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Inspection on 09/10/08 for Halas Home

Also see our care home review for Halas Home for more information

This inspection was carried out on 9th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The registered manager and organisation have responded to previous inspection reports with comprehensive action plans for the required improvements to be put into place. The organisation had produced a range of written information in alternative formats, using pictures and symbols suitable for residents and other people unable to easily understand the written information. Some examples were the service user guide, menus, questionnaires and complaints procedure, which helped residents to understand how the service was provided and be able to use the complaints process if they needed to. We saw that the majority of residents were able to make their own choices and were able to express preferences and pursue their own individual lifestyles, though this had become more limited. Some people could attend day activities provided by the Local Authority, though this service had been reduced. More people were encouraged to attend day time activities provided by staff from Halas Homes in a separate building in the grounds. We looked at some of the projects they had been involved with, such as the Easter theme, making cardboard musical instruments to compliment their percussion instruments, and puppets, which had been used to put on a production of Red Riding Hood. We were told that this was such an enjoyable experience that the activities coordinator was looking for a similar story for a new production. Many of residents also had hobbies and interests outside the home, for example attending the Gateway Club, going to the cinema and attending sporting events such as football or swimming. Some people enjoyed visits to the hairdressers. We also noted that there were organised trips to places such as local parks, pubs and garden centres, though the inclement weather had limited some outings. There was evidence of regular entertainment taking place in the home, examples were an organist, singers and exercises to music. Residents told us that they had been supported to go away for holidays according to their personal choice. Small groups of residents had enjoyed summer holidays in Somerset and at an adapted hotel in Blackpool. One person had been on a cruise and had recorded a request in the residents meeting to go on another cruise next year. We saw plans for a small group of residents and staff due to take place in November 2008. A number of residents continued to attend church services and be part of the social life of churches. Some people have attended the Catholic Church, others the local United Reform Church, travelling by their preferred mode of transport. Most people continued to use the Ring & Ride service and one person liked to travel by taxi. Residents meetings have continued to take place on a regular basis, with a wide range of topics discussed and with opinions given about the running of the home. Some residents remembered meetings, others did not. During discussions some people confirmed that they knew about meetings taking place to talk about what was good and what should be changed at the home. The organisation had held discussions at the residents meeting in May 2008 about the new information made available by the local authority to safeguard vulnerable people so that residents knew how to tell someone ifthey were unhappy or had concerns. The home was clean, tidy and homely. Each resident had their own bedroom, decorated and furnished to their choice. Some people had chosen to have keys and were able to lock their bedrooms for privacy. The home had a semi independent flat on the second floor of the main house, where up to three residents could choose to live semi-independently using its kitchen facilities to make their own drinks and snacks. The menus had colourful descriptive pictures of the meal options and there was a food council made up of 16 people including residents, catering staff and carers, who held regular meetings to assess and comment on the food provided. One person had requested asparagus and escargot, another wanted liver and bacon, and steak and chips. There had been changes to the staff group, though there were still a number of people had worked at the home for a long time and knew the residents well. They were caring, committed and flexible, often willing to work extra shifts, especially to support residents with outings and trips away from the home. There continued to be strong commitment to undertake training, which had benefits for the residents. Some comments from relative surveys included, "it is a first-class home and our relative is completely satisfied", and "all the staff make the care home as comfortable and home like as possible." The organisation had continued with excellent progress to make sure that all staff received appropriate training to give them awareness of challenging behaviour and issues relating to the protection of vulnerable adults. The organisation had also responded swiftly and with openness to very difficult complaints and allegations, and had co-operated with the local authority as the lead agency and with the CSCI. We saw that there was strong commitment to staff training and development with a ratio of 19 of 26 care staff qualified to the NVQ level 2 or above. There were also senior staff with the NVQ level 3 care award. The operations manager had continued to provide appropriate awareness training in Equal opportunities, Racism and Disability awareness for all staff. We saw and heard a lot of friendly banter between the members of staff and residents during the visit. During discussions and observations staff have showed a dedicated approach to their work, they could clearly explain the residents likes and dislikes and what to do to meet their needs. The responses we received indicated that the majority of residents liked living at the home, with comments such as," I am happy living here". The person with experience of using care services for people with learning disabilities who accompanied us included in his report the good things about the home, "I liked the fact that one lady had her artwork on the walls in her bedroom and is encouraged to paint. Everyone had their own picture on their bedroom door. In the satellite house it was good so see that people had a choice of how their room was decorated. It was good to see that people had photographs and personal things in their rooms." This inspection was conducted with full co-operation of the general manager, staffteam and residents. The atmosphere throughout the inspecti

What has improved since the last inspection?

The written assessments of known risks were generally improved. The organisation was looking at ways to minimise and manage risks with the residents, especially relating to personal safety, activities, holidays. There were records of findings held as part of each residents plan. The redecorating and renewal programme had continued with improvements to residents bedrooms with a number of new beds and furniture provided. The planned programme of work for the small satellite houses had taken place. The kitchens and flooring had been renovated and the whole premises were redecorated with colours chosen by the residents. The work to the grounds, the main house and around the outbuildings had been continued resulting in well maintained attractive surroundings. The sensory garden as noted at the previous visit was a particularly peaceful and pleasant area, with herbs such as lavender, sage and thyme, a water feature, and seating area around a mature tree. We saw that that improvements had been made to health and safety at the home, for example a regular written accident analysis had been put in place to highlight any trends or increased risks, which needed to be minimised, though this had lapsed recently in the registered managers absence and must be resumed so that residents were as safe as possible.

