Inspection on 08/06/09 for Haddon House

This inspection was carried out on 8th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haddon House 28/06/07

Haddon House 03/11/06

Haddon House 08/12/05

Haddon House 27/06/05

Haddon House 15/03/05

Haddon House 26/10/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Haddon House 145 West Heath Road West Heath Birmingham West Midlands B31 3HD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 0 8 0 6 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: Haddon House 145 West Heath Road West Heath Birmingham West Midlands B31 3HD 01214751681 01214751681 haddon@cttm.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Haddon House Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Residents must be aged under 65 years Date of last inspection Brief description of the care home Haddon House is a large detached house situated in the West Heath area of Birmingham. It is situated along a service road adjoining the main West Heath Road. The home has six single bedrooms, two of which are on the ground floor and four on the first floor all of which have en-suite facilities. The lounge and dining room are to the rear of the premises. A toilet and shower room are situated on the ground floor. There is a bathroom on the first floor with a grab rail. There is room for parking on the front driveway and access to the house is via sloped wooden decking area, providing wheel chair access. There is a well maintained rear garden that also benefits from a wooden decking area that is covered over. This provides an attractive seating area for people. A sloping ramp leads to a further small patio area and lawn. There is a range of garden furniture for the people to use. The home has access to vehicles to transport its residents on occasions, but encourages them to use public transport enabling Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home service users to access local facilities and Birmingham City Centre. Local amenities such as shops, banks and the GP practice are close by and the home has good transport connections via bus and rail services. The home is registered to provide personal care and accommodation to a maximum of six adults who have a mental disorder. A copy of the latest inspection report is available in the home for visitors who wish to read it. The service users guide does not include details of the range of fees to live at the home and so people would need to contact the manager for fee details. 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: This inspection was carried out over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake 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 aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We sent surveys to all the people who live at the home (six), nine staff and six care Care Homes for Adults (18-65 years) Page 6 of 32 professionals. Surveys were returned to us by one person at the home, four staff and one care professional. We case tracked the care received by two people living there. This involved establishing individuals experience of living in the care home by meeting and talking with 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 service. We looked at parts of the home and a sample of care, staff and health and safety records were looked at. We also spoke with people who live at the home, the manager and staff. 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: An up to date copy of the service user guide should be available in the home so that people have all the information they need to help them decide if they would like to live there. Care Homes for Adults (18-65 years) Page 8 of 32 Management of risks to people need to be improved so that risks are safely managed and people are as safe from harm as possible. The medicine management must improve to safeguard the health and wellbeing of the people who live in the home. Training arrangements for night staff should be reviewed to make sure they get the training they need to help them to meet peoples needs. Increase the frequency of staff supervision so that staff receive this at least every other month to make sure they get the support they need. The recommendations of the West Midlands Fire Service should be acted on to reduce the risk of a fire occurring. 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. People have most of the information they need so they can make a choice as to whether or not they want to live there. Peoples needs are assessed before they move in to help ensure they can be met there. Evidence: The home had a service user guide available to people in the home. This did not have up to date information about our new address and did not include the range of fees to live at the home. The manager said that there was an updated version that had been completed but was unable to find it during our visit. The up to date version of the guide needs to be available to people so that they have current information about the home. One person told us during our visit that its wicked here, I looked round before I moved in and they came out and did an assessment. I did not get a service user guide but other residents told me all about the home, I got enough information. Another person who lives at the home returned a survey to us said they were asked if they wanted to move to the home but they could not remember if they had received Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: enough information. One person had moved into the home since our last inspection. Discussion with them, the manager and a social work student working in the home indicated that an assessment had been completed before they moved in. However a copy of the assessment was not available when we visited. This was sent to us soon after the inspection and showed that the home had assessed their needs before they moved in. The persons views had been included and showed they had been involved in the assessment process. