Inspection on 20/04/09 for Ledbury ABI Transitional Living Unit

This inspection was carried out on 20th April 2009.

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

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

Other inspections for this house

Ledbury ABI Transitional Living... 19/03/10

Ledbury ABI Transitional Living... 30/04/08

Ledbury ABI Transitional Living... 19/10/06

Similar services:

Tanglewood

88 Church Lane

Harmony Care Home

Olivet Christadelphian Care Homes

Sayer House

Beacon Centre For The Blind

60 Olive Lane

Bryndale Avenue, 41 Flats 13, 14 & 18

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ledbury ABI Transitional Living Unit Market Street Ledbury Herefordshire HR8 2AQ     The quality rating for this care home is:   one star adequate 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: Sarah Blake     Date: 2 0 0 4 2 0 0 9 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. 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. 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 34 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Ledbury ABI Transitional Living Unit Market Street Ledbury Herefordshire HR8 2AQ 01531637600 01531673619 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Shaw Healthcare (Ledbury) Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 0 physical disability sensory impairment Additional conditions: 10 10 The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 10 Sensory impairment (SI) 10 Date of last inspection Brief description of the care home Ledbury Acquired Brain Injury Transitional Living Unit opened on May 1 2003. It is operated by Shaw Healthcare. The unit is situated within the Ledbury Community Care Centre in the heart of the town. The Centre contains a number of separate services including a Social Service office, various dental, medical and therapy services, a minor injuries unit, an intermediate care unit (ICU), and a nursing home for older people. The last two are also registered with the Care Quality Commission as care homes and are also operated by Shaw Healthcare. This report is only about the Acquired Brain Injury Transitional Living Unit. The other two services are inspected separately. Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home The unit offers care for up to 10 people aged 18 - 60. It offers services for people who need support and time to regain or to practice the skills necessary for independent living. The statement of purpose identifies the normal maximum length of stay in the unit as being five years. There are 10 single bedrooms with en-suite facilities, a sitting/dining room, an activities room and a therapy area. The unit has a laundry service and full meals service from a central kitchen but additionally, there is a kitchen on the unit for use by the people staying there. The unit is accessed by stairs or lift from the Centres main reception area, and also has its own front door accessed across a walkway. Outside the unit has a separate patio area with seating and a canopy, and an enclosed garden with raised beds. Information regarding fees can be obtained from the registered manager at the unit. A copy of this report can be viewed at the unit. Care Homes for Adults (18-65 years) Page 5 of 34 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 was an unannounced inspection. Two inspectors spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, 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. The service had previously completed an Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 6 of 34 (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the care home does well: What has improved since the last inspection? What they could do better: Complicated paperwork means that people living at the home are not able to be fully involved in planning and reviewing their own care. Care plans are not always up to date or consistent. There is evidence that the home does not always manage medication safely. The home does not always ensure that all risks have been identified and managed appropriately. The home has not made much progress in involving people who live there in the development of the service. Care Homes for Adults (18-65 years) Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 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. The home provides information to help people decide if they wish to move in, and this information is available in formats which make it accessible to people. The home carries out assessments before people move in, so that people can be confident that the home can meet their needs. Evidence: The home has a Statement of Purpose and a Service User Guide, both of which give detailed information about the home and what life is like there. The Service User Guide has recently been updated and is now presented in a format with large print, clear explanations, and pictures, so that it more closely meets the communication needs of people who use the service. The manager told us that the Service User Guide is given to people when they first visit the home, or at the pre-admission assessment visit. In our surveys, people told us that they felt that they had not been given enough information to help them decide if the home was the right place for them. We spoke to one person who had recently moved into the home, and they told us that, although Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: they felt that they had not been given enough information before moving in, they had visited the home and had the opportunity to decide that they wanted to move in. We looked at the records for one person who had recently moved into the home. These showed that staff from the home had visited the person at their previous address to carry out an assessment of their needs. We saw that this assessment was hand-written, and was very difficult to read. The records contained a typed assessment dated January 2009, and this assessment had been reviewed before they moved into the home, and was very informative. The section about medication had not been completed, but we saw that there was a list of medication elsewhere in the records. These documents would give staff most of the information they