What the care home could do better:

We noted that some of the homes assessments, care plans and other records did not contain the detailed information to make sure that all staff, particularly agency staff were guided to meet all residents needs and choices. The organisation must continue the development of the care planning processes. This is to make sure each person`s plan is centred around their individual needs and is in a format that they can understand, such as large print, pictures or symbols. There must also be short term care plans to provide information and guidance for additional care needs for example if residents are unwell and need additional medicine, care and attention. There were individual activity records for each resident, however these did not give any detail for their individual activities at Halas Home day centre, which operated between 9:30 a.m. and 2 p.m. There were no recorded activities during the evenings or weekends on the sample of individual activity records looked at. These records need to be expanded to show what activities have been offered, taking account of their preferences, and whether the resident has enjoyed the activity or why they have refused to participate in a particular activity. The organisation must make further progress with multi-agency discussions and decisions made with each person about their lifestyle choices, which must include the management of finances and any limitations on choice. Specimen signatures had been obtained from residents who could meaningfully give their signature and consent. Theorganisation must establish each persons level of capacity, using independent advocacy if necessary. Progress must be made to develop financial care plans with the aim to have individual bank accounts for residents wherever this is possible. The organisation must also clarify the protection given to individual residents money held in the communal corporate account, given the current banking crisis and uncertain situation. The home was providing care and accommodation for a large number of residents in three separate houses. All residents had individual and often complex needs and aspirations, which require appropriate levels of staff support and supervision. The organisation must seriously review and consider the number of care staff on duty in the main house, the satellite houses and the day-care centre to provide the additional support and supervision for the independence and safety of all residents.The person accompanying us reported the following comment made by one of the residents, "One person said, "Sometimes we are short staffed in the mornings when they are trying to get every one up". We were also told it was sometimes difficult for activities to take place on an individual basis and the home was also short of staff who could drive the minibuses. The organisation should look carefully at the comments made by the person with experience of using care services for people with learning disabilities, particularly relating to choices and independence. Routines and regimes at the home must be centred around each persons individual needs for support and stimulation and should not be allowed to become centred around tasks.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Halas Home Wassell Road Hasbury Halesowen West Midlands B63 4JX     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: Jean Edwards     Date: 0 9 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 43 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Halas Home Wassell Road Hasbury Halesowen West Midlands B63 4JX 01215013604 01215857821 info@halashomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Halas Homes care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Includes 2 satellite houses at 64 and 66 Wassell Road. Service users may remain at Halas Homes when they reach age of 65 years for as long as the home can demonstrate it can meet their needs. Within the 37 registered beds, two beds may be used for new admissions of up to 2 older people (over 65 years) with a learning disability (LE(E)). Date of last inspection Brief description of the care home Halas Home located a housing estate near to Halesowen, is a large detached house in its own grounds, with two small, semi-detached, ex-council houses. The houses on Wassall Road have rear access to the grounds of the main house. There is a building in the grounds used for group activities and meetings. The Home can have up to 37 people, with a range of learning disabilities, living there. The main house has 2 lounges, dining room and conservatory on the ground floor. Up to 28 people can live in bedrooms on the ground and first floors. There are bathing and showering facilities and WCs throughout the home. The 2nd floor has 2 semi-independent living flats for people able to practice daily living skills. The large kitchen in the main house supplies food Care Homes for Adults (18-65 years) Page 4 of 43 Over 65 0 37 Brief description of the care home stocks to the small houses and a daily hot main meal for everyone. The laundry is in a separate building. There is a large staff team supported by the Voluntary Organisation, run by a committee of volunteer members. Care Homes for Adults (18-65 years) Page 5 of 43 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 last key inspection took place on 16 October 2006 and the CSCI undertook an Annual Service Review in 2007-8. We, the Commission for Social Care Inspection (CSCI), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. A lead inspector visited the home between 08:20 am and 8:15 pm and was accompanied for part of the inspection by a person who had used care services for younger adults with learning disabilities with their supporter. This persons report and views about this home have been included throughout this report. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included: discussions Care Homes for Adults (18-65 years) Page 6 of 43 with the general manager, operational and finance managers, and staff on duty during the visit. We also had discussions with residents, and made observations of residents without verbal communications. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the CSCI. A number of records and documents were examined, including responses to recent complaints and allegations, which were being investigated by the Local Authority as the lead agency for safeguarding vulnerable people. The registered persons submitted the homes Annual Quality Assurance Assessment (AQAA) as requested at the time of the inspection visit. We toured the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents bedrooms, with their permission, where possible. The range of fees for the service had not been included in the homes service user guide. People are advised to contact the home for up to date information about the fees charged. The quality rating for this service is Two Stars. This means the people who use this service experience good quality outcomes. What the care home does well: The registered manager and organisation have responded to previous inspection reports with comprehensive action plans for the required improvements to be put into place. The organisation had produced a range of written information in alternative formats, using pictures and symbols suitable for residents and other people unable to easily understand the written information. Some examples were the service user guide, menus, questionnaires and complaints procedure, which helped residents to understand how the service was provided and be able to use the complaints process if they needed to. We saw that the majority of residents were able to make their own choices and were able to express preferences and pursue their own individual lifestyles, though this had become more limited. Some people could attend day activities provided by the Local Authority, though this service had been reduced. More people were encouraged to attend day time activities provided by staff from Halas Homes in a separate building in the grounds. We looked at some of the projects they had been involved with, such as the Easter theme, making cardboard musical instruments to compliment their percussion instruments, and puppets, which had been used to put on a production of Red Riding Hood. We were told that this was such an enjoyable experience that the activities coordinator was looking for a similar story for a new production. Many of residents also had hobbies and interests outside the home, for example attending the Gateway Club, going to the cinema and attending sporting events such as football or swimming. Some people enjoyed visits to the hairdressers. We also noted that there were organised trips to places such as local parks, pubs and garden centres, though the inclement weather had limited some outings. There was evidence of regular entertainment taking place in the home, examples were an organist, singers and exercises to music. Residents told us that they had been supported to go away for holidays according to their personal choice. Small groups of residents had enjoyed summer holidays in Somerset and at an adapted hotel in Blackpool. One person had been on a cruise and had recorded a request in the residents meeting to go on another cruise next year. We saw plans for a small group of residents and staff due to take place in November 2008. A number of residents continued to attend church services and be part of the social life of churches. Some people have attended the Catholic Church, others the local United Reform Church, travelling by their preferred mode of transport. Most people continued to use the Ring & Ride service and one person liked to travel by taxi. Residents meetings have continued to take place on a regular basis, with a wide range of topics discussed and with opinions given about