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Inspection on 27/10/08 for 29 Greenhill Road (westholme)

Also see our care home review for 29 Greenhill Road (westholme) for more information

This inspection was carried out on 27th October 2008.

CSCI found this care home to be providing an Good service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Admission procedures are satisfactory and ensure the home can meet people`s needs. Staff often ask the people living there what they think of the home and how it could be better. People who live at the home have an annual review. It is good that staff work with people before the review to seek their views. Support to people is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. People who live there do the activities they enjoy doing and that help them to develop skills and meet their needs. The staff are very good at helping people stay in touch with their family. This includes making phone-calls, writing letters and in person. People have lots of fruit and vegetables and get the food they like. The home has a satisfactory complaints procedure that ensures complaints are appropriately investigated. The premises is generally in good order, making the home a nice place to live. Each person has their own bedroom that is decorated in the way they have chosen. Staff are trained in safeguarding people from abuse so that people are protected and appropriate action is taken if abuse is suspected. There is a quality assurance system that asks what the people living there think about the home so that their views make a difference to the service provided.

What has improved since the last inspection?

Improvements have been made to the medication administration system so that people get the medication they need safely. An extractor fan has been installed in the bathroom in Hilltop so it has better ventilation. The home now obtains information about agency staff so that people are safeguarded from having unsuitable staff working with them. A manager has been registered with us to help the home to be managed well. Staff make sure they often do the fire and health and safety checks to make sure that the people who live there, staff and visitors are safe.

What the care home could do better:

Processes for staff having access to updated care plans need to be speeded up so that they have all the information they need to help them meet peoples needs. Where people have put on or lost significant weight their care records should fully record what action staff have taken in response to ensure their health is maintained. it is recommended that where handwritten amendments are made to medication administration records two staff should check and sign the amendments to make sure they are accurate. The missing panelling in the bathroom on Westholme needs repair so that the bathroom is well maintained and a nice room to use. A full analysis of the homes staffing needs should be undertaken to ensure there are enough staff on duty. Training needs to be arranged for staff regarding pressure care to ensure they have the right skills and knowledge to help prevent sores developing and know what to do if they occur.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Greenhill Road, 29, (westholme) Greenhill Road, 29, (westholme) Moseley Birmingham West Midlands B13 9SS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Greenhill Road, 29, (westholme) Greenhill Road, 29, (westholme) Moseley Birmingham West Midlands B13 9SS 01214496383 01214496573 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: TRACS Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: 14 people requiring care for reasons of learning disability or acquired brain injury (14 LD,PD) Residents must be aged under 65 years Date of last inspection Brief description of the care home 29 Greenhill Road comprises of two units, TRACS Westholme, and TRACS Hilltop. The home is registered to accommodate up to fourteen people who have a Learning Disability or Acquired Brain injury. Three of the rooms within the accommodation on the ground floor have been adapted to support people with impaired mobility. The remaining bedrooms are on the first floor and second floors. Westholme has a communal lounge, dining room, smoke room, kitchen, bathrooms and toilets on both floors. Hilltop occupies the second floor of the home. Hilltop provides care and support for up to four people working towards more independent living. It offers people the opportunity to develop skills such as budgeting, cooking, home making and taking greater responsibility for planning their lifestyle. This area of the home has its own Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 14 14 Brief description of the care home facilities such as a lounge, kitchen, laundry and bathroom. The home has a large, mature garden at the rear. The home has its own transport, and is located close to local bus routes. Copies of CSCI reports are available in the home, on request. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit was carried out over two days, the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2008 to 2009. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home called an Annual Quality Assurance Assessment (AQAA). Four people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the Care Homes for Adults (18-65 years) Page 6 of 33 service. Surveys were received from three people who live at the home and five staff. People who live at the home were also spoken to during the visit. Their views of the home are reflected in the report. We looked at some parts of the home and we sampled some records to include staff and health and safety. During the visit we spoke with staff and the deputy manager, the manager of the home was on annual leave when we visited. The current scale of charges for living at the home, as recorded in the service user guide dated June 2008 ranges from one thousand and two hundred pounds to one thousand five hundred pounds per week. The fee information included in this report applied at the time of the inspection and the reader may wish to obtain more up to date information from the care service. What the care home does well: What has improved since the last inspection? Improvements have been made to the medication administration system so that people get the medication they need safely. An extractor fan has been installed in the bathroom in Hilltop so it has better ventilation. The home now obtains information about agency staff so that people are safeguarded from having unsuitable staff working with them. A manager has been registered with us to help the home to be managed well. Staff make sure they often do the fire and health and safety checks to make sure that the people who live there, staff and visitors are safe. Care Homes for Adults (18-65 years) Page 8 of 33 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to moving