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a care plan so that staff know how to support them to meet their needs and achieve their goals. People are involved in their care plans and have a choice as to what they do each day. The home does not always manage risk in a way that helps to promote peoples safety and well being. Evidence: The records of two people living at the home were sampled. These included an individual care plan. These stated the likes and dislikes of the person, their physical and mental health needs, dietary requirements, personal care and hygiene, leisure/social, contact with family and friends, psychological support, finances, domestic skills, cultural and religious needs. Care plans had been regularly reviewed and updated. Plans sampled were generally detailed in content so that staff had information about how to meet peoples need. Plans detailed how people needed to be supported to maintain and develop their independence. However plans could be further improved by including more information on peoples wishes and goals for the future and how these will be achieved. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Regular meetings with the people that live there are held and these are recorded. Meetings are chaired by people who live at the home. Minutes of meetings show recent discussions around holidays, menus, activities, the garden, people have also been told about the new Deprivation of Liberty Safeguarding legislation. Minutes also show people have been consulted about if they would like to have the security code for the front door of the home. People told us they are consulted about their care plans and encouraged to make choices for themselves. One person told us they had been unhappy with the keyworker they had been allocated but that they had been listened to when they had asked for someone different. The social work student told us the whole ethos of the home was to promote independence, they give lots of choice and involve people. We saw people making choices and decisions throughout our visit, for example what to eat, when to eat, where to go out and how much money they wanted for shopping. Information on advocacy services is available in the home. One person told us that the home had helped her to get an advocate to sort out an issue that she had been unhappy about. We looked at how the home assessed and managed risks to people. For one person risks had been clearly identified and assessed. These included undertaking domestic tasks, going swimming and their general vulnerability. However for another person the management of risk had been poor. Their assessments indicated they were at risk from self harm, substance abuse, self neglect and may display aggressive behaviour. There had been some serious incidents since they have been in the home that have resulted in medical attention being needed. Risk assessments for these high risk areas were not available in the home to make sure staff are aware of how to keep the person as safe as possible and reduce the risk of incidents occurring. The manager accepted that these should have been available. Soon after our visit we were sent copies of risk assessments that had been completed shortly after the person moved into the home. It is not clear why these were not available in the home when we visited. Assessments had been completed for falls, absconding, poor eating, mental health and self harm. The assessment for self harm identified risks but lacked information on how the home would manage these risks. The assessment recorded that risk control measures needed to be agreed with health professionals. The manager told us at the visit that for this person there had been a lack of support from health professionals. The manager provided evidence that they had been requesting additional support for the person from mental health services. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: However it is important that whilst the home is waiting for health professional input that some control measures are agreed with the staff team. This will help to ensure staff work in a consistent manner with the person in a way that will help to reduce the risk of self harm occurring. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there experience a meaningful lifestyle that meets their individual needs. Evidence: Discussion with people and records sampled showed that they are supported to do the activities they enjoy. A plan of activities that each person would like to do is completed on a weekly basis with them. People have the opportunity to participate in a wide range of community activities, they go shopping, to the local gym, the pub, the cinema, bowling, football training, to art galleries and local events. Where people choose to do so they are supported to visit places of worship appropriate to their culture and religion. In house activities include cooking, film nights and visits from a mobile beautician. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The provides two vehicles that people can use to access the community but staff also encourage people to walk locally e.g. to the shops or to use public transport. People who live there told us: There are lots of activities, I get a choice. There are lots of activities to choose, I recently went to both Stratford and Redditch, used the train, would not change anything here. Its the best home Ive been in, its like being in Florida. Theres loads of activities, go to the pub, had a barbacue, get to go places like Warwick castle. Love it here, always out and about. Throughout the day people were observed to be encouraged to be as independent as possible. They made their own drinks, went shopping for their toiletries and one person baked some biscuits. Records showed that people help staff to prepare meals, do the food shopping, do their own laundry and tidy their bedrooms. Records showed and people said that they are supported to keep in contact with their family and friends so they do not lose relationships that are important to them. Menus sampled showed that a variety of healthy food is offered that reflects the cultural background of the people living there. Staff told us that the menu is agreed with people at the home. Fresh fruit was available so that the people living there could help themselves when they wanted it. Staff spoken with were aware of peoples food preferences. People are supported to meet their dietary needs where appropriate and to follow the advice of the Dietician. We had lunch with people at the home. There was a choice of sandwiches and accompliments such as pickled onions and sauces. Staff ate with people making it a pleasant social occasion. People who live at the home told us: Food is good, we choose the meals and do cooking. Food is good, get to choose, we go food shopping. 