the running of the home. Some residents remembered meetings, others did not. During discussions some people confirmed that they knew about meetings taking place to talk about what was good and what should be changed at the home. The organisation had held discussions at the residents meeting in May 2008 about the new information made available by the local authority to safeguard vulnerable people so that residents knew how to tell someone if Care Homes for Adults (18-65 years) Page 8 of 43 they were unhappy or had concerns. The home was clean, tidy and homely. Each resident had their own bedroom, decorated and furnished to their choice. Some people had chosen to have keys and were able to lock their bedrooms for privacy. The home had a semi independent flat on the second floor of the main house, where up to three residents could choose to live semi-independently using its kitchen facilities to make their own drinks and snacks. The menus had colourful descriptive pictures of the meal options and there was a food council made up of 16 people including residents, catering staff and carers, who held regular meetings to assess and comment on the food provided. One person had requested asparagus and escargot, another wanted liver and bacon, and steak and chips. There had been changes to the staff group, though there were still a number of people had worked at the home for a long time and knew the residents well. They were caring, committed and flexible, often willing to work extra shifts, especially to support residents with outings and trips away from the home. There continued to be strong commitment to undertake training, which had benefits for the residents. Some comments from relative surveys included, it is a first-class home and our relative is completely satisfied, and all the staff make the care home as comfortable and home like as possible. The organisation had continued with excellent progress to make sure that all staff received appropriate training to give them awareness of challenging behaviour and issues relating to the protection of vulnerable adults. The organisation had also responded swiftly and with openness to very difficult complaints and allegations, and had co-operated with the local authority as the lead agency and with the CSCI. We saw that there was strong commitment to staff training and development with a ratio of 19 of 26 care staff qualified to the NVQ level 2 or above. There were also senior staff with the NVQ level 3 care award. The operations manager had continued to provide appropriate awareness training in Equal opportunities, Racism and Disability awareness for all staff. We saw and heard a lot of friendly banter between the members of staff and residents during the visit. During discussions and observations staff have showed a dedicated approach to their work, they could clearly explain the residents likes and dislikes and what to do to meet their needs. The responses we received indicated that the majority of residents liked living at the home, with comments such as, I am happy living here. The person with experience of using care services for people with learning disabilities who accompanied us included in his report the good things about the home, I liked the fact that one lady had her artwork on the walls in her bedroom and is encouraged to paint. Everyone had their own picture on their bedroom door. In the satellite house it was good so see that people had a choice of how their room was decorated. It was good to see that people had photographs and personal things in their rooms. This inspection was conducted with full co-operation of the general manager, staff Care Homes for Adults (18-65 years) Page 9 of 43 team and residents. The atmosphere throughout the inspection was relaxed and friendly. What has improved since the last inspection? What they could do better: We noted that some of the homes assessments, care plans and other records did not contain the detailed information to make sure that all staff, particularly agency staff were guided to meet all residents needs and choices. The organisation must continue the development of the care planning processes. This is to make sure each persons plan is centred around their individual needs and is in a format that they can understand, such as large print, pictures or symbols. There must also be short term care plans to provide information and guidance for additional care needs for example if residents are unwell and need additional medicine, care and attention. There were individual activity records for each resident, however these did not give any detail for their individual activities at Halas Home day centre, which operated between 9:30 a.m. and 2 p.m. There were no recorded activities during the evenings or weekends on the sample of individual activity records looked at. These records need to be expanded to show what activities have been offered, taking account of their preferences, and whether the resident has enjoyed the activity or why they have refused to participate in a particular activity. The organisation must make further progress with multi-agency discussions and decisions made with each person about their lifestyle choices, which must include the management of finances and any limitations on choice. Specimen signatures had been obtained from residents who could meaningfully give their signature and consent. The Care Homes for Adults (18-65 years) Page 10 of 43 organisation must establish each persons level of capacity, using independent advocacy if necessary. Progress must be made to develop financial care plans with the aim to have individual bank accounts for residents wherever this is possible. The organisation must also clarify the protection given to individual residents money held in the communal corporate account, given the current banking crisis and uncertain situation. The home was providing care and accommodation for a large number of residents in three separate houses. All residents had individual and often complex needs and aspirations, which require appropriate levels of staff support and supervision. The organisation must seriously review and consider the number of care staff on duty in the main house, the satellite houses and the day-care centre to provide the additional support and supervision for the independence and safety of all residents.The person accompanying us reported the following comment made by one of the residents, One person said, Sometimes we are short staffed in the mornings when they are trying to get every one up. We were also told it was sometimes difficult for activities to take place on an individual basis and the home was also short of staff who could drive the minibuses. The organisation should look carefully at the comments made by the person with experience of using care services for people with learning disabilities, particularly relating to choices and independence. Routines and regimes at the home must be centred around each persons individual needs for support and stimulation and should not be allowed to become centred around tasks. 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 11 of 43 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 12 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good, clear information about the service which means that residents and their advocates have good information to base their decisions about their choice of home. All residents have their needs assessed and reviewed with multidisciplinary health care professionals but these are not always reflected in the homes assessment information. The home actively encourages introductory visits and people are given ample opportunity and time to make decisions which are right for them. Everyone has a contract with terms and conditions of residency giving information about their rights, entitlements and any agreed restrictions. Evidence: The information contained in the homes AQAA about what it did well stated All service users needs are assessed and reviewed with multi-disciplinary health care professionals. Service user contracts and terms and conditions of occupancy are updated and maintained. Tea visits are encouraged and records evidencing service user input are maintained. Care Homes for Adults (18-65 years) Page 13 of 43 Evidence: The AQAA stated that the evidence to show what it did well included, Up to date and and relevant information about the organisation and its services are within the service user guide. The format is clear and contains picturebank illustrations which are meaningful to service users. Admission criteria of new service users is only agreed after a summary of care management assessment and copy of care plan is received. Full needs assessment is undertaken to ensure the home can meet assessed needs.Professionals, service user and relative or representative are involved in the assessment. Re-assessment takes place to ensure changing needs are met. Prospective service users are given opportunity to spend time in the home by means of tea visits and overnight stays. Prospective service users are encouraged to join in with activities and integrate. Service user contracts state fees and what is included within the fee. We looked at copy of the homes statement of purpose and service user guide, which had been updated in August 2008. The documents contained comprehensive information and the service user guide was in pictorial format. We saw that each resident had been given their own copy. The organisation had not included information about the range of fees in the service user guide. We discussed this omission with the general manager and operations manager who told us that the basic fees charged were based on the fees paid by the Local Authorities. We recommended that information about fees should be included in the service user guide to give