visit and the staffing rota reflected this. Staff met during the visit were able to answer our questions about peoples care and support needs with confidence. As identified previously within this report, we evidenced that there were occasions when people were left for unacceptable lengths of time before staff answered their call bells. This has resulted in people not receiving the care that they require and their dignity being compromised. People living at the home told us that they take part in the selection of new staff so that they have a say in who supports them. Volunteers are employed and we were told that they have to go through the same recruitment process as permanent staff. We asked to examine examples of volunteer recruitment files, and were told that in the absence of the volunteer co ordinator these were not available. Staff recruitment files sampled for new workers contained all information required to deem the people suitable to work with younger adults. Due to unforeseen circumstances, staff training records were not available on the day of our visit however a copy of a staff personal development plan and a training matrix were sent to us shortly after the visit. We spoke with a new member of staff who confirmed that she had undertaken induction training in health and safety matters. The training matrix identified that there is a rolling programme of training so that staff have access to regular sessions and updates to assist them to care for the people who live there. This showed that staff had recently undertaken training in a number of areas including wound care, health and safety, care planning, first aid, fire safety, food hygiene, swallowing disorders and risk assessing. One staff member met during the visit said They are hot on all training. There are currently 66 of staff who have completed a National Vocational Qualification (NVQ level 2 in Care) so that they should have the necessary skills and knowledge to provide a good standard of care. Records identified that staff meetings are held regularly. This means that staff are involved in the running of the home, and are kept up to date with training and development opportunities. Care Homes for Adults (18-65 years) Page 26 of 32 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. There are systems in place to protect and promote peoples health, safety and welfare. Evidence: The manager has been in post for the past two years, and was on leave during the visit. In his absence alternative arrangements for managerial cover were in place, so that the home would be managed effectively. This report has identified some of the ways that the views of people are sought, such as group meetings and their involvement in the recruitment of staff. We saw that people living at the home are encouraged to cover the reception desk, meet and greet visitors to the home, and are available to answer any questions that visitors may have. We were told that questionnaires had recently been distributed to people living at the home in order to find out what they think about the home and how they can improve. Prior to the inspection, the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This included comprehensive Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: details about the home, staff, and people who live there, and what the service hoped to achieve for the benefit of the people living there. Senior external managers undertake regular quality monitoring visits at the home, and there was evidence that people living there are involved in these visits. Health and safety and maintenance records sampled were up to date, and any hazards identified were rectified. This means that that people can be confident that their health and safety is promoted. People living at the home are part of the health and safety committee, and this further endorses their involvement in the running of the home. Accident records were well maintained and regularly audited, and there was evidence that actions are taken to reduce the risk of accidents of a similar nature from occurring again. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 12 Care records must include 30/06/2009 up to date information about the specific support required by people. This is so that the effectiveness of care provided can be monitored, in order to meet peoples health care needs. 2 18 12 Systems must be in place so 30/06/2009 that people receive care and support at the times that they require. This is to ensure that their health, welfare and dignity is maintained. 3 20 13 Systems in place for the recording of variable doses of medication must be reviewed. So that it is possible to determine the amount of medication given. 30/06/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 20 The system in place for the recording of medication that has been discontinued should be reviewed, in order to protect people living at the home and the staff team. Arrangements should be in place so that the personal records of all staff and volunteers are available at the home. 2 34 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 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. 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