into the home so they can be confident their needs can be met by the home. Evidence: Copies of the homes Statement of Purpose and Service User Guide were observed to be readily available to people in the home. As recommended at the last inspection they have been updated to reflect the new management arrangements in the home. The documents included relevant information so that prospective service users would have the information they need to make a choice as to whether or not they want to live there. Some new people have moved into the home since our last inspection. We looked at the admission procedures followed for one new person. Prior to them moving in a detailed assessment of their needs had been completed. This covered areas such as health and personal care, communication, meals, activities, mobility and behaviour. Records showed that they had the opportunity to visit the home to see if they wanted Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: to live there. They also had the opportunity to choose which bedroom they wanted from those available. We spoke with another person who was quite new to the home, they told us that they had wanted to move there and that they liked the home. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have most of the information they need to support people to meet their needs and keep them safe so ensuring their well being. The people living there are supported to make choices and decisions about their day-to-day lives. Evidence: The care provided to four people was tracked, this included looking at their care records. Each person had an individual care plan that stated how staff are to support the individual with their daily routine, sleeping, diet and nutrition, their communication needs, the things they like and dislike including activities and leisure interests, the things they need help with and the things they can do on their own. Care plans were generally detailed and person centred. Care plans cross-referenced to other documents where appropriate such as behaviour management strategies so that it was clear to staff how to support the person in all areas of their life. People who live at the home have an annual review. It is good that staff work with Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: people before the review to seek their views and they are encouraged to attend their review meeting, which includes staff, relatives and other care professionals as appropriate. All of the care plans sampled had been reviewed in the last six months so that most of the information was current and reflected individual needs. One plan had been reviewed but had not been updated. The deputy manager said that the plan had been sent to headquarters for amending and printing. The deputy manager was able to obtain a copy of the new plan, this was dated as reviewed in August. This means that staff were having to use an outdated care plan for a couple of months. Whilst staff did have access to an evaluation sheet that detailed the changes made this had to be read in conjunction with the care plan. It is recommended that processes for staff having access to updated plans are speeded up so that they have all the information they need to help them meet peoples needs. People had clearly made choices within their care plan, for example completing declarations about how often they wanted to be checked during the night by staff. Staff were observed to consult with people during the visit, for example about what they wanted to drink and if they wanted to go out. People told us in the surveys that they sent us that they were able to make decisions. It is good that peoples meetings are held regularly so that they have an opportunity to say how the home should be run. Issues discussed included activities, holidays and menus. The minutes of meetings are put on display in the home for people to read. Some people may struggle to read the minutes as they are handwritten and not always easy to read, consideration should be given to typing the minutes. Tracs also holds an annual focus day where people from across all the homes in the area have the opportunity to attend and are consulted about their views of the service. Records sampled included individual risk assessments. These detailed the support the person needed to be as independent as possible whilst minimising the risks to their safety and well being. Risk assessments had been regularly reviewed and updated where needed so that people were supported appropriately. One person was identified at being from possible risk of pressure sores but there was no risk assessment regarding this however there is some information about this in personal care assessments. Discussion with the deputy manager indicated that measures had been put in place to reduce the risk. The deputy said that the home had input from the district nurse regarding pressure care and that she had advised the use of a pressure relieving mattress. A written assessment needs to be available in the home so that staff know the level of risk and the measures they need to take to reduce the risk of pressure damage occurring. Care Homes for Adults (18-65 years) Page 14 of 33 Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle similiar to others of the same age and gender. The people living there are offered a healthy diet and said that they enjoy their meals. Evidence: Sampled records and discussion with people who live at the home show that a wide variety of in house and community activities are on offer. Each person has their own activity schedule, activities include attending day centres, college, shopping, swimming, cinema, walks, pub, the library, music, visits to local parks and attending religious services. During the visit staff offered people the opportunity to participate in activities, several people went out with staff to do food shopping, one person went out for a meal.One person told us that he is always out, another said that its brilliant here, always out, very busy. A third person said he was always out and about doing Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: something different. Activities are encouraged that provide opportunities for personal development, this includes cooking, computing and shopping for food. One person told us they were doing a GCSE course in history another said they were learning Spanish. Peoples cultural and religious needs are respected and staff support people to attend a church of their choice, one person is regularly offered the chance to visit an Afro Caribbean community centre. Observation of the notice board in the home shows that people are kept informed of events in the area so that they can chose where they would like to go. There was evidence in care notes and when talking with people that family contact is maintained. This can be in person, by letter and phone. Details of peoples family birthdays are