people comprehensive information about the service to help them make decisions about the choice of home. From the information provided at the home we noted that the majority of residents were funded through the Local Authorities. We looked at the care records for two people admitted to the home since the last key inspection. We saw evidence that they had contracts and terms and conditions, which had been updated and included information about individual fees. We were told that everyone living at the home had been given contracts with up-to-date terms and conditions and information about their individual fees. We noted that two people whose care was funded through Dudley Directorate for Adults, Community and Housing Services (DACHS) were provided with comprehensive care assessments and care plans, called My Plan, from the professionals involved in their care. The documents were in easy read and picturial formats and written in a person centered style. We saw that a senior member of staff from Halas Home had recorded some assessment information and attempts had been made with some picture formats. We discussed with the general manager how the home could adopt improved formats, such as those used by Dudley Directorate for Adults, Community and Housing Services. These would lead staff to use person centered planning and encourage residents to have meaningful participation and involvement. Some of the Care Homes for Adults (18-65 years) Page 14 of 43 Evidence: assessment information recorded at the home was very basic and was not fully completed. For example assessment of daily living activities and communication skills contained only one word good. We noted that people were offered the opportunity for trial visits to the home and each person had visted the home before deciding to come and live there. The general manager told us that someone had made a number of visits to the home and was in the process of making their own arrangements to move in as a permanent resident. Care Homes for Adults (18-65 years) Page 15 of 43 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. The care planning system generally provides staff with the information they need to meet each persons needs. The home has not fully developed a more person centred approach so that residents have as much control as possible over their lifestyle and care. Most people have risk assessments to cover aspects of personal and social and health care to minimise risks to their health and well being. Evidence: We looked at a sample of residents case files containing care plans, risk assessments and held discussions with residents and staff about how peolple were supported and given assistance to meet their daily needs. We noted that two residents or their relatives and representatives, had signed the plans to indicate their agreement. However it was not clear as to how much involvement that each person had in the development of their individual plan. The care plans we looked at did not demonstrate that they were developed following Care Homes for Adults (18-65 years) Page 16 of 43 Evidence: person centred planning principles and though there were some pictures and symbols they were not all in easy read formats that residents would easily understand and would relate to themselves. We looked at care plans for two new residents and other residents who had lived at the home for some time. There were copies of Dudley DACHS care assessment and care plans on the care files for the new residents. One persons included the information, may have skills, has not had opportunity to use them, to be encouraged to as much as for self as possible, the home had not recorded how these goals would be achieved. The person centered care plan My Plan provided by Dudley was in a pictorial and easy read format and gave the home a lead about what should be provided, for example the home should have described how personal choice and preference was to be offered. It also indicated that the homes care plan should show how the person was involved in developing their own personal care plan. There was some evidence that the home was developing the staff team to have skills and ability to support and encourage residents to be more actively involved in the ongoing development of their plan. The home had a key worker system, which should enabled staff to establish special relationships and work on a one to one basis. However we heard from some staff who felt that a senior member of staff had taken over much of the development of care planning and risk assessment, which meant that not all staff had comprehensive knowledge of residents needs. This situation did not seem to have been recognised by the the registered manager who had countersigned some of the care records. We have recommended that the registered manager and general manager delegate decisions to residents with staff support wherever possible and that the managerial roles be used to monitor and develop the service. We noted that care plans were reviewed regularly. We looked at Dudley DACHS review notes for a new resident, which included the comments, Mum says she is happy and thinks I have settled well. I joined Gateway club, youths music club, and I have made new friends and I like one person I live with One of the plans for an existing resident had not considered all aspects of the persons life including health, specialist treatments, personal and social care needs. This persons care plan and risk assessments had not been revised to reflect long term changes to their physical or mental condition. This persons activity plan recorded Monday to Friday Halas day centre but there was no detail entered of what the activities would be and no activities or social interaction recorded for weekends or evenings. This did not accurately reflect care and activity provided for this person who had been cared for in bed for many weeks. Similarly we did not see evidence that the care plans reflected short term care needs, such as antibiotics and extra care needed to deal with infections. Care Homes for Adults (18-65 years) Page 17 of 43 Evidence: We were told that the home had actively promoted the development of skills for some residents, independent living skills. The home was able to show that some residents had moved to supported living arrangements and the flat on the second floor of the main house had continued to provide semi independent living accommodated for up to three residents, who had the use of the kitchenette to make their own drinks and snacks. The sample of care records included some risk assessment elements, which we were told the registered manager and senior staff were continuing to develop. The home had tried to balance the management of risks taking into account the age, specialist needs of people who use the service, with their aspirations for independence and choice. However we noted that sometimes the limitations in place could stifle opportunities for independence. There were examples cited by the person accompanying us, who had used care services for young adults with learning disabilities, relating to people not being involved with pouring or adding milk and sugar to their own drinks in the dining room. All decisions need to have been made with the resident and their family or other professional workers. There were comprehensive risk assessments in place for residents participating in activities and holidays outside the home. There were also examples of some risk assessments and risk management stragegies developed with the Intensive Support Team, which was very positive. We looked at the management of residents finances. The home had continued to use a comprehensive computerised system for managing residents finances, which was well established and had been revised to make it more transparent. However the organisation continued to hold residents finances in a joint corporate account in a local bank, which in the current banking crises may expose individuals to risks. Although it was positive that action had been taken to review all residents finances held by the Organisation, there were no individual residents accounts and promoting financial independence, even where this was possibily achievable with two new residents. The home had obtained sample signatures from all residents who were able to meaningfully sign documents. We discussed the operation of the corporate account and we were told that if individual residents overspends their debits were written off by the organisation, which operates as a charity. This meant that residents were allowed to spend beyond their means. We were also told that any resident with a surplus received interest accumulated. We were told that there were six out of thirty two residents with accounts in credit. Care Homes for Adults (18-65 years) Page 18 of 43 Evidence: We noted that in addition to the electronic records each resident now has a hard copy file of records of financial transactions. We were unable to accurately audit and reconcile receipts to expenditure because dates on receipts did not exactly correspond to dates of trips or dates recorded as financial transactions. Some records of financial transactions contained little or no detail of the actual expenditure making monitoring and reconciliation difficult. We noted that there were still communal receipts in use, particularly from the barber. We discussed the issue of protection of residents individual finances held in a joint commercial account, in the current thinking financial crisis. The financial manager was unaware of what protection would be available given the large amount of money held in the joint corporate account operated by the organisation. We have strongly recommended that clarity be sought from the bank and from the organisation and insurance to make sure the residents finances are fully