need to make sure that the home can meet the persons individual needs. Care Homes for Adults (18-65 years) Page 12 of 34 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. Complicated paperwork means that people living at the home are not able to be fully involved in planning and reviewing their own care. Care plans are not always up to date or consistent. This means that staff may not always know the care that needs to be provided to meet peoples needs. Evidence: During the inspection, we saw that staff were working with people living at the home in a way which promoted dignity and privacy. Staff made sure that they always knocked before entering a bedroom, and they explained any procedures clearly before carrying them out. At the last inspection a year ago, we found that peoples care plans were too bulky and complex, and were not reliably up to date. Although the manager told us in the AQAA that New Care plans will encourage service user involvement and goal setting aims, we were disappointed to see that the new care plans are not yet being used to support Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: person-centred planning for people living at the home. The British Institute of Learning Disabilities (BILD) explains that Person centred planning reflects a persons capacities, what is important to a person (now and for the future) and specifies the support they require to make a valued contribution to their community. Because the ABI Unit is a transitional living unit, which means that people are only there for a maximum of five years, it is very important that their care plans reflect the ways in which their progress is planned and evaluated. This will mean that people feel more in control of their own lives, and staff can see clearly what goals people have, and how they can support people to achieve those goals. We looked at three peoples records in detail, and saw that the old care plans were still being used for all of them. Two peoples records contained blank sheets for the new care plans. In the third persons records, a few parts of the new care plan had been completed, but this was not enough to give a full picture of the persons needs and wishes. The manager told us that the delay was partly due to the internal processes of Shaw Healthcare and its Quality Team. We would have expected the implementation of the new care plans to have been a priority for the home, as the current care plans do not support person-centred planning, and are not in a format which is suitable for peoples communication needs. Last year, we asked the home to consider making peoples care plans more accessible to them. We saw that care plans are now kept in the lounge, and the manager explained that there is always at least one member of staff in the lounge, which means that people can only access the care plans if they are authorised to do so. This improvement means that people living at the home are able to look at their care plans whenever they wish to. When we looked at the care plans for someone who had recently moved into the home, we saw that there was no guidance for staff on the goals that the person wanted to achieve, and no information about day-to-day decision making. Although the home allocates a named nurse and a key worker to each person, the new person had not been allocated either, even though they had been living at the home for nearly two weeks. We saw that one person had a care plan written by a Speech and Language Therapist, because they had problems swallowing. The care plan stated it is sensible to keep fluid and food intake charts to make sure that Xs (name of person) weight stays stable. We saw no evidence that staff were recording the persons food or fluid intake. The care plan also stated make sure that Xs mouth is clean after feeding. We saw Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: that the home had carried out a risk assessment for mouth health, which indicated that mouth care was needed every two to three hours. There was no evidence of mouth care being given. The manager told us that there was no need to give mouth care, as the person is taking large amounts of oral fluids. It was not possible to check this, as there were no records. We saw staff offering the person drinks during the day. It is important that care plans and risk assessments reflect the current situation, so that staff can easily see the care that needs to be provided. In our surveys, only three people told us that they can always or usually make decisions about what they do each day, and four people told us that they can sometimes or never make decisions about what they do each day. We saw in the records that people are offered a choice of activities, and had been given the opportunity to choose a Top Ten list of favourite activities. We could not see any evidence that people had been involved in decisions which affect their lives, such as planning for their future. We saw that one person had a behaviour support plan drawn up with input from a clinical psychologist. This included information about how behaviour issues might be triggered and the types of behaviour. The plan also showed clearly how staff should respond to any behaviour issues. This plan was kept in a folder in the lounge, where staff could easily access it if necessary. Care Homes for Adults (18-65 years) Page 15 of 34 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. There is a wide range of leisure and social opportunities for everyone living at the home, including life skills and opportunities to take part in local community activities. Meals provide a well balanced and nutritious diet. Evidence: The home employs an Occupational Therapist, who works closely with the Activities Co-ordinator to ensure that people have social and leisure opportunities which meet their individual needs. The Activities Co-ordinator told us that the staff have a weekly meeting to discuss activities. It is disappointing that this meeting does not involve at least some of the people who live at the home. We looked at three peoples activity records in detail. These showed that the home tries to make sure that people can take part in activities which interest them, and will Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: support them to gain life skills. The Occupational Therapist told us that she works with people on their money handling skills. This includes coin recognition and managing a budget. People are given support to put this into practice when shopping. We were told that one person was supported on a train journey by being shadowed by staff, but had to make all decisions and transactions himself. One persons activity records showed that within the previous two weeks, they had been on outings to Dymock Woods and the Malvern Hills, and had been shopping and to the library. We saw that each person has an individual weekly planner, showing their planned activities for each weekday morning and afternoon. The planners included activities such as Riding for the Disabled, cinema, ten pin bowling, gym sessions, pub meals, Growing Point (a local charity which encourages and assists people who are unable to manage traditional methods of growing plants to enjoy the therapeutic benefits of horticultural activities) and attending local football matches. In our surveys, people told us about some of the activities they enjoy doing. One person said I like to do shopping, art, Glazydays pottery, listening to pop music, dance music and disco clubbing music, reading, outings and activities such as ten pin bowling, swimming, gym, walking around town, looking round the shops and spending lots of money, dancing and singing to karaoke. The home now has a garden, with raised beds so that people who use a wheelchair are able to take part in gardening. We saw that the Occupational Therapist had a one to one gardening session with one person on the afternoon of the inspection. Although the home does not provide formal activity sessions in the evenings and at weekends, we saw records which showed that people sometimes go to the local pub in the early evening, and some choose to attend church on Sundays. We saw that one person had told staff that they wished to make contact with people who share their sexual orientation. The manager told us that staff have been trying to access local groups, but had been unable to do so. We were able to find information about local groups without any difficulty. The home provides meals which are cooked in a central kitchen and transported in heated trolleys to the home. People who live at the home are sometimes supported to take part in food shopping as part of their life skills with the Occupational Therapist and Activity Co-ordinator. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: We saw that the menu for the week was on display in the lounge. Lunch on the day of the inspection was scampi or beef cobbler, with mashed potato, cauliflower and mixed vegetables, followed by yoghurt or fresh fruit. The menu did not show any vegetarian options, although the manager told us that these are always available and would be offered to people. Records showed that at least one of the people living at the home was vegetarian, so it would make people feel more included if there was always a vegetarian option on the menu. The manager told us that this will be done from now on. Care Homes for Adults (18-65 years) Page 18 of 34 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. The home is generally able to meet peoples health and personal care needs, but there are some areas where improvements should be made. People cannot be confident that medication is always managed safely. Evidence: Records showed that the home makes sure that people have access to any medical care that is needed. Everyone who lives at the home is registered with a local GP practice, where the doctors have specific expertise in working with people with an acquired brain injury. We saw that one person who had recently moved into the home had visited the GP for an introductory visit. We saw that peoples healthcare needs are identified and action is taken as necessary. For example, one person had a wound on their leg. The care plan gave clear and comprehensive instructions for staff on how to manage the wound. It included a wound diagram with a clear explanation of what to look out for, for example observe for heat or oedema, elevate limb if oedema present. Daily records of the management of the wound were detailed and up to date. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: We saw that one person, who is at risk of putting on too much weight, had a care plan for their nutritional needs. There was no nutritional assessment in their records, and no weight management regime, just a comment in the care plan carbohydrates and fatty foods should be minimal. The person also had a care plan about supporting them to feed themselves, and this included short and long term goals. We spoke to staff, who showed a good knowledge of how to support the person to feed themselves. In the AQAA, the manager told us that a neuro-psychologist visits the home every month to carry out assessments and to advise on aspects of care. We saw records of these visits and examples of plans that had been drawn up as a result of the neuropsychologists advice. The home takes responsibility for the medication of everyone who lives there. In the past year, the home has reported four errors in medication. We looked in detail at the medication records for three people. We found some minor shortfalls, such as a medication which had been signed for, but not given, on one occasion. We saw that one person had been prescribed paracetamol to be taken as and when required. There was no care plan to show why the person had been prescribed the paracetamol, and under what circumstances it should be given. When we asked a senior member of staff why it had been prescribed, she responded I think its for joint pain. In another persons records, we saw the care plan for as required medication, which included a sedative medication and a steroid cream, both of which could be potentially hazardous if not given correctly. There was no explanation as to when these medications should be given or the possible side-effects. When medication is prescribed to be taken as required, there should be a clear explanation for staff to tell them when it can be given and any special