recorded in care files so that people can be supported to send birthday cards. For one person the home are trying to get them a be-friender so that their social circles are wider. The rights of people who live at the home were respected by staff. For example people were given choices throughout the day, this included what time to get up, what they wanted to eat and if they wanted to go out. Staff were observed to knock on bedroom and bathroom doors before entering. Discussion with one person indicated they had been given a key to their bedroom. Meals are usually cooked by staff for the people who live in Westholme whilst people who live in Hilltop are more independent and usually cook their own meals with support. Menus for Westholme showed that a variety of food is offered that includes fresh fruit and vegetables. Meals being cooked matched the menu for the day. Records and discussion with staff show that culturally appropriate foods are on offer. One person did not like what was being cooked for the evening meal and they told us they had chosen something else. One person told us meals are okay, some staff can do restaurant quality meals. One survey received from staff said that the budget for food shopping for people on Hilltop was not enough. Another staff told us that the budget had been the same for the last four years. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health needs of the people who live there are generally met so ensuring their well being. Evidence: Care plans sampled stated how individuals are to be supported with their personal care. Attention was observed to be given to individuals personal care. The people living there were dressed appropriately to their age, gender, the weather and the activities they were doing. Records show that where people need specialist health input they are referred, for example one person has had input from an occupational therapist and physiotherapist regarding the number of falls he has had. The outcome of any health appointments are recorded and records showed that staff follow the advice given to ensure individuals health and well being. Records sampled showed that each person is registered with a local GP, who they are supported to visit if they are unwell. Records were available to show that people are Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: supported to attend health checks to include the dentist and optician. The deputy manager said that the optician was visiting the following week for people who needed check ups. Records showed that peoples weight is monitored regularly. One persons care plan said that the GP should be notified if they had any sudden weight loss or gain. Their weight record showed they had put on 7lbs in the last month but there was no record of any action being taken as a result. At the last inspection we made a number of requirements and recommendations about medication practice in the home. A Tracs manager had since done an audit of the medication system and staff had been informed at a staff meeting about the things that needed to improve. At this visit we found that the medication systems had improved. Staff who administer medication have received training to do so, some staff have also recently received refresher training. Discussion with the deputy manager indicates that the process of assessing staff to ensure they are competent to administer medication has also begun. Copies of prescriptions are retained so that staff can check the correct medication has been received from the chemist. It is good that for each person there is information about what the medication is for and any side effects that staff need to look out for. Medication is stored in a locked cabinet in the office although some people have locked cabinets for medication in their bedroom. For each person an assessment is completed to establish if they have the ability to administer their own medication. Discussion with the deputy manager indicates that people are encouraged to administer their medication where possible, with support as needed given by staff. Some people are prescribed as required (PRN) medication. Protocols were in place for people who are prescribed PRN medication that stated when, why and how much of the medication should be given to the person to ensure it is used appropriately. Medication administration records were sampled and were found to have been generally satisfactorily completed. Two records had handwritten amendments and the home was reminded of the need to double sign any amendments to make sure changes were accurate. Care plans sampled included peoples wishes on death so that staff know the arrangements they make when someone passes away will be in line with their wishes. Training for staff on loss and bereavement is included in this years training plan for staff so that they will have the knowledge they need to deal with bereavement in a Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: sensitive manner. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 to ensure that the views of the people living there are listened to and acted on so as to improve the service. The people living there are protected from abuse, neglect and self-harm. Evidence: The complaints procedure was clearly displayed in the hallway along with complaint forms, the procedure is also included in the service user guide. Surveys received from people who live at the home recorded that they were all aware of how to make a complaint. Information in peoples care plans showed that the complaints procedure had been explained to them. The annual quality assurance assessment (AQAA) completed by the manager indicates that the home has received nine complaints in the last twelve months. A log of complaints was available in the home. We sampled some of the complaints received, these included a complaint from a neighbour regarding noise and one from someone who lives at the home about bedding. Records were available to show the complaints had been responded to and resolved. One person had made a complaint about staff being rude to him, this resulted in staff disciplinary action. One complaint was from a relative, this was responded to by the home but the complainant was not happy with the outcome. As a result a full investigation was undertaken by Tracs staff external to the home and some recommendations were made. A letter from a social worker Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: indicated this matter had now been resolved. Records show that staff receive training on safeguarding people from abuse as part of their induction to the home. The AQAA recorded that the manager is a qualified trainer in this area and has developed a training pack for staff. It is intended that all staff will have refresher training this year. The home has notified us of five incidents where people have needed to be safeguarded. Some of these incidents