protected. Care Homes for Adults (18-65 years) Page 19 of 43 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. Links with the community are generally good with planned and spontaneous activities take place. Residents are generally able to take advantage of and develop socially stimulating opportunities, including holidays away from the home. The menus are designed to offer residents choices of healthy and good quality meals. Evidence: The homes AQAA stated what they do well, Service users have links with the local community with planned and spontaneous activities taking place. We offer opportunities for service users to participate in stimulating and personal developmental activities. Menus are designed to be varied and healthy with consideration given to differing appetites and personal health needs. The homes AQAA cited the evidence to show what it does well, Attainment of Gold Care Homes for Adults (18-65 years) Page 20 of 43 Evidence: standard for the Promoting Healthy Food Choices Service users are involved in planning menus an have opportunities to discuss preferences and dislikes through regular Food Council Meetings. Colourful pictorial menus display various choices including healthy options. A dedicated member of staff organises and evaluates activity programmes resulting in service users having access and opportunity to integrate into the local community. Examples of trips are visits to garden centres, shopping centres, local public houses, cinema and theatres. Local transport and Halas Homes vehicles are used. Service users attend a weekly music club and have the opportunity to work alongside professional musicians whilst performing music and dance in shows at Halas Homes and recently at the Salvation Army Citadel in Cradley Heath. Various holidays are taken by service users including The Bond Hotel in Blackpool, the caravan in Somerset, The Grand Hotel, Scarborough and a Mediterranean cruise. Opportunity is given to develop and maintain important personal and family relationships, and some people are able to visit family members for weekend visits. Other service users have family visitors to the home. Responses from the relatives survey confirm that privacy is offered and comments regarding communication visits were stated as my relative can telephone me at any time and is informed whenever I visit The Registered Manager and her senior staff ensure that where appropriate service users are involved in domestic routines. The person accompanying us with experience of using care services reported,I started my visit in the dining room and there were about 11 people seated in the dining room. All of the people in the dining room used words to communicate. This persons observations included, When I sat down the cook was giving everyone a drink. There were all these cups laid out on the bar and the cook asked people what they wanted to drink but no one there made their own. They poured it, put sugar in it. Most of the people I spoke to in there were capable of pouring their own tea. Even if the cook made a pot and let people pour their own. The other cook was buttering bread rolls, not one resident was in the kitchen helping. There were able people sitting in there could be helping in the kitchen. This may be a residential home but it should not stop people from doing things for themselves. Everything is done for them. The satellite house is run exactly the same, both homes are not an enabling environment. The people that I spoke to said that they did not go food shopping. The cooks order it in from Macro, a big hypermarket. Three people I spoke to said that they are not involved in writing the shopping list. Whilst I was there the manager gave out chocolates in a box that was brought in bulk. The manager confirmed that the shopping is brought in bulk from Macro every 2 weeks.One lady said We do well with the food. There is a picture menu up on the wall, this was good to see but it needs to be meaningful, as no one knew what they were having for tea that evening. The people in the dining room told me that they have a cooked meal on an afternoon and Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: just sandwiches and cobs on an evening. I was told that they get two choices to choose from. We get two choices. The manager said that the cooks would do other things for people if they do not want the choices they were offering. People told me that the home manages their money but they have one big bank account that it is paid into. Only two people out of the six I spoke to say that they go out on a Saturday and spend their own money. I go out on a Saturday shopping. Another lady said I do not really go out. Three people told me that the staff go and buy toiletries and they go out occasionally to choose clothes. They said that this does not happen very often. One lady said that she has a pound a day to buy tea and coffee at the day centre. I asked people if they go out or do any activities and they said that they rarely go out apart from 2 who said that they go out on a Saturday. All of them said that all they do on an evening is watch TV. One person said, There are times when we all fall out and argue when we are all bored. They told me that the staff do take them out on trips. One man told me that he and two other people were going on holiday to the seaside. This is good to hear, that they can go in a small group. Some people told me that they go to the day centre out in the community but some people said that they use the day centre attached the home. If they do not go out because there is not enough staff then those people barely leave the grounds. Staffing issues need to be addressed as this is impacting on peoples lives. People told us that they have just had a new minibus so that they can now go out in groups of 15. People seem more than able to go out on a bus. People said that they do not go out without support. People told me that all of the activities took place over at the day centre apart from a music man comes in on a Friday to do exercises. One person said that she paints once a week. We saw evidence that a number of people do activities outside of the home at weekends, including some people who have weekend stays with relatives. The home informed us that in fact the music man came weekly at alternate times, afternoons and evenings, to give everyone an opportunity to participate, We were told that this entertainer did not do exercises with the residents. We looked at peoples activity plans, activity records and spoke to the homes activities co ordinator, other staff and the residents. We also noted the considerable amount of expenditure on activities and outings recorded in the finacial records. There was evidence of a commitment to enabling residents to develop their skills, including some independent living skills. We saw evidence of structured activity programmes for some residents, whilst some residents prefered a more spontaneous approach to activities. Unfortunately the activity plans and records had not been maintained with the same level of detail as seen at the previous inspection. For example though there no activities detailed for a sample of 3 residents during the evenings or weekends, with the activity plan stating, Halas day centre from Monday to Friday. We established Care Homes for Adults (18-65 years) Page 22 of 43 Evidence: during discussions that the day centre offered a range of activities from 09:30 to 2:00pm. This was staffed by the activities co ordinator and 3 staff and the number of residents varied between 10 and 22 each day, which placed limitations on what could be provided. There was some limited access to local community events and there were trips and holidays away from the home. We were told of examples of some people being encouraged to to use public transport as well as using the homes vehicles. Examples of trips and holidays included small groups of residents visiting the cinema at Merry Hill, Barnett Hill Garden Centre, the hotels in Blackpool and Scarborough, and a chalet in Burnham on Sea. We were told that the Local Authority was in the process of reducing access and attendance of organised and funded community based day activities. This had placed pressures in terms of staffing and finances for the home to make sure that education and occupation opportunities continued to be encouraged, supported and promoted. There were still a number of people who were continuing to attend community based day opportunities for younger people organised by the funding local authorities but at a reduced frequency. We noted that fewer of the older residents had continued to attend day centres for older people, one person told us I have retired. We noted that residents were encouraged and supported to practice their faith, attending local churches according to their preference. Some people attended the local Catholic Church for services and social occassions, and others regularly attended services at the local Free Church. We were told that the majority of residents had the opportunity to develop and maintain important personal and family relationships, and some people were able to visit family members for weekend visits. Other people have family visitors at the home. We received responses to the CSCI surveys confirming that visitors and families felt welcomed at the home. We were told that where it was thought appropriate residents were involved in the domestic routines of the home. We were given examples that some people could take responsibility for their own room or help with tasks in the dining room and kitchen. We noted that one of the residents particularly enjoyed helping the maintenance staff and gardener. Unfortunately the ethos of the home was not always demonstrated by practices observed during this inspection visit. Some less than postive