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. Arrangements ensure that the personal care and health needs of the people living there are met. Management of the medication needs to improve to ensure people get the medication they need in a safe way. Evidence: Care plans sampled showed how the person needed support with their personal care and to meet their health needs. People at the home are generally quite independent with regards to their personal care. People were seen to be well groomed in their own individual styles. One person told us that they were going out with staff that day to purchase their own toiletries. Records sampled showed that the home seeks input from other health professionals when this is appropriate. For example dietician or psychiatrist. The manager told us that they did not think that one person at the home was receiving enough support from health professionals. Evidence was provided that the home had requested more support on their behalf. Health action plans have been completed for people so that staff know what support Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: they need to stay healthy. It is good that regular exercise is incorporated into peoples activity plans as this helps to promote a healthy lifestyle. We received one survey from a health professional, they told us that peoples healthcare needs are always met and that the home always seeks advice. Records sampled showed that the people living there had regular health check ups, for example with the dentist and optician. Medication is now kept in locked cabinets in peoples bedrooms. This means that people can have their medication administered in the privacy of their room. Staff who administer medication have received training to do so. The people living there are assessed as to whether or not they can manage their own medication or what support they might need to achieve this if they want to. A photograph of the person is kept with the medication administration chart (MAR) so that new staff would know who the person is. This reduces the risk of medication being given to the wrong person. Several MARs had handwritten amendments or directions. These had not been signed by staff. Where staff make handwritten amendments these should be checked by two staff against the prescription and signed by both staff on the MAR to reduce the risk of error. In September 2008 the home was advised they needed to do this by their pharmacist so it is disappointing this advice is not being followed. We saw that one person was prescribed medication where they should have one or two tablets. Staff had not recorded on the MAR how many tablets had been given so it was difficult to track how many they had been given. There were also some gaps on the records where staff had not signed to say if people had their medication or used the code to show why people had not had their medication. Some people were prescribed PRN (as required) medication. For the majority of these an individual protocol was in place stating when, why and how much of this should be given to the person. However protocols had not been completed for when staff should give PRN medication to a recently admitted person, these need to be completed. We were made aware by the local authority that they had some concerns about medication practice in the home with regards to the use of PRN. There was a concern that the home was not giving one person their PRN medication when they needed it. Feedback from the social worker regarding this indicates there was no evidence to uphold this concern. Records and discussion with the home manager indicate their had been some problems in getting medication for one person who was new to the home. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Prescriptions and medications have been provided by the mental health team as the GP has been awaiting confirmation of the medication prescribed from the consultant. We looked at the MARs for this person and saw that one medication was recorded twice on separate charts covering the same seven day period. We were concerned that the person may have had more medication than they were supposed to and so asked the care director for the home to investigate this. We have received a full report of their investigation. This indicates that there were two separate MARs due to an original mix up by the pharmacist but that there has also been some poor practice by staff. The investigation does however indicate that the person was not given the same medication twice. The care director has told us that the home is taking steps to ensure medication practice is improved. Disciplinary procedures have been instigated where needed and further staff training has been booked. Staff are administering medication in pairs until they have completed the additional training. The investigation into this matter appears to have been well completed and whilst there has been an incident of poor practice we are confident that things are being put right. 