Inspection on 03/03/09 for The New House

This inspection was carried out on 3rd March 2009.

CSCI 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

The New House 04/02/08

The New House 31/07/06

The New House 11/01/06

The New House 30/06/05

The New House 13/10/04

The New House 15/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: New House, The 17 Stonerwood Avenue Hall Green Birmingham West Midlands B28 0AX     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: Brenda ONeill     Date: 0 3 0 3 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 33 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 33 Information about the care home Name of care home: Address: New House, The 17 Stonerwood Avenue Hall Green Birmingham West Midlands B28 0AX 01217786391 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Mary McNamara care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The home must ensure assessment is undertaken by a qualified person to ascertain bathing facilities in the home meet the needs of service users. The home must reassess needs regularly to ensure that increasing physical needs are recognised and met. The two current service users who were under 65 at time of admission can continue to be cared for in this home for such a time that their needs can be met. Three service users, by reason of mental disorder (3MD) exc. LD and DE aged under 65 years Date of last inspection 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home The New House is a detached two-storey house that was constructed in 1991 for the purpose of providing residential care to three adults for reasons of mental illness. Accommodation consists of three single bedrooms, one of which has en suite facilities and there is a separate bathroom on the first floor. Ground floor accommodation includes a lounge, kitchen/dining room, conservatory, with a lobby off the kitchen providing access to a toilet and sleep-in room /lounge for visitors and staff. There is a small, well-maintained garden to the rear of the property with off road parking at the front. The home offers ongoing support to people with mental health needs. People living there are actively involved in the day-to-day running of the home. The fees for staying at the home that were detailed in the service user guide were not the current fees. People wanting this information should refer to the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was undertaken in February 2008. This inspection was carried out over one day. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. An Annual Quality Assurance Assessment (AQAA) had been sent to the home. The manager had completed this but had returned it to the previous address for the Commission. She was trying to retrieve this at the time of writing this report. The AQAA is a document that provides information about the home Care Homes for Adults (18-65 years) Page 6 of 33 and how they think that it meets the needs of people living there. One of the people living in the home was case tracked. This involves establishing individuals experiences of living in the care home by meeting them, 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. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: The information about the home needed to be update to ensure people who may want to move into the home had all the current information to help them decide if the home could meet their needs. The manager needed to ensure staff working with the people living in the home had all the required checks undertaken to ensure they were the appropriate people to work in the home and did not expose the people living there to any risks. There needed to be management plans in place for any challenging behaviours to ensure the people living in the home were fully safeguarded. To ensure the well being of the people living in the home there needed to be written guidance for staff about how they would recognise if a persons mental health was Care Homes for Adults (18-65 years) Page 8 of 33 deteriorating and what they should do about it. To ensure the people living in the home were fully safeguarded all the checks required by the fire service needed to be undertaken and records maintained. 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 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that the home provides all the information they need to help them decide if the home could meet their needs. The manager was able to demonstrate how the home would assess the needs of people wishing to move into the home to ensure they could be met. Evidence: There was a service user guide for the home but it had not been updated for a considerable amount of time. Some of the information was not up to date, for example, the address of the Commission was incorrect and the fees were not the current fees. It was strongly recommended that the document was updated and a copy issued to the people living in the home. This would ensure they had all the information they needed about the home. There had been no new people admitted to the home for a considerable amount of time therefore it was not possible to fully assess the pre admission assessment procedure. However there was an admission procedure on site and the manager was able to tell us what she would do if she had anyone new referred to the home. This Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: included liaising with social workers, going to see the person and inviting them to visit the home. It was recommended that the manager referred to the National Minimum Standards about the areas that should be looked at during the assessment period and develop a document she could use to record the information she obtained throughout the pre admission process. This would ensure the staff at the home had all the information they needed to meet the needs of anyone admitted to the home. The people living in the home had signed contracts on their files which detailed the terms and conditions of living in the home. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were in place that generally detailed the needs of the people living in the home and any assistance they needed from staff. Risk assessments needed to be improved to ensure the risks people were exposed to were managed responsibly. The people living in the home made decisions about their lives on an ongoing basis. Evidence: The care plan for one of the people living in the home was looked at in depth and another one just briefly. New care plans had been drawn up since the last inspection. The care plans included a profile of the person and this included an overview of why the person was living at the home, how they liked to spend their time, family contact, medical history and so on. There was also some good details about the individuals preferred daily routines. The care plans included details of the individuals abilities and where they needed assistance from staff. For example, only assist when getting in and out of the bath and drying. Where there were any special dietary needs these were also detailed, for Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: example, low fat diet due to high cholesterol. One of the care plans seen gave some very good detail as to how staff would know if the persons mental health was deteriorating and what staff were to do about this. The other file sampled did not include this information. Staff need to have this information to ensure peoples mental health is monitored and any deterioration can be recognised quickly. Other areas of the care plans could have been further developed. For example they did not detail what tasks people were able to do around the house. It was evident from the daily records, observations made and speaking to the people living in the home that they were able to do quite a lot around the home. For example, making drinks and keeping their bedrooms clean and tidy. This ensured they maintained their independence. The risk assessments and management plans for any identified risks had also been reviewed. These were generally adequate and detailed what control measures were in place to enable the individuals to take responsible risks. There were risk management plans for such things as, falling, using the stairs and making drinks. Parts of the care plan also included some risk management strategies. For example, for one person who went out independently it was detailed how long they are generally out and when they would be deemed missing. Staff were to raise the alarm at this point. The manager was advised it would be better if she clarified what raised the alarm meant so that staff were clear about what they should do if the person went missing. It was evident the risk management plans had been discussed with the people living in the home. One of the people had one for making drinks for other people saying she should not carry the drinks due to possible spillages. She was heard asking people to carry their own drinks due to this. It was also noted in one of the care plans that one of the people living in the home could on occasions be verbally abusive to one of the other people living there. The care plan stated staff were to monitor this but not how to manage it to ensure it was stopped and prevent the other person being verbally abused. This was discussed with the manager and she was able to tell us how staff managed this by separating the two and telling the one person this is not acceptable. This needed to be documented for staff to ensure they followed this consistently. The care plans and risk assessments were being regularly reviewed and any changes in needs noted. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: The people living in the home made decisions about their daily lives on an ongoing basis including what they do, where they go, what they eat, what they wear and who they have contact with. All the people living in the home were spoken with. They were clearly very satisfied with the service they were receiving. They told us they had keys for their bedrooms but did not want to lock their bedrooms. One spoke about going out independently and she decided when she did this. Two of the people remained totally independent financially and drew their own money from the post office when they wanted it and paid their own fees to the manager. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home lead active and fulfilled lives and they were satisfied with the catering arrangements in the home. Evidence: During the course of the inspection all the people living in the home were spoken with. Two were able to express verbally how satisfied they were with their lives and what they do with their time. The other person had some difficulties communicating verbally to any degree but was able to make us understand that she was happy and that she liked living in the home by her gestures, expressions and some words. All of the people living in the home attended a variety of day centres, and clubs throughout the week. All were out when we arrived to start the inspection. One person returned on their own and told us she had been to a luncheon club where she had met her friends, played bingo and had lunch. The other two people were escorted back by Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: the manager later. The daily records for the people living in the home showed that people regularly went shopping, out for walks, to the park in better weather and to the post office to collect their money. The manager told us the people living in the home were not really interested in doing activities when at home but liked to relax. They told us they do not get bored they like to watch certain programmes on the television, one person told us she reads a lot and particularly enjoys detective books, another enjoys listening to music in their bedroom. All the people living in the home take an active part in the daily tasks around the home to help them maintain their independence. They told us they take it in turns to wash up, lay the table for meals, feed the cat and they also help prepare meals. They were seen to make drinks for themselves and the others in the home. They also told us they kept their bedrooms clean and tidy but staff changed their beds for them and they helped clean the