observations were described by the person accompanying us. The home strived to involve residents in menu planning and assisting with meals, though this was not well demonstrated during this visit. The cook was experienced and knowledgeable about residents dietary need and made efforts to provide the food they Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: preferred and liked. The home had a food council, a resident showed us her photograph displayed in the dining room, along with the other resident members pictures. The colourful pictorial menus were varied with a number of choices including healthy options. The home introduced tasting sessions, which included a variety of dishes to encourage residents to try new and different food. Residents told us they liked the food, saying there was plenty to eat and choices. We noted that there were ample supplies of fresh fruit, hot and cold drinks were readily available in the open kitchen area. The home had achieved the Gold Award for healthy eating. We spoke to staff who were aware of the needs of those residents who find it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of feeding at the residents pace, so that they were not hurried. A small number of residents chose to have their meals, particularly breakfast at a different time, to allow them time and space to eat at their own pace. Care Homes for Adults (18-65 years) Page 24 of 43 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 health needs of residents are generally well met with good evidence of multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. Evidence: The homes AQAA cited the following evidence for what they say they do well, Staff demonstrate awareness and understanding of principles of offering personal support. Staff demonstrate their sensitivity toward privacy and dignity when providing personal care to service users. Daily task lists reflect service users preferences toward receiving personal support. Healthcare booklets are current and provide information on individual service users access to health professional services and aspects of well being. Where service users are unable to access local services health professionals visit the home and these include optician, chiropodist and dentist. A hairdresser visits the home regularly for those service users unable to access local facilities. Service users are offered access to health care screening and they are encouraged to regularly check themselves for any abnormal or unusual changes in their bodies. The homes Care Homes for Adults (18-65 years) Page 25 of 43 Evidence: policy on medicines is accessible to staff, and staff administrating medicines have to undertake accredited training course as well as mandatory complementary in house training with the Registered Manager. The Registered Manager regularly updates her training with the pharmacist. Staff have access to training in health care matters and are encouraged to attend seminars and lectures arranged by local health care organisations on specialist work areas. We saw that staff had awareness and understanding of principles of support for personal care and were generally responsive to the varied and individual requirements of the residents. They told us that they knew that personal care was highly individual and needed to be flexible and reliable. Staff were generally attentive and sensitive when supporting people, ensuring privacy and dignity when providing personal care. We were told that whenever possible residents were able to have choice about which staff provided their personal care, though this was dependant on staff availability. However there were no male staff for male residents to choose to give them assistance or to relate to. The home should take postive action to recruit male staff. We noted that some residents were supported and helped to be responsible for their own personal hygiene and personal care where it was possible. We saw that though the majority of residents were up and about at the start of this inspection, some of the older residents had chosen to rise later and have breakfast at a more leisurely pace. However during the evening of this inspection visit, at approximately 7:15 pm we saw several residents, male and female returning to sit in the large communal lounge in their nightwear. We were told that they had been assisted with their personal care and to change in to their night attire. As this appeared to be the usual practice we discussed this routine with the general manager. This practice did not appear to be documented in plans for personalised care and there did not appear to be consideration given to maintaining each persons rights to choice, privacy and dignity. We also noted that some daily routines appeared task orientated, rather than lead by residents daily living activities. An example was at the 2pm shift change over, and as Halas day care finished with all residents at home returned to the main house, the majority of staff on the afternoon shift were engaged in transferring clean clothes from the laundry, in the grounds, to each residents bedroom, using wheelie bins. There were no residents involved in this task. We strongly recommended that the management of the home review routines to make them less institutional and consider how each resident could be more involved in daily living activities. Previously we had recommended that the home consider a checklist (for example monthly) for each person to demonstrate and monitor that their personal hygiene and Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: health care needs had been provided in accordance with their preferences. We were not shown any evidence that this good practice recommendation had been actioned. The person who had experience of using care services who accompanied us, included the following in their report, One person told me that everyone goes to bed at 9 oclock. Another person said that they could go between 9.30 and 10pm. Another person said, We can all go at different times. One person told me that everyone has to get up at 7 am. This person was not very happy about this. Another person told me Some of us have to wait until 7am to get up when the staff come in but some of us can get ourselves dressed. One person said, there is only 1 waking staff on a night who checks us every hour. This is not enough for 29 residents. I did see a bedroom for staff on two levels of the house so I presumed there is more than 1 staff member on. One person said, Sometimes we are short staffed in the mornings when they are trying to get every one up. If this is the case, this needs to be addressed. We saw evidence that residents had good access to health care services that meet their assessed needs both within the home and in the local community. The majority of residents were able to choose their own GP, within geographical boundaries, and attended local dentists, opticians and other community services. Health care professionals manage the health care needs of residents unable to access local services with visits to the home. The home had introduced appropriate ways to educate residents and help them to understand the need to regularly check themselves for any abnormal or unusual changes in their bodies. There were pictorial booklets, discussed at residents meetings and with residents on an individual basis. We noted that residents were offered access to health care screening processes, with agreements, outcomes or refusals recorded in each persons case file, which was good practice. There was continuing work with community nursing colleagues to implement Priority Screening for Health, health passports, for each resident covering all aspects of well being. We looked at the weight records, especially relating to a resident with weight loss, that staff had told us about. We were concerned to see that the home had reverted to using a communal list to record residents weight each month. We discussed the issues around Data Protection and each persons rights to privacy. We strongly recommended that each resident has an individual weight record, held as part of their care records. The home had a comprehensive medication policy, which was accessible to staff. We looked at the MAR sheets, which were well maintained and up to date for each resident, with only one gap noted. Medication received, administered and disposed of was appropriately recorded. Improvements such as the homely remedies policy and records of medication balances on MAR sheets had been implemented. Senior staff were responsible for the administration of medication and we were told that all senior Care Homes for Adults (18-65 years) Page 27 of 43 Evidence: staff had received accredited medication training. We spoke to senior staff who were knowledgeable and aware of each persons medication needs. Care Homes for Adults (18-65 years) Page 28 of 43 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. There is a comprehensive complaints system, provided in pictorial and other alternative formats for residents. Staff understand the need to listen and to act upon areas of concern. The home has policies, procedures, guidance and supports staff with training in order to provide residents with safeguards from abuse. Evidence: The home had alternative formats for the complaints procedure, such as pictorial and easy to read versions, which were more suitable for residents capabilities. We were told that there had been five complaints made directly to the home and these were recorded in the homes complaints log, with information that 4 were upheld and all responses were within the 28 day timecale. The responses of the CSCI service user survey undertaken in February 2008 were confirmed during discussions with residents who told us that they could voice any concerns either directly with the manager or