instructions, such as the amount of time between doses and any possible side-effects. We saw that one person needed twice daily injections of insulin. It was not clear from the records whether the person was able to give their own insulin, or whether staff needed to give it. The daily records stated that on one day X (name of person) did agree to administer their insulin. Two members of staff confirmed that the person does not administer their own insulin. We asked the person and they told us that the staff members fill the pen syringe but do not administer it. It is important that the records clearly show who is responsible for each stage of the process when giving any medication. Medication was stored securely in the home, and staff records showed that all staff who administer medication have received training in this area. Care Homes for Adults (18-65 years) Page 20 of 34 Care Homes for Adults (18-65 years) Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any concerns will be listened to and acted upon. The home does not always ensure that all risks have been identified and managed appropriately. Evidence: The home has a clear complaints procedure, which is displayed on a notice board in the corridor. The complaints procedure has recently been produced in a format which makes it suitable for peoples communication needs. It is in large print, with photos and pictures to illustrate each point, and is written so that it is easily understood, without the use of jargon and in short sentences. In our surveys, six out of seven people told us that they knew how to make a complaint, and would know who to talk to if they had any concerns. One person said If Im not happy, I just need to speak to somebody and it gets sorted out. Staff training records showed that staff receive training in how to protect people from the risk of harm or neglect. We spoke to staff, who showed a good understanding of the protection of vulnerable adults, and were able to describe how they would report any concerns. We saw that people who were at risk of self-harm had a care plan. One persons care Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: plan stated that they needed to be supervised whilst in the kitchen and when out in the town. We spoke to a member of staff, who was able to tell us exactly what level of supervision was needed. Records showed that one person living at the home had recently been involved in several incidents involving violence towards staff, and one incident involving another person who lives at the home. The home had not informed either the commission or the Local Authority of this incident, as they are required to do under the Local Safeguarding Adults procedures. The care plan did not tell staff clearly how to respond to this persons behaviour, or any strategies for preventing the behaviour. The home looks after peoples day to day spending money for them, and keeps detailed records. The money is stored securely, and is available to people whenever they want it. Care Homes for Adults (18-65 years) Page 23 of 34 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 home provides a safe and comfortable environment for people to live. Infection control is well managed. Evidence: The home is on the first floor of a purpose-built Health and Community Care Centre in the centre of Ledbury. There is a reception desk on the ground floor, and access to the home is via stairs or a lift. The home is light and airy, with large windows overlooking the town. All the bedrooms have en-suite facilities and there is also a bathroom with a specialist assisted bath. We saw that the bathroom was clean and tidy, and was provided with liquid soap and paper hand towels, the use of which helps to prevent the spread of infection. Although the only hoist in the home was broken on the day of the inspection, the home is able to use equipment belonging to one of the other services located in the Centre. The lounge is spacious and comfortably furnished with sofas and armchairs. There is a Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: table and chairs, and one person told us that they enjoy playing board games with the staff there. A daily planner is displayed on a whiteboard in the lounge. It is divided into half hourly slots and is completed every day by the Activities Co-ordinator. People can choose to eat their meals in the lounge, in their bedrooms, or in the kitchen/dining room, where there are facilities for people to prepare drinks or snacks. The home also has a sensory room. One person offered to show us their bedroom, and we saw that it was personalised with posters, furniture and DVDs, videos and books. The room was clean and tidy. A noticeboard on the bedroom wall had a weekly planner with photos to illustrate activities, such as a daily visit to the local shop to get the newspaper. Care Homes for Adults (18-65 years) Page 25 of 34 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. Staff are caring and provide people with care that meets their needs. Staff receive training to give them the skills they need to work in this specialist unit. Evidence: On the day of the inspection, we saw staff working with people in a way which showed respect, and promoted privacy and dignity. In our surveys, people living at the home told us that staff treat them well. One person said theyre fairly strict, although caring and kind. Staff surveys showed that some staff have concerns about communication. One said There is a major lack of organisation and communication, put down to time management, but things just get put to one side and forgotten, and another said communication isnt great at the moment. We spoke to staff, and they told us that they considered that managers and senior staff communicated well. We saw that the home uses a communication book to pass on general information to staff, and that there is a hand-over at the beginning of each shift, so it was not easy to see what these concerns related to. Records showed that staff recruitment is managed in a way which protects people Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: living at the home from the risk of unsuitable staff being employed. The home carries out all the required pre-employment