have involved staff behaviour but others have been about someone who lives at the home and their behaviour towards other people. The home has followed satisfactory safeguarding procedures that have included notifying social services. Some people at the home sometimes display challenging behaviour. Records sampled included individual behaviour management strategies. These show staff how to work with the person in a positive way that can reduce the likelihood of the person displaying these behaviours, what are the common triggers for the behaviours and how they can be managed so that the person, the other people living there and staff are safe. Where physical intervention has been used detailed records are kept and show it has been used to keep people safe. In the files sampled, each individual had their own inventory of personal possessions. These were up to date. This shows that staff at the home assist individuals in looking after their possessions and have a system to monitor if anything goes missing. A money handling assessment is completed for each person to see what support they need from staff. Staff check monies daily. The finance records of one of the people living there was checked. They had been supported to spend their money on personal items and receipts were kept of all purchases. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are sufficient to ensure that people live in a homely, comfortable and clean environment that meets their needs. Evidence: We looked at some parts of the home. The home is made up of two separate units, Hilltop and Westholme, each having their own separate facilities. Areas we looked at were homely in style. Some hallways were a little tatty in appearance and in need of redecoration, however the maintenance man was in the home during our visit and he had recently repainted the hallways in Hiltop and said he would be doing the other hallways. At the last inspection we found that one bathroom had recently had an assisted bath installed. Installation of the bath had meant that some panelling to the walls had to be removed, the manager had told us that this would be repaired soon. At this visit we found that this had still not been done. The deputy said that there had been some difficulty in obtaining the required panels and that consideration was now being given to having an external company come and do the work. However it appears that no firm decisions have been made about this. Action needs to be taken as soon as possible to repair the damage so that the bathroom is nice and well maintained for people. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: At our last visit the bathroom on Hilltop had a lack of ventilation resulting in some mould growth on the ceiling and wall. At this visit we found that a new extractor fan has been installed, however attention is still needed to the walls where previous mould growth has damaged parts of the decor. Each person has their own bedroom. Rooms seen were well decorated and furnished to the individuals tastes and interests. One person spoken with said they were happy with their bedroom and it was decorated how they wanted it. The overall condition of peoples bedrooms is regularly audited, as recommended at the last inspection the audit now includes if people are happy with the temperature of their bedroom. Some people have mobility difficulties and so to enable people to be as independent as possible the home has the facilities of a passenger lift, assisted baths and level access shower. Call bells are located around the home so that people can call for assistance if needed. One person has frequent falls and an assessment by an occupational therapist resulted in recommendations being made. This included raising the height of the toilets and this has been done. It was also recommended that a push button release system is fitted to the smoke room door. Discussion with the deputy manager and observation of the door indicates that this is underway but that the home is waiting on the installation company to finish the work. This will need to be done as records show the person has recently fell in the smoke room, however as the fall was not witnessed it is not clear if the lack of push button door release was a contributory factor. The home was clean and infection control audits were seen to be undertaken. The environmental health officer visited the home in May and said that standards of hygiene in the kitchen were good. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing are variable, which could impact on how the needs of the people living there are met. The recruitment practices are robust, safeguarding the people living there. Evidence: Support to people who live at the home is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Several staff have an NVQ at level 2 or 3 and several staff are undertaking NVQ at level 2.However, overall less than 50 of staff have achieved at least a level 2 National Vocational Qualification (NVQ) in care so more staff need to achieve this so that they have the skills and knowledge to meet the needs of the people living there. In the surveys received, people who live at the home said that staff treat them well. One person said that staff are brilliant and caring, 11 out of 10. There were no staff who told us that there were always enough staff on duty in the staff surveys we received, staff said that there were usually or sometimes enough staff on duty. Staff comments in the surveys included staffing needs to improve, bare minimum of staff and sometimes not enough staff or too many. We spoke with one staff during the inspection who also told us that sometimes there were not enough Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: staff on duty. We discussed the staffing levels with the deputy manager who told us that during the day there were six to seven staff on duty dependent on who was at home. Staff at the home not only undertake care tasks but undertake laundry, cleaning and cooking duties. Discussion with staff indicates that on Westholme staff cook for people at the home and for staff who eat with people. This is a lot of people to cook for, one staff told us that they usually take about an hour and a half to cook a main meal but that some staff can take up to three hours. A risk assessment was seen to be in place this covered the support that each person at the home needed. However it was not clear from the assessment the time needed to supervise the person at risk of falls and it did not include the number of staffing hours lost due to staff breaks and undertaking cooking and cleaning duties. A full analysis of the homes staffing needs should be undertaken to ensure there are enough staff on duty. Care plans for one person who has had a lot of falls indicate that he needs a lot of supervision from staff to help him to stay safe. An accident analysis form in the home recorded