staff. However there were complaints from staff from other organisations made to Dudley Adult Protection Coordinator with allegations about staff from Halas House and their behaviour towards residents on a recent holiday. The organiosation took swift action to suspend 2 staff without prejudice, whilst the lead agency, Dudley DACHS (Directorate of Adult, Community and Housing Services) conducted an investigation into the allegations. Additionally a further 3 anonymous letters of complaint were sent to the Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: CSCI office, Birmingham. The allegations contained in the letters were referred through the safeguarding procedures to Dudley DACHS and further investigations have been started. The organisation had been given access to the findings and were required to conduct its own internal investigations. The organisation had previously worked proactively with other agencies and had a record of providing swift and comprehensive responses. The outcomes from a previous referral have been managed well with issues satisfactorily resolved. The management of the organisation acknowledged that some staff shortages had been recently been experienced, however staffing levels had been maintained with use of existing staff working extra hours and agency staff, where needed. During discussions with staff they indicated that they were aware of the homes procedures to safeguard residents and the Local Authority multidisciplinary procedure, Safeguard and Protect, for the protection of vulnerable adults. The management of the organisation had regularly arranged staff training in the areas of protection of vulnerable adults and the operations manager was exploring options of additional training. There were no concerns raised during discussions with residents and interviews with staff throughout the inspection visit. Care Homes for Adults (18-65 years) Page 30 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the decor within this home is good with evidence of improvement through ongoing maintenance. The home generally presents as a safe, homely and comfortable environment for residents. Evidence: Halas Home provided accommodation for up to 37 adults with learning disabilities over a wide age range. The premises included the large three-storey house with two extended ground floor wings and two small 2 bedded, ex council houses as satellite houses. There was ample car parking in the grounds, with security provided by electronic gates, activated by sensor. The grounds were well maintained, with a pleasing sensory garden, which provided a haven of peace and quiet. We took a brief tour of the premises there was evidence that the home continued to be maintained to high standards with an ongoing maintenance program. We were told that there was continued progress to provide lockable space in residents bedrooms on a prioritised basis and bedroom locks and keys had been provided for people wishing to have them. The kitchen was well organised, with well maintained equipment, and a wide range of Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: food stocks stored and prepared in good compliance with food safety. The home was inspected by Dudley Directorate of Urban Environment and had a copy of the EHO report dated 13/2/08, which had 3 legal requirements and 1 good practice recommendation, which were all met. The home had achieved the Gold Award for food safety and healthy eating. The large extended laundry, located in a separate building in the grounds, was well equipped with commercial washers and tumble dryers. The laundry service was generally well organised and the designated laundry staff show good standards of infection control. There was a laundry procedure and measures in place for supplies of disposable gloves and aprons to be readily available in the laundry at all times. Throughout the home good standards of cleanliness continued to be maintained and there were no discernable malodours during this visit. The person accompanying us who had experience of using care services also toured the home and reported his perceptions. In the satellite house it was good so see that people had a choice of how their room was decorated. This did not seem to happen over the big house everyones room that we saw said that the painting have been done for them and that they did not chose how it was decorated. Two bedrooms we saw was magnolia and another was slightly more yellow. People should choose how their rooms are decorated more. It was nice to see that people had their own picture on the doors to their rooms. One lady had her own artwork up on the walls. It was good to see that people had photographs and personal things in their rooms. The wardrobes were nice as they were fairly new and people had a sink and toilet in their rooms. These were clean and tidy. We noted there were other bedrooms at the main house where there was evidence that people had chosen colour schemes and murals painted by a professional artist, such as a spitfire aircraft. He reported his view about things that could be improved, This home is far too big, there should be smaller homes so that people are encouraged to be more independent. One person we spoke to said that she did see her father on Saturdays but did not have anywhere private that she could meet with him. Usually see him downstairs but theres lots of other people around. People should be able to see family in private. I struggled with the stairs so I worry that if any one is unsteady on their feet there are 3 flights of stairs. He disagreed with the culture of the home that everyone should be cared for. Just because people live in residential settings does not mean that they cannot do things for themselves, there are people living there that are more than able to make drinks. He was concerned about seating arrangements in the large communal Care Homes for Adults (18-65 years) Page 32 of 43 Evidence: lounge, the chairs were positioned in the lounge, nobody was speaking to each other,it is hard to when everyone is sat in rows against the wall. I was shocked that the men over in the satellite house was still treated same as the people in the main house. These men should be encouraged to do cooking, their own washing. He questioned How can having a washing machine in a home with support be a health and safety issue. He also reported good things about the home, I liked the fact that one lady had her artwork on the walls in her bedroom and is encouraged to paint. Everyone had their own picture on their bedroom door. In the satellite houses it was good so see that people had a choice of how their room was decorated. It was good to see that people had photographs and personal things in their rooms. The homes AQAA cited the following evidence as improvements made in the last 12 months, Adaptation of shower room in satellite home to provide a wet room for wase of accessibility and further improve health and hygiene needs.Door furnishings to include kick board.Re-carpeting of specific bedroomsReplacement of carpets in communal areas. Replacement of carpets to anti slip flooring to improve Health and Safety. Fitting of new disco lighting for evening events and discos and purchase of amplification system and musical decor items. Removal of fencing on grounds to open up and create space. The managers told us their plans for improvements over the next 12 months included, an allotment area for service users to include greenhouse, potting and tool shed and appropriate gardening tools. Care Homes for Adults (18-65 years) Page 33 of 43 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 home has an enthusiastic staff team and the organisation continues to demonstrate a strong commitment to staff training and development to ensure residents receive consistent assistance and support to develop their potential. Staffing levels and deployment of staff may mean that residents routines are not as personalised or flexible as they need to be. There are rigorous staff recruitment processes, which provide good safeguards for residents. Evidence: The homes AQAA cited the following as evidence of what they do well, The staff team has seen some changes since October 2007 with 12 resignations. Staffing levels are supplemented on occasions by overtime with the major cause being long term sickness for valid reasons and maternity leave combined with intermittent sickness absences due to chronic and seasonal ailments. Rigorous recruitment and selection practices with adherence to legislative requirments with comprehensive documentation. Service users are involved in the interview process. Clear job descriptions, training records and staff qualifications together with supervisons files and training plans evidence staff support. Comprehensive induction audit trails and regular supervision sessions are maintained. Annual appraisals take place with a cycle of supervision sessions ensuring the development of all staff. Regular departmental staff meetings take place as well as Care Homes for Adults (18-65 years) Page 34 of 43 Evidence: the Registered Manager holding staff meetings and and reinforcing communication through staff newsletters and staff notice board. Professional visitors survey confirms that staff demonstrate a clear understanding of the care needs of service users with staff documenting any instructions received in their handover to ensure all members of staff are fully aware. Amongst training planned and delivered is Challenging Behaviour [NHS], Abuse Awareness, Mental Capacity Act, Wheelchair, Communication passports, Infection control, Breakaway training, Supervisory management, Equal opportunities and Diversity, Speech and Language, Incontinence, Person Centred planning, Swallowing awareness. Investors in people. Employees have an employee forum. From assessment of