checks, including a Criminal Records Bureau (CRB) check and two written references, one of which is from a previous employer. Staff have a thorough induction, which meets the Common Induction Standards set out by Skills for Care, and receive regular training in all the required areas, such as moving and handling, fire safety, infection control and the protection of vulnerable adults. One staff member told us we get regular training which is very good which keeps us up to date and fills in the blanks. At the previous inspection, some staff had commented that they would like to have more training in the specific needs of the people they are working with. We saw that some staff had received training in the management of behaviour issues, but one member of staff told us Id like to know more about what happens in the body when someone has a brain injury. The staffing rotas showed that there are enough staff on duty to meet the needs of the people living at the home. Most staff in our surveys agreed that there are usually enough staff on duty. The manager told us that the home does not use agency staff, but has a bank of staff who they can call on if required. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run so that people can live safely and comfortably. There has not been much progress in involving people who live there in the development of the service. Evidence: The home is managed by Lorraine Cooling, who is the registered manager. This means that she has been judged to have the skills and experience necessary to manage the home. Mrs Cooling is also the registered manager of the care home within the Centre. During the past year, Mrs Cooling has enhanced her knowledge of the specialist needs of the people at the home by completing a module with the University of Northampton in the Management of Acquired Brain Injury. The manager is supported by a deputy manager, who has previously worked with people with an acquired brain injury. There is a team of nurses and care staff, with varying knowledge and experience of working in this area. The manager sent us the AQAA when we asked for it. It contained brief information Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: about each aspect of the service, but did not give many examples of evidence to show how the service has improved over the past year. The manager told us in the AQAA that her plans for the next year are to Ensure Rehabilitation practice is integrated into our nursing approach involving all members of the multi-disciplinary team. This will help to ensure that people living at the home experience a service which is responsive to their needs and helps them to achieve their individual goals. It is disappointing that so little has been done over the past year to improve the way in which care is planned and reviewed so that staff are clear about each persons goals and aspirations, especially as this was an area which was highlighted in last years inspection. Although records show that people are able to make decisions about their everyday lives, we saw no evidence to show how people who live at the home are involved in the development of the service. For example, we did not see any evidence of involvement in staff recruitment. The unit has detailed records to show that all equipment is correctly serviced and maintained. Health and safety are generally well managed, but the lack of written information for staff to refer to in the event of people becoming agitated could place staff and people living at the home at risk of injury. This is an area which needs further work, and it would be beneficial if all staff received training in the management of potential and actual aggression (MAPA). This training would give staff the skills to calm a situation down, but also to respond in a way which protects everyone involved from the risk of harm. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 34 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 7 15 (2)(b) You must ensure that care plans are kept up to date and are amended to reflect peoples changing needs. This is so that staff are aware of, and are able to meet, peoples individual needs. 03/07/2009 2 19 17 (1)(a) You must ensure that you carry out individual assessments of needs for any person who has specialist nutritional needs. This is so that people can be confident that their nutritional needs will be met. 03/07/2009 3 20 13 (2) You must ensure that you provide clear written instructions for every medication which is to be administered by staff, and that staff know who is responsible for the 03/07/2009 Care Homes for Adults (18-65 years) Page 31 of 34 administration of peoples medication. This is to help make sure that people living in the home receive the correct levels of medication and are not at risk from mistakes. 4 20 13 (2) You must ensure that, for any medication labelled for use when required, as directed or with a variable dose, there is always clear written direction for staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. 5 23 13 (6) You must ensure that 03/07/2009 risk assessments are carried out for any identified risk, and that you use the outcome of the risk assessments to inform care planning. This is to ensure the safety and welfare of everyone living at the home. 03/07/2009 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. Care Homes for Adults (18-65 years) Page 32 of 34 No. Refer to Standard Good Practice Recommendations 1 7 You should ensure that care plans are person-centred, so that they reflect what is important to each individual person. You should ensure that care plans are written in a format which makes them accessible to people living at the home, so that they can take part in planning and reviewing their own care. You should ensure that people are supported to make contact with local groups which meet their social needs. You should ensure that every meal includes a vegetarian option, so that food choices meet the needs of everyone who lives at the home. You should ensure that any incidents which might compromise the safety or welfare of people living at the home are reported to the appropriate authorities. 2 7 3 4 15 17 5 23 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!