lounge. One of the people living in the home was able to go out independently and she told us about going to get her own cigarettes and how she always met people she knew and would stop and have a chat with them. Two of the people living in the home spoke enthusiastically about the centres they attended and of taking part in activities and meeting their friends there. Two of the people living in the home had regular contact with their families. One person went out with their family every week for lunch at their home and had visits from them at other times. Another told us about seeing her sons regularly and of using the phone in the home to keep in contact with family. The manager told us about how they had offered to try and contact the family of one of the people living in the home for them as they had not seen them for some time but this had been declined. The rights and responsibilities of the people living in the home were recognised, for example, all had keys to their rooms but chose not to lock them. Their rights to privacy were detailed in their care plans, details of their rights to refuse visitors and be able to see visitors in private without being disturbed were also in care plans. They had access to all areas of the home apart from other peoples bedrooms unless invited. They were aware of the rules in relation to smoking in the home and told us they could only smoke in the lounge area. There was a menu on display in the kitchen but the manager said people often Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: changed their minds and had something different. When asked about the food they had they told us the food is always good and there is plenty of food. The people living in the home were free to help themselves to food when they wanted it and were seen having access to the fridge and food cupboards and making themselves drinks. One person was able to tell us that she has to have low fat foods and that staff made sure these were available. The manager should ensure that records of the food being served to the people living in the home were restarted, as these had lapsed, to evidence that they received a nutritious diet, choices were available and also that the medical diet needed by one of the people was being catered for. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service ensures the health and well being of people by ensuring they attend regular health care checks with health care professionals when required. The medication administration system was well managed ensuring people received their medication as prescribed Evidence: The people living in the home were generally self caring in relation to personal hygiene and only needed prompting or reminding. Their preferences and abilities in relation to personal care were detailed in their care plans, for example, bath or shower. Any assistance was generally only with getting in and out of the bath or drying themselves. One person spoke to us about having her hair done by the hairdresser that visits the home and she preferred this to going to the hairdressers. The records in the home showed that people had access to health care professionals as necessary. These included GPs, dentists, chiropodists, psychiatrists and attendance at clinics and hospitals. Records showed that staff were quick to notice health concerns and ensure these were followed up. For example, one of the people living in th home had a health concern, an appointment was made with the GP the next day Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: and the person was referred to the hospital very quickly. Staff were keeping very detailed records of the outcome of medical appointments ensuring any issues could be tracked easily and followed by other staff coming on duty. People were also being weighed regularly to ensure they were not gaining or losing weight excessively. The people living in the home told us that they saw the chiropodist at the centre they attended. One person told us he had been in hospital for an operation. Another person told us she can see the doctor when she wants and that staff will make appointments. One of the people living in the home had had some issues with her mental health. These had been very well documented by the staff. The records included details of what had happened and what they had done about it and there was clear evidence that the appropriate professionals had been consulted. The majority of the medication in the home continued to be administered via a 28 day monitored dosage system which was well managed. Medication was acknowledged as being received on the MAR (medication administration record) charts when going into the home and was signed for when administered. There was some boxed medication in the home and a random audit of this was undertaken. All the balances checked were correct. It was noted that one of the people had some paracetamol this could not be easily audited as the balance carried forward from the previous month had not been entered onto the MAR chart. The manager was reminded to ensure that any balances remaining at the end of the 28 day cycle that were to be used were carried forward to the next MAR chart. This will ensure there is a complete audit trail. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were satisfied that they were listened to and their views acted on. Some issues raised meant that the people living in the home were not fully safeguarded. Evidence: There had been no complaints lodged with us about the home since the last key inspection and none had been logged at the home. There was a complaints procedure on display in the home but the address and telephone number for the Commission were incorrect. This needed to be updated to ensure people had the correct information should they want to raise a complaint with the Commission. We asked the people living in the home what they would do if they were unhappy about anything and they said they would tell Mary (Mary is the manager) and they were confident she would sort it out. They were very comfortable in the presence of the manager and relationships between them were very good which would give them the confidence to raise any issues. All of the people living in the home had contact with several people outside of the home including families and staff at various clubs and day centres they could raise issues with also. The manager was able to tell us what she would do should there be any suspicion or Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: event of abuse in the home and this corresponded to the multi agency guidelines. Past inspections have shown us that staff have received training in adult protection issues. However this would now need updating for some of the staff. It was recommended that a copy of the multi agency guidelines for adult protection was obtained, as one could not be found, so that staff had these to refer to at all times. Two of the people living in the home managed their own financial affairs and went to the post office to draw their money when they needed it. One person was heard speaking to the manager about going to get her money to pay her fees. One of the people living in the home was not able to manage their own finances. This was done by the manager. The records for the safe keeping of this persons money were seen and were robust. All income and expenditure was detailed and receipts were available for any expenditure made on behalf of the person. The manager had recently appointed a voluntary worker at the home. The records for this person were sampled and were not complete which could put the people living in the home at risk. This is further explained in the staffing section of this report. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, safe environment that presents its self as a family home. Evidence: The home was very much the same as a family dwelling and blended in with surrounding properties. The home was safe, well maintained, very comfortable and clean. The people living in the home treated it very much as their own home. There were personal possessions and photographs around belonging to them as in any family home. The communal space was adequate with a lounge, conservatory and kitchen/diner. All areas were nicely furnished and decorated. There was also a nicely maintained garden with seating available. One of the people living in the home told us she particularly likes spending time in the garden in the better weather. The people living in the home showed us their bedrooms. They were very satisfied with their rooms which were nicely personalised. They told us they had keys for their bedrooms but chose not to lock their doors. It was noted that people would be able to leave keys in the doors of the present locks when they were inside their rooms meaning staff would not be able to enter if necessary. It was strongly recommended Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: that the types of locks fitted to the bedroom doors were changed to a type that staff could always access in the event of an emergency. The bathing and toilet facilities were appropriate for the needs of the people living in the home. There was a bathroom and toilet on the first floor, the bath had a hand rail to help people get in and out of the bath. One of the bedrooms had an en-suite shower and toilet. The person who occupies this room does allow the other two people to use the shower if they wish. This has been discussed with the person at previous inspections to ensure they do not object to this. There is also an additional toilet on the ground floor of the home but this is mainly used by staff. The kitchen was clean and hygienic and the fridge and freezer temperatures were recorded on a daily basis to ensure the equipment is working effectively. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home expressed satisfaction with the staff team and indicated they could meet their needs. Some training needed to be updated to ensure people were cared for safely. Evidence: The home has a small staff team and staff turnover is very low which is very good for the continuity of care of the people living in the home. There was always one person on duty which appeared to meet the needs of the people living in the home as all were fairly independent. We were told that other staff would be brought in if necessary. One member of staff slept in at the home every night. The manager spent a lot of time working in the home. We did not meet any staff on the day of the inspection as the manager was on duty. The people living in the home were able to tell us the names of the staff who work at the home and that they were very satisfied with the staff group. They told us staff are very nice, they help when needed and there is always someone here at night. The files for two staff were sampled. One was for a staff member who had worked at the home for some time the other was for a voluntary worker recently taken on at the home. The file for the long standing member of staff included all the required documents to show she was safe to work with the people living in the home including references and CRB check. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: The file for the voluntary worker at the home did not include all the required documentation. There was only one reference on file and no CRB check had been obtained. This person had unsupervised access to the people living in the home and therefore needed to have all the required checks undertaken to ensure the people living in the home were fully safeguarded. This was discussed with the manager. This person had been known to the manager for a number of years and the manager did not feel the people living in the home were at risk. She stated she had sent for a CRB check but as the persons passport had expired the form had been returned and they were now waiting for a new passport. The training records seen for one staff member showed she had undertaken training in first aid, dementia awareness, food hygiene, medication handling and infection control. There were also a range of certificates on the wall in the office for a variety of training courses including moving and handling, fire prevention and adult protection. However some of these certificates were out of date. The manager needed to ensure that all the training staff required to ensure they could care for people safely was up to date. Over fifty percent of the staff had undertaken NVQ training. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensured the smooth running of the home in a competent manner. The home is run as a family where the people who live there contribute to the running of the home. Evidence: The manager of the home is also the owner. She has owned and managed the home for many years. She was present throughout the inspection and demonstrated she had a very good knowledge of the needs of the people living in the home. The relationships between the manager and the people living in the home were very good. They were very comfortable in her presence and spoke fondly of her. There have been some improvements made since the last inspection. The systems in place for care planning and managing risks had improved. These ensured that the documentation for staff detailed how staff were to care for the people living in the home and how to minimise the majority of risks they were exposed to. There were some informal ways of monitoring the quality of the service offered in the Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: home, for example, health and safety checks, meetings with the people living in the home, occasional staff meetings and satisfaction surveys. It was recommended that the home had a development plan, which took into account the views of the people living in the home, with a view to improving the service offered. The health and safety of the people living in the home and the staff were generally well managed. Staff had received training in safe working practices however the manager did need to ensure this was updated as necessary. The home was well maintained and safe. There was evidence that water temperatures were regularly checked to ensure they were safe and fridge and freezer temperatures were recorded daily to ensure equipment was working efficiently. The manager needed to ensure that the checks required by the local fire officer were undertaken and records maintained. There was evidence that the fire procedure was discussed with the people living in the home on a regular basis. Staff were recording any accidents or incidents that happened in the home. The manager needed to ensure we were notified when these affected the well being of the people living in the home. For example, people had been in hospital and we had not been notified. Notifications should be sent to us so we can be assured incidents and accidents are being managed in the best interests of the people living in the home. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must detail how staff would recognise any relapse in the mental health of the people living in the home. This will ensure the well being of the people living in the home. 30/04/2009 2 9 13 There must be management plans in place for any challenging behaviours. This will ensure the people living in the home are safeguarded. 30/04/2009 3 23 19 The recruitment procedures used in the home for staff and voluntary workers must be robust. This will ensure the people living in the home are fully safeguarded. 30/04/2009 Care Homes for Adults (18-65 years) Page 30 of 33 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 4 35 18 The manager must ensure 31/05/2009 staff training in safe working practices is up to date. This will ensure staff have all the required skills and knowledge to care for people safely. 5 42 13 The manager must ensure that the checks required by the fire officer are undertaken at the required intervals and records are maintained. This will ensure the people living in the home are fully safeguarded. 30/04/2009 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. No Refer to Standard Good Practice Recommendations 1 1 The service user guide for the home should be updated to ensure it includes all the information people would need to help them decide if the home can meet their needs. It was recommended the manager developed a document to record the required information during the pre admission period to ensure the home had all the information they needed to be able to meet the needs of people being admitted. Further detail could be included in the care plans to ensure staff are fully aware of what people do when in the home. This will ensure peoples independence is maintained. The manager should ensure that records of the food being served to the people living in the home are kept to 2 2 3 6 4 17 Care Homes for Adults (18-65 years) Page 31 of 33 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 evidence that people receive a nutritious diet, choices are available and any medical diets are catered for. 5 20 To ensure there is complete audit trail for all medication any balances held in the home at the end of the 28 day cycle should be carried forward to the next MAR chart. The complaints procedure should be updated to ensure people have all the information they need to raise a complaint outside of the home. The manager should obtain a copy of the multi agency guidelines for adult protection so that are available at all times for staff to refer to. Staff should have their adult protection training updated where necessary to ensure they are aware of how to report any allegations or suspicions of abuse appropriately. It is strongly recommended that the types of locks fitted to the bedroom doors are changed to a type that staff can always access in the event of an emergency. It is recommended that the home had a development plan, which takes into account the views of the people living in the home, with a view to improving the service offered. The manager should ensure that the Commission is notified of any accidents or incidents that affect the well being of the people living in the home. This will ensure incidents are being managed in the best interests of the people living in the home. 6 22 7 23 8 23 9 25 10 39 11 42 Care Homes for Adults (18-65 years) Page 32 of 33 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 33 of 33 - 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!