information provided by the home, we noted that the staff team at Halas Home had lost some stability, with a total of 13 staff leaving the homes employ for a variety of reasons. Additionally 3 staff remained suspended, without prejudice, to allow allegations of abusive behaviour to be fully investigated. The staffing rotas and discussions with the general manager, operations manager, senior staff and support workers show that there had been occasions when the staffing levels have had to be supplemented by existing staff working extra shifts and use of agency staff. We received assurances from the general manager and operational manager that this situation was being managed and though it had inevitably placed additional stresses on some members of staff, most people demonstrated a commitment to the residents. Although the staffing rotas at this visit generally indicated that the home was usually maintaining adequate staffing levels, there were examples where residents needs were being met as a group rather than in an individual, personalised way. Furthermore we noted that the home was experiencing considerable difficulties in obtaining cover for the night shift on the day of this inspection visit. We strongly recommended that the home put in place more robust contingency measures, such as agreeing a temporary employment of agency staff for a specified period, in order that all residents needs of can be met to consistently. The registered persons must make sure that there are sufficient numbers of staff on duty in the main house and satellite houses at all times to meet each residents individual health and well-being needs and promote their rights to choice, privacy, independence and social stimulation. During discussions staff demonstrated that they are aware of the aims, policies and procedures of the home. We saw evidence that staff had a warm rapport with residents and families and were generally knowledgeable about their needs and preferences. However comments from staff confirmed that at times they felt they did not have sufficient time to spend with residents on an individual basis. Comments from the staff surveys, included, need more carers for residents assistance. There were also comments relating to staffing levels contained in the report from the person Care Homes for Adults (18-65 years) Page 35 of 43 Evidence: accompanying us, which have been included in previous sections of this report. Comments from relatives surveys were entirely positive and included, all the staff make the care home as comfortable and home like as possible, and consideration of the person in their care with respect to the different temperaments and problems. We looked at a sample of staff personnel files at this visit and the operations manager continued to demonstrate commendable recruitment practice, with very well organised and maintained staff files containing comprehensive documentation. We noted that the organisation continued to demonstrate a strong commitment to staff training and development and had continued to provide all staff with appropriate training to raise awareness and skills to respond to residents changing needs. We saw evidence that 19 of 26 care staff had achieved an NVQ level 2 care award or LDAF (Learning Disability Framework Award) or above, with new candidates registered for training. We were told that all staff had an annual appraisal and there was a formal structured supervision system, with the aim that all care staff received a minimum of 6 one-to-one supervision meetings each year. Care Homes for Adults (18-65 years) Page 36 of 43 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with clear leadership and staff demonstrating an awareness of their role and responsibilities. The systems for resident consultation at Halas Home are good with a variety of evidence that indicates that peoples views are both sought and acted upon. The compliance with all aspects of records and health and safety is satisfactory, which minimises potential of risks residents safety and well being. Evidence: The registered manager, Kathryn Rudge was not available during this inspection visit. The inspection was conducted with the assistance of the general manager, the operations manager and senior staff. The management team have had many years of experience managing care services, with qualifications related care, managerial, human resources and staff training. We looked at the homes quality assurance system and noted that committee members made regular visits and provided the home with Regulation 26 reports about the conduct of the home. The operations manager had made good progress to develop a Care Homes for Adults (18-65 years) Page 37 of 43 Evidence: comprehensive quality assurance system, which had been used for monitoring and self-evaluation of all service areas, using the National Minimum Standards as a basis. It was commendable that an analysis of the homes current position has been undertaken. There was an up-to-date annual development plan in place and the results of resident, relatives and stakeholder questionnaires had been collated and evaluated to identify the homes strengths and weaknesses. There were regular residents, Food Council and staff meetings, with minutes available. The organisation had continued with the excellent progress to develop applicable policies into formats, such as pictorial, audio and video, which were suitable to residents capabilities. We looked at a sample of mandatory staff training records, fire safety and maintenance service records, which were generally satisfactory. We noted that there were some gaps in mandatory training, which need to be provided for all staff commensurate with their role. We looked at the accident records for the past 12 months. There were 53 recorded accidents relating to residents and 32 recorded accidents relating to staff or other in the last 12 months. We saw evidence that the registered manager had undertaken regular documented accident analysis. Howver the accident analysis usually done weekly by the registered manager, had not been completed in her absence and needed to be resumed. Care Homes for Adults (18-65 years) Page 38 of 43 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 39 of 43 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 33 12 The registered persons must 01/12/2008 make sure that there are sufficient numbers of suitably qualified, competent and experienced staff on duty in the main house and satellite houses at all times to meet each residents individual health and wellbeing and promote their rights to choice, privacy, independence and social stimulation. This is to ensure each residents individual health and well-being and promote their rights to choice, privacy, independence and social stimulation. 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 It is recommended that information about fees should be included in the service user guide to give people Page 40 of 43 Care Homes for Adults (18-65 years) comprehensive information about the service to help them make decisions about the choice of home. 2 2 That the homes assessment documentation should be fully completed with comprehensive information, in easy to understand person centred formats, which reflect the assessed needs identified by the placing agency. This will demonstrate the home can meet each persons assessed needs. That person centred care plans be fully developed demonstrating the active involvement of the resident to identify their preferences for support and care in all areas of their lives, to meet their aspirations and promoted their independence. That short term care plans are put in place to provide information and guidance for additional care needs during episodes of illness or increased need. 4 7 It is strongly recommended that clarity be sought from the bank and from the organisation and insurance to make sure the residents finances are fully protected. Progress should be made for each person to have an individual bank account, wherever this is achievable. That a review be undertaken to look at the way daily living activities are organised and serious consideration should be given to how in this large home residents can be encouraged and supported to make individual decisions and receive a more personalised service. That a review of the homes routines be undertaken and regular consultations take place with each resident, with their decisions about their daily routines recorded in their care plan, together with regular reviews of staffing levels and delegated duties to make sure routines are flexible to residents needs. It is strongly recommended that each resident has an individual weight record, held as part of their care records, to maintain privacy and compliance with the Data Protection Act. That serious consideration be given to making sure all staff have refresher training in relation safeguarding vulnerable people, preferably making use of Dudley DACHS training provision, which would mean that staff had a better awareness and understanding of the Lead Agency safeguarding procedure, Safeguard and Protect. That the organisation takes account of the perceptions of a person who uses care services and holds discussions with residents about these views to see if there are 3 6 5 16 6 18 7 19 8 23 9 24 Care Homes for Adults (18-65 years) Page 41 of 43 opportunities to make the large home less institutional and feel more individual for each person. 10 33 We strongly recommended that the home put in place more robust contingency measures, such as agreeing a temporary employment of agency staff for a specified period, in order that all residents needs of can be met to consistently. Care Homes for Adults (18-65 years) Page 42 of 43 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. 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