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 the people living in the home are listened to and acted on. The people living there are protected from abuse, neglect and selfharm. Evidence: There had been no complaints made to the home or the CSCI in the last year. The complaints procedure was available to the people living there and they said they knew how to make a complaint if they were unhappy about anything. One person told us they had been unhappy with an outside agency and that the home had helped them to obtain the services of an advocate. The advocate had assisted them to make a complaint. Surveys we received from staff recorded that they knew what to do if people wanted to complain. Training records showed that staff had received training in adult protection and the prevention of abuse and in the Mental Capacity Act so they know how to ensure people are protected and their rights are respected. We spoke with two staff about what they would do if they suspected people were being abused. The actions they described would help to ensure people are safeguarded from abuse. The manager told us that she had recently been made aware by a contracts officer from Birmingham City Council that the multi agency safeguarding guidelines they had were out of date. The manager showed us that the home now had access to the new guidelines. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: As stated earlier in this report the local authority social services department have recently investigated some safeguarding concerns about the home. This matter has now been closed. We were informed by them that the outcome of investigations indicates that the home needs to do more to help people to eventually move on from the home and become more independent. People are provided with a safe place to keep their money. Care plans were in place stating the support that staff are to give. This included help with budgeting and supporting people to go to the bank. We saw that when people ask staff for their money this is given to them and staff ask them to sign the record to show they have received it. Records show that the care director often undertakes audits of peoples money as part of their visits to the home. This helps to ensure peoples money is looked after. 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 safe, homely and comfortable environment that meets their individual needs. Evidence: On the ground floor there were two bedrooms, a laundry room, kitchen, dining room, WC for staff, lounge and office. As required from our last inspection the lounge has been redecorated and refurnished so that it now looks a nice place to spend time in. Peoples bedrooms that were seen were well decorated and furnished in the way that they wanted them to be. People told us they were happy with their bedrooms. There were photographs of people important to them and pictures that reflected their interests around peoples rooms. Some people have their own fridge in their bedroom where they can keep drinks and snacks that they can have when they want them. Each person has an en suite shower and toilet. There is a shared bathroom upstairs so that people can have a bath if they want to. At the rear of the home there is decking that leads to the garden. This is covered and seating is provided and people were observed spending time sitting there and having a drink or snack. A barbecue is provided and the people living there said this is used. The rear of the garden is fenced off and is not used. People have recently written to Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: the provider to ask if this area can be developed for use, one person told us they would like to use it to grow vegetables. The annual quality assurance assessment completed by the manager records that it is hoped to landscape the back garden in future. The home was clean and free from offensive odors throughout. Staff do the cleaning but the people living there are involved in this and are encouraged to keep their bedrooms clean and tidy. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements generally ensure that the people living there are supported by a trained, supported and supervised staff team who can meet their individual needs. The people living there are protected by the homes recruitment practices to ensure their safety and well being. Evidence: The majority of staff at the home have achieved a National Vocational Qualification in care. This means that people are supported by staff who have the right qualifications. Staff interaction with people during our visit was good and people were treated in a friendly and professional manner. The health professional who returned our survey told us that staff have the right skills. People who live at the home told us: Staff support and listen. They will do anything and everything for you, they cant do anything better. Staff are great. The manager said and rotas showed that there is usually three or four staff on during the day. At night there is one waking night and one sleep-in staff. Bank staff are used to cover vacancies so that people are usually supported by staff they know well. The manager said there are usually one or two social work students from a local university on placement at the home and they are also supernumerary to the rota. We saw that there were enough staff on duty when we visited to meet peoples needs. Staff who Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: returned surveys to us said they were enough staff on duty. Three staff records were sampled. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken to ensure that suitable people are employed to work with the people living there. The home does not have a training matrix in place that gives an overview of all the training the staff team has had. The manager told us that this was something they had identified that they needed and was planned to be completed. Surveys that we received from staff at the home indicated they felt they had the training they needed to meet peoples needs. Staff training records sampled indicate that in general staff have the training they need. However one member of staff had not done much training since they started work in the home. It was identified in their supervision records that they needed more training. The manager told us that due to the staff working nights they had found it difficult to attend training during the day. The home needs to look at training arrangements for this member of staff to make sure they get the training they need. Discussion with the manager indicates that it is hoped to provide staff with more training around the areas of conflict management, mental health and the new Deprivation of Liberty Safeguards legislation. Staff meeting minutes showed that these are held regularly, this helps to ensure staff can be updated about peoples needs and good practice issues. We looked at the supervision records for two members of staff. These showed that staff do have supervision but there had been times when staff had gone several months without supervision. Staff who returned surveys to us said they felt well supported. However support systems would be improved if staff have supervision at least every other month to make sure they get the support they need. Each member of staff has a formal annual appraisal so it is clear that their performance is regularly monitored so they can continue to support the people living there to meet their needs. 