that the high levels of supervision needed were having a detrimental effect on other people at the home and more staff were needed. The Deputy said that a request for extra funding had been made. An incident report for October recorded that staff had heard a noise and the individual on the floor in the smoke room. Staff are supposed to supervise him when he has his cigarettes, if staff were there the fall would have been witnessed and possibly even prevented. Four recruitment records of staff were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been applied for to ensure that suitable people are employed to work with the people living there. One person had started work in the home a few days prior to their full CRB being received, but confirmation had been obtained that they were not on the list of people who are not allowed to work with vulnerable people. The manager said that all new staff work extra to staffing numbers for the first two weeks and that staff awaiting the full CRB check are not left alone with people who live at the home. Staff surveys received indicate that staff are happy with the training they receive. Staff spoken with during our visit to the home said training is amazing another said I got a full induction. Staff records showed that people have an induction to the home and all but one staff survey was positive about the induction received. At the last inspection a recommendation was made to review the formats for recording training as it was difficult and time consuming to establish the training undertaken by Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: staff. This was still the case at this visit and three sets of records had to be looked at to see what training staff had undertaken. There is an active training programme in place for staff that includes health and safety, medication, acquired brain injury, fire, food hygiene, manual handling and safeguarding people. Staff also receive training in Studio III (a method of responding to and managing challenging behaviour). Staff need to have an annual refresher training in this but a couple of staff had not received any training since 2006. The deputy said that getting places on this training had been difficult as it was often over subscribed, she provided evidence that the manager had brought this to Tracs attention. Two people at the home have been identified as being at risk from pressure sores and so staff need to have some training in this area so that they can prevent pressure sores occurring. Minutes of a staff meeting in August do show that the manager is intending to organise this training for staff. Sometimes the home uses agency staff when there are not enough permanent staff on duty. Discussion with the manager at the last inspection indicated that the home did not routinely ask staff agencies for details of agency staffs CRB check, experience and training history. This is now being done to ensure that suitable agency staff are working at the home who have the right skills and experience. Records and staff surveys show that staff usually receive regular supervision and staff meetings are usually held monthly so that staff are kept up-to-date with the running of the home and organisation and the changing needs of the people who live there. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home. Evidence: At the last inspection the home had an acting manager in place who had transferred from another Tracs home. The acting manager has since been successful in applying to us to become the registered manager for this home. The manger has the required skills and experience to manage the home and has achieved a National Vocational Qualification at level 4 in care as well as the Registered Managers Award. At the time of our visit the manager was on annual leave and the home was being run in her absence by the deputy manager. One person who lives at the home told us the manager is very good. The area manager visits the home monthly and writes a report of their visit. These were detailed and included meeting with the staff and people living there and their involvement in the home. Other systems are in place to make sure the home is being Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: well managed this includes regular audits on records, the environment, medication and infection control systems. To ensure views of people living at the home are sought Tracs has a client focus day annually for people across homes in the region where they are consulted. Questionnaires are also available for staff and people at the home to complete. In September the staff held a strategy day to discuss what improvements could be made, following this a development plan for the home has been developed. Fire records showed that staff regularly test the fire equipment to make sure it is working. Staff had received regular training in fire safety. Regular fire drills are held so that staff and the people living there would know what to do if there was a fire. An engineer had tested the fire system to make sure it was in good working order. Certificates were available to show that equipment is regularly serviced to make sure it is safe for people to use. A monthly analysis of accidents is completed, this includes a summary of each accident and what action has been taken to try and reduce future occurrences. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 It is recommended that processes for staff having access to updated plans are speeded up so that they have all the information they need to help them meet peoples needs. Information about the risk of pressure sores to one person needs to be made clearer within their risk assessments so that staff have more information about the level of risk and what they need to do to prevent them occurring. Where people have put on or lost significant weight their care records should fully record what action staff have taken in response to ensure their health is maintained. Where handwritten amendments are made to medication administration records two staff should check and sign the amendments to make sure they are accurate. The missing panelling in the bathroom on Westholme needs repair so that the bathroom is well maintained and a nice room to use. A full analysis of the homes staffing needs should be undertaken to ensure there are enough staff on duty. Arrangements need to be made for staff who need it to attend annual refresher training in Studio III so that they have the skills they need to manage challenging behaviour safely. Page 31 of 33 2 9 3 19 4 20 5 24 6 7 33 35 Care Homes for Adults (18-65 years) 8 35 Training needs to be arranged for staff regarding pressure care to ensure they have the right skills and knowledge to help prevent sores developing and know what to do if they occur. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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