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. The management arrangements ensure that the home is well run for the benefit of the people who live there. Evidence: The manager is registered with us to manage the home. They have many years experience of working in care. They have trained in nursing people who have a learning disability (RNLD) and also to work with people who have mental ill health. They completed their NVQ level 4 and Registered Managers Award in 2006. We spoke with two staff about the management arrangements in the home. They told us you can raise things and know they will be dealt with, the Home runs smoothly and if there is a problem the manager will always listen and try and work out a solution. The manager completed and returned the annual quality assurance assessment when we asked for it. This was completed to a satisfactory standard and told us about the improvements the home had made and improvements they intend to make this year. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The care director visits the home monthly and writes a report of their visit as required under Regulation 26. The most recent report was not available at the inspection but was sent to us soon after we visited. Reports showed that the views of the people living there had been asked for. People living there had completed comment cards that asked for their views about the home. We sampled these and found that people were generally positive in their comments. We suggested to the manager that the comment cards would be a more useful tool if all the results from them were put into one report that could then be made available to people who live there. The fire procedure was produced using pictures making it easier to understand and was displayed in the dining room. Regular fire drills are held so that staff and the people who live there know what to do if there was a fire. An engineer regularly services the fire equipment to make sure it is working and well maintained. Staff test the fire alarms regularly to make sure they are working. The home has a fire risk assessment and this is now due for review. The West Midlands Fire Service (WMFS) last visited the home in 2006. They recommended that the gaps in the decking to the rear of the home needed to be filled in or the area under the decking cleaned and swept out twice a year. This is because the rear decking area is used as a smoking area and dropped cigarettes could cause a fire. The manager told us that this had not been done and we saw that she had sent many emails to the maintenance department requesting this is actioned. We also saw in the minutes of a staff meeting in April that the manager had discussed that people were flicking ash on to the decking and that this was a fire risk. The recommendations of the WMFS need to be actioned to reduce the risk of a fire happening. Certificates were available to show that the annual test of the gas equipment had been completed and stated that it was safe to use. An electrician completed the five yearly test of the electrical wiring in February 2006 and stated that it was in a satisfactory condition. Staff test the water temperatures weekly to make sure they are not too hot or cold, which could put the people living there at risk of harm. 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 9 13 Up to date assessment of risks to people must be available in the home that detail how risks will be safely managed. To help ensure that risks to people are reduced and they are as safe from harm as possible. 29/07/2009 2 20 13 Staff at the home need further training in safely administering medication. This is to ensure medication practice in the home is improved and to reduce the risk of any future errors occurring. 28/08/2009 3 20 13 The medication administration record must be signed when people receive their medication or the code used to show why it has not been administered. It must also show the dose administered 10/07/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 where people are prescribed a variable dose. This is to ensure that the records accurately reflect the medication people have been given. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 An up to date copy of the service user guide should be available in the home so that people have all the information they need to help them decide if they would like to live there. Written guidelines should be available for all as required PRN medication so that staff know when they should be given and to make sure people get the medication they need. Handwritten amendments to medication records should be checked and signed by two staff to reduce the error of mistakes. An overview of the training completed by the staff team should be completed to make it easier for the home to see what training people have done and plan for future training needs. Training arrangements for night staff should be reviewed to make sure they get the training they need to help them to meet peoples needs. Increase the frequency of staff supervision so that staff receive this at least every other month to make sure they get the support they need. The recommendations of the West Midlands Fire Service regarding the rear decking should be acted on to reduce the risk of a fire occurring. 2 20 3 20 4